Robert H Press, Lei Hu, Sheng Huang, Shaakir Hasan, J Isabelle Choi, Charles B Simone, Arpit M Chhabra, Daphna Y Gelblum, Rafi Kabarriti, Richard L Bakst, Jen R Cracchiolo, Sean M McBride, Nancy Y Lee
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We sought to quantify the dosimetric advantages of this approach and hypothesized that intensity-modulated proton therapy (IMPT) may further reduce organs at risk doses compared with intensity-modulated radiation therapy (IMRT).</p><p><strong>Materials and methods: </strong>Five patients with oral tongue cancer treated with postoperative radiation therapy from August 2020 to September 2021 were retrospectively reviewed. Novel clinical target volume contours, excluding the oral tongue, were generated while maintaining coverage of bilateral at-risk lymph nodes. Comparison IMRT (X) and IMPT (PBT) plans were generated using standard treatment volumes (control) and avoidance volumes (study) (n = 4 plans/patient). Dosimetric variables for organs at risk were compared using the paired <i>t</i> test.</p><p><strong>Results: </strong>The prescribed dose was 60 Gy in 30 fractions. D95% clinical target volume coverage was similar between X and PBT plans for both control and study clinical target volumes. Comparing control with study plans, both X (58.9 Gy vs 38.3 Gy, <i>P</i> = .007) and PBT (60.2 Gy vs 26.1 Gy, <i>P</i> < .001) decreased the oral cavity dose<sub>mean</sub>. The pharyngeal constrictor dose<sub>mean</sub> was also reduced (<i>P</i> < .003). There was no difference between control and study plans for larynx (<i>P</i> = .19), parotid (<i>P</i> = .11), or mandible dose (<i>P</i> = .59). For study plans, PBT significantly reduced oral cavity dose<sub>mean</sub> (38.3 Gy vs 26.1 Gy, <i>P</i> = .007) and parotid dose<sub>mean</sub> (23.3 Gy vs 19.3 Gy, <i>P</i> = .03) compared with X. For control plans, there was no difference in oral cavity dose<sub>mean</sub> using PBT compared with X, but PBT did improve the parotid dose<sub>mean</sub> (26.6 Gy vs 19.7 Gy, <i>P</i> = .02).</p><p><strong>Conclusion: </strong>This study quantifies the feasibility and dosimetric advantages of oral tongue avoidance while still treating the at-risk lymph nodes for oral tongue cancer. The dosimetric difference between PBT and X was most prominent with an oral tongue-avoidance strategy.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":"9 4","pages":"253-260"},"PeriodicalIF":2.1000,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10166015/pdf/","citationCount":"0","resultStr":"{\"title\":\"Dosimetric Comparison of Intensity-Modulated Radiation Therapy (IMRT) and Intensity-Modulated Proton Therapy (IMPT) for a Novel Oral Tongue Avoidance Concept in Low-Risk Squamous Cell Carcinoma of the Oral Tongue.\",\"authors\":\"Robert H Press, Lei Hu, Sheng Huang, Shaakir Hasan, J Isabelle Choi, Charles B Simone, Arpit M Chhabra, Daphna Y Gelblum, Rafi Kabarriti, Richard L Bakst, Jen R Cracchiolo, Sean M McBride, Nancy Y Lee\",\"doi\":\"10.14338/IJPT-22-00032\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>After adequate surgical resection, early-stage oral tongue cancer patients can harbor a low risk of local recurrence but remain at risk of regional recurrence. Oral tongue avoidance during adjuvant radiation therapy is an attractive potential treatment strategy to mitigate treatment toxicity. We sought to quantify the dosimetric advantages of this approach and hypothesized that intensity-modulated proton therapy (IMPT) may further reduce organs at risk doses compared with intensity-modulated radiation therapy (IMRT).</p><p><strong>Materials and methods: </strong>Five patients with oral tongue cancer treated with postoperative radiation therapy from August 2020 to September 2021 were retrospectively reviewed. Novel clinical target volume contours, excluding the oral tongue, were generated while maintaining coverage of bilateral at-risk lymph nodes. Comparison IMRT (X) and IMPT (PBT) plans were generated using standard treatment volumes (control) and avoidance volumes (study) (n = 4 plans/patient). Dosimetric variables for organs at risk were compared using the paired <i>t</i> test.</p><p><strong>Results: </strong>The prescribed dose was 60 Gy in 30 fractions. D95% clinical target volume coverage was similar between X and PBT plans for both control and study clinical target volumes. Comparing control with study plans, both X (58.9 Gy vs 38.3 Gy, <i>P</i> = .007) and PBT (60.2 Gy vs 26.1 Gy, <i>P</i> < .001) decreased the oral cavity dose<sub>mean</sub>. The pharyngeal constrictor dose<sub>mean</sub> was also reduced (<i>P</i> < .003). There was no difference between control and study plans for larynx (<i>P</i> = .19), parotid (<i>P</i> = .11), or mandible dose (<i>P</i> = .59). For study plans, PBT significantly reduced oral cavity dose<sub>mean</sub> (38.3 Gy vs 26.1 Gy, <i>P</i> = .007) and parotid dose<sub>mean</sub> (23.3 Gy vs 19.3 Gy, <i>P</i> = .03) compared with X. For control plans, there was no difference in oral cavity dose<sub>mean</sub> using PBT compared with X, but PBT did improve the parotid dose<sub>mean</sub> (26.6 Gy vs 19.7 Gy, <i>P</i> = .02).</p><p><strong>Conclusion: </strong>This study quantifies the feasibility and dosimetric advantages of oral tongue avoidance while still treating the at-risk lymph nodes for oral tongue cancer. The dosimetric difference between PBT and X was most prominent with an oral tongue-avoidance strategy.</p>\",\"PeriodicalId\":36923,\"journal\":{\"name\":\"International Journal of Particle Therapy\",\"volume\":\"9 4\",\"pages\":\"253-260\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2023-02-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10166015/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Particle Therapy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14338/IJPT-22-00032\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Particle Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14338/IJPT-22-00032","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：早期口腔舌癌患者经过适当的手术切除后，局部复发的风险较低，但仍有区域复发的风险。在辅助放疗期间避开口腔舌是一种有吸引力的潜在治疗策略，可减轻治疗毒性。我们试图量化这种方法的剂量学优势，并假设与调强放射治疗（IMRT）相比，调强质子治疗（IMPT）可进一步降低危险器官的剂量：回顾性研究了2020年8月至2021年9月期间接受术后放疗的5例口腔舌癌患者。在保持覆盖双侧高危淋巴结的同时，生成了不包括口腔舌部的新临床靶体积轮廓。使用标准治疗容积（对照）和避免容积（研究）生成了 IMRT (X) 和 IMPT (PBT) 比较计划（n = 4 计划/患者）。使用配对 t 检验比较危险器官的剂量变量：处方剂量为 60 Gy，分 30 次进行。对于对照组和研究组的临床靶体积，X计划和PBT计划的D95%临床靶体积覆盖率相似。对照计划与研究计划相比，X（58.9 Gy vs 38.3 Gy，P = .007）和 PBT（60.2 Gy vs 26.1 Gy，P < .001）均降低了口腔剂量平均值。咽部收缩剂量平均值也有所降低（P < .003）。对照计划和研究计划在喉部剂量（P = .19）、腮腺剂量（P = .11）或下颌骨剂量（P = .59）方面没有差异。对于研究计划，与 X 相比，PBT 可显著降低口腔剂量平均值（38.3 Gy vs 26.1 Gy，P = .007）和腮腺剂量平均值（23.3 Gy vs 19.3 Gy，P = .03）。对于对照计划，与 X 相比，使用 PBT 的口腔剂量平均值没有差异，但 PBT 确实提高了腮腺剂量平均值（26.6 Gy vs 19.7 Gy，P = .02）：本研究量化了在治疗口腔舌癌高危淋巴结的同时避开口腔舌的可行性和剂量学优势。在口腔舌癌避开策略中，PBT 和 X 的剂量学差异最为突出。
Dosimetric Comparison of Intensity-Modulated Radiation Therapy (IMRT) and Intensity-Modulated Proton Therapy (IMPT) for a Novel Oral Tongue Avoidance Concept in Low-Risk Squamous Cell Carcinoma of the Oral Tongue.
Purpose: After adequate surgical resection, early-stage oral tongue cancer patients can harbor a low risk of local recurrence but remain at risk of regional recurrence. Oral tongue avoidance during adjuvant radiation therapy is an attractive potential treatment strategy to mitigate treatment toxicity. We sought to quantify the dosimetric advantages of this approach and hypothesized that intensity-modulated proton therapy (IMPT) may further reduce organs at risk doses compared with intensity-modulated radiation therapy (IMRT).
Materials and methods: Five patients with oral tongue cancer treated with postoperative radiation therapy from August 2020 to September 2021 were retrospectively reviewed. Novel clinical target volume contours, excluding the oral tongue, were generated while maintaining coverage of bilateral at-risk lymph nodes. Comparison IMRT (X) and IMPT (PBT) plans were generated using standard treatment volumes (control) and avoidance volumes (study) (n = 4 plans/patient). Dosimetric variables for organs at risk were compared using the paired t test.
Results: The prescribed dose was 60 Gy in 30 fractions. D95% clinical target volume coverage was similar between X and PBT plans for both control and study clinical target volumes. Comparing control with study plans, both X (58.9 Gy vs 38.3 Gy, P = .007) and PBT (60.2 Gy vs 26.1 Gy, P < .001) decreased the oral cavity dosemean. The pharyngeal constrictor dosemean was also reduced (P < .003). There was no difference between control and study plans for larynx (P = .19), parotid (P = .11), or mandible dose (P = .59). For study plans, PBT significantly reduced oral cavity dosemean (38.3 Gy vs 26.1 Gy, P = .007) and parotid dosemean (23.3 Gy vs 19.3 Gy, P = .03) compared with X. For control plans, there was no difference in oral cavity dosemean using PBT compared with X, but PBT did improve the parotid dosemean (26.6 Gy vs 19.7 Gy, P = .02).
Conclusion: This study quantifies the feasibility and dosimetric advantages of oral tongue avoidance while still treating the at-risk lymph nodes for oral tongue cancer. The dosimetric difference between PBT and X was most prominent with an oral tongue-avoidance strategy.
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