Proton Therapy for Maxillary Sinus Carcinoma
Department of Radiation Oncology, University of Florida, Jacksonville, FL, USA. American journal of clinical oncology
(Impact Factor: 3.06).
06/2009; 32(3):296-303. DOI: 10.1097/COC.0b013e318187132a
To compare the dose-volume data of three-dimensional conformal proton therapy (3DCPT) versus intensity-modulated radiotherapy (IMRT) for a paranasal sinus malignancy.
3DCPT and IMRT plans were created for a T4N0 maxillary sinus carcinoma.
The target volume dose distributions were comparable for 3DCPT and IMRT. The mean and integral doses for all normal tissues were lower for 3DCPT. The maximum doses for both plans to the ipsilateral optic nerve/retina/lens, temporal lobe, pituitary, and brain exceeded tolerance doses. The contralateral parotid, lacrimal gland, and lens were avoided with 3DCPT. Neither 3DCPT nor IMRT exceeded the maximal tolerated dose for the brainstem, optic chiasm, contralateral temporal lobe, parotid, or lacrimal gland.
Both 3DCPT and IMRT sufficiently covered the target volume(s). Although 3DCPT reduced the mean and integral dose to all of the normal tissues, both 3DCPT and IMRT irradiated the ipsilateral optic structures beyond acceptable tolerance doses.
Available from: Zelig Tochner
- "Again, several dosimetric studies have been performed evaluating proton therapy, for the most part 3D-CPT, compared to IMRT. These support the ability of proton therapy to result in sparing of normal tissue when radiation is required to the paranasal sinuses (Miralbell et al., 1992; Mock et al., 2004; Chera et al., 2009), nasopharynx (Brown et al., 1989; Taheri-Kadkhoda et al., 2008; Widescott et al., 2008), and oropharynx/hypopharynx/larynx (Slater et al., 1992; Cozzi et al., 2001; Johansson et al., 2004; Steneker et al., 2006). Lomax et al. (2003) have also demonstrated the potential for dose escalation during treatment of head and neck cancers with proton therapy based on dosimetric work. "
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ABSTRACT: Proton therapy is associated with significant benefit in terms of normal tissue sparing and potential radiation dose escalation for many patients with malignant diseases. Due to recognition of these qualities, the availability of this technology is increasing rapidly, both through increased availability of large centers, and with the possibility of smaller, lower cost proton therapy centers. Such expansion is associated with increased opportunity to provide this beneficial technology to larger numbers of patients; however, the importance of careful treatment planning and delivery, deliberate patient selection, rigorous scientific investigation including comparison to other technologies when possible, and mindfulness of ethical issues and cost effectiveness must not be forgotten. The obligation to move forward responsibly rests on the shoulders of radiation oncologists around the world. In this article, we discuss current use of proton therapy worldwide, as well as many of the factors that must be taken into account during rapid expansion of this exciting technology.
Available from: Anna Nikoghosyan
- "3D conformal and intensity-modulated (IMRT) radiotherapy allow more conformal dose distributions and hence improved normal tissue sparing. Various planning studies were already able to demonstrate that especially patients with sinunasal tumours highly profit from modern RT-techniques [8-13]. Chen et al performed a retrospective analysis over five decades in their institution and could impressively show that also in practice introduction of new radiotherapy treatment techniques led to reduction of accompanying side-effects [14,15]. "
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ABSTRACT: Most patients with cancers of the nasal cavity or paranasal sinuses are candidates of radiation therapy either due incomplete resection or technical inoperability. Local control in this disease is dose dependent but technically challenging due to close proximity of critical organs and accompanying toxicity. Modern techniques such as IMRT improve toxicity rates while local control remains unchanged. Raster-scanned carbon ion therapy with highly conformal dose distributions may allow higher doses at comparable or reduced side-effects.
The IMRT-HIT-SNT trial is a prospective, mono-centric, phase II trial evaluating toxicity (primary endpoint: mucositis ≥ CTCAE°III) and efficacy (secondary endpoint: local control, disease-free and overall survival) in the combined treatment with IMRT and carbon ion boost in 30 patients with histologically proven (≥R1-resected or inoperable) adeno-/or squamous cell carcinoma of the nasal cavity or paransal sinuses. Patients receive 24 GyE carbon ions (8 fractions) and IMRT (50 Gy at 2.0 Gy/fraction).
The primary objective of IMRT-HIT-SNT is to evaluate toxicity and feasibility of the proposed treatment in sinonasal malignancies.
Clinical trial identifier NCT 01220752.
Available from: Hui Liu
- "Chera et al. conducted a study comparing the dose-volume data between 3D-CPT and IMRT for a T4N0 maxillary sinus carcinoma. The target volume dose distributions were comparable for 3D-CPT and IMRT. "
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ABSTRACT: Radiation dose escalation and acceleration improves local control but also increases toxicity. Proton radiation is an emerging therapy for localized cancers that is being sought with increasing frequency by patients. Compared with photon therapy, proton therapy spares more critical structures due to its unique physics. The physical properties of a proton beam make it ideal for clinical applications. By modulating the Bragg peak of protons in energy and time, a conformal radiation dose with or without intensity modulation can be delivered to the target while sparing the surrounding normal tissues. Thus, proton therapy is ideal when organ preservation is a priority. However, protons are more sensitive to organ motion and anatomy changes compared with photons. In this article, we review practical issues of proton therapy, describe its image-guided treatment planning and delivery, discuss clinical outcome for cancer patients, and suggest challenges and the future development of proton therapy.
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