Helical tomotherapy vs. Intensity-modulated proton therapy for whole pelvis irradiation in high-risk prostate cancer patients: Dosimetric, normal tissue complication probability, and generalized equivalent uniform dose analysis

Lamberto Widesott, Alessio Pierelli, Claudio Fiorino, Antony J. Lomax, Maurizio Amichetti, Cesare Cozzarini, Martin Soukup, Ralf Schneider, Eugen Hug, Nadia Di Muzio, Riccardo Calandrino, Marco Schwarz

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To compare intensity-modulated proton therapy (IMPT) and helical tomotherapy (HT) treatment plans for high-risk prostate cancer (HRPCa) patients. Methods and Materials: The plans of 8 patients with HRPCa treated with HT were compared with IMPT plans with two quasilateral fields set up (-100°; 100°) and optimized with the Hyperion treatment planning system. Both techniques were optimized to simultaneously deliver 74.2 Gy/Gy relative biologic effectiveness (RBE) in 28 fractions on planning target volumes (PTVs)3-4 (P + proximal seminal vesicles), 65.5 Gy/Gy(RBE) on PTV2 (distal seminal vesicles and rectum/prostate overlapping), and 51.8 Gy/Gy(RBE) to PTV1 (pelvic lymph nodes). Normal tissue calculation probability (NTCP) calculations were performed for the rectum, and generalized equivalent uniform dose (gEUD) was estimated for the bowel cavity, penile bulb and bladder. Results: A slightly better PTV coverage and homogeneity of target dose distribution with IMPT was found: the percentage of PTV volume receiving ≥95% of the prescribed dose (V 95%) was on average >97% in HT and >99% in IMPT. The conformity indexes were significantly lower for protons than for photons, and there was a statistically significant reduction of the IMPT dosimetric parameters, up to 50 Gy/Gy(RBE) for the rectum and bowel and 60 Gy/Gy(RBE) for the bladder. The NTCP values for the rectum were higher in HT for all the sets of parameters, but the gain was small and in only a few cases statistically significant. Conclusions: Comparable PTV coverage was observed. Based on NTCP calculation, IMPT is expected to allow a small reduction in rectal toxicity, and a significant dosimetric gain with IMPT, both in medium-dose and in low-dose range in all OARs, was observed.

Original languageEnglish
Pages (from-to)1589-1600
Number of pages12
JournalInternational Journal of Radiation Oncology Biology Physics
Volume80
Issue number5
DOIs
Publication statusPublished - Aug 1 2011

Keywords

  • Intensity-modulated proton therapy
  • Normal tissue complication probability
  • Pelvic lymph nodes
  • Prostate
  • Tomotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

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