Estimated radiation pneumonitis risk after photon versus proton therapy alone or combined with chemotherapy for lung cancer

Ivan R. Vogelius, David C Westerly, Marianne Camille Aznar, George M. Cannon, Stine Korreman, Thomas R. Mackie, Minesh P. Mehta, Søren M. Bentzen

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    Resumé

    Background. Traditionally, radiation therapy plans are optimized without consideration of chemotherapy. Here, we model the risk of radiation pneumonitis (RP) in the presence of a possible interaction between chemotherapy and radiation dose distribution. Material and methods. Three alternative treatment plans are compared in 18 non-small cell lung cancer patients previously treated with helical tomotherapy; the tomotherapy plan, an intensity modulated proton therapy plan (IMPT) and a three dimensional conformal radiotherapy (3D-CRT) plan. All plans are optimized without consideration of the chemotherapy effect. The effect of chemotherapy is modeled as an independent cell killing process using a uniform chemotherapy equivalent radiation dose (CERD) added to the entire organ at risk. We estimate the risk of grade 3 or higher RP (G3RP) using the critical volume model. Results. The mean risk of clinical G3RP at zero CERD is 5% for tomotherapy (range: 1-18 %) and 14% for 3D-CRT (range 2-49%). When the CERD exceeds 9 Gy, however, the risk of RP with the tomotherapy plans become higher than the 3D-CRT plans. The IMPT plans are less toxic both at zero CERD (mean 2%, range 1-5%) and at CERD = 10 Gy (mean 7%, range 1-28%). Tomotherapy yields a lower risk of RP than 3D-CRT for 17/18 patients at zero CERD, but only for 7/18 patients at CERD = 10 Gy. IMPT gives the lowest risk of all plans for 17/18 patients at zero CERD and for all patients with CERD = 10 Gy. Conclusions. The low dose bath from highly conformal photon techniques may become relevant for lung toxicity when radiation is combined with cytotoxic chemotherapy as shown here. Proton therapy allows highly conformal delivery while minimizing the low dose bath potentially interacting with chemotherapy. Thus, intensive drug-radiation combinations could be an interesting indication for selecting patients for proton therapy. It is likely that the IMRT plans would perform better if the CERD was accounted for during optimization, but more clinical data is required to facilitate evidence-based plan optimization in the multi-modality setting.
    OriginalsprogEngelsk
    TidsskriftActa Oncologica
    Vol/bind50
    Udgave nummer6
    Sider (fra-til)772-776
    ISSN0284-186X
    DOI
    StatusUdgivet - 2011

    Citer dette

    Vogelius, I. R., Westerly, D. C., Aznar, M. C., Cannon, G. M., Korreman, S., Mackie, T. R., ... Bentzen, S. M. (2011). Estimated radiation pneumonitis risk after photon versus proton therapy alone or combined with chemotherapy for lung cancer. Acta Oncologica, 50(6), 772-776 . https://doi.org/10.3109/0284186X.2011.582519
    Vogelius, Ivan R. ; Westerly, David C ; Aznar, Marianne Camille ; Cannon, George M. ; Korreman, Stine ; Mackie, Thomas R. ; Mehta, Minesh P. ; Bentzen, Søren M. / Estimated radiation pneumonitis risk after photon versus proton therapy alone or combined with chemotherapy for lung cancer. I: Acta Oncologica. 2011 ; Bind 50, Nr. 6. s. 772-776 .
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    title = "Estimated radiation pneumonitis risk after photon versus proton therapy alone or combined with chemotherapy for lung cancer",
    abstract = "Background. Traditionally, radiation therapy plans are optimized without consideration of chemotherapy. Here, we model the risk of radiation pneumonitis (RP) in the presence of a possible interaction between chemotherapy and radiation dose distribution. Material and methods. Three alternative treatment plans are compared in 18 non-small cell lung cancer patients previously treated with helical tomotherapy; the tomotherapy plan, an intensity modulated proton therapy plan (IMPT) and a three dimensional conformal radiotherapy (3D-CRT) plan. All plans are optimized without consideration of the chemotherapy effect. The effect of chemotherapy is modeled as an independent cell killing process using a uniform chemotherapy equivalent radiation dose (CERD) added to the entire organ at risk. We estimate the risk of grade 3 or higher RP (G3RP) using the critical volume model. Results. The mean risk of clinical G3RP at zero CERD is 5{\%} for tomotherapy (range: 1-18 {\%}) and 14{\%} for 3D-CRT (range 2-49{\%}). When the CERD exceeds 9 Gy, however, the risk of RP with the tomotherapy plans become higher than the 3D-CRT plans. The IMPT plans are less toxic both at zero CERD (mean 2{\%}, range 1-5{\%}) and at CERD = 10 Gy (mean 7{\%}, range 1-28{\%}). Tomotherapy yields a lower risk of RP than 3D-CRT for 17/18 patients at zero CERD, but only for 7/18 patients at CERD = 10 Gy. IMPT gives the lowest risk of all plans for 17/18 patients at zero CERD and for all patients with CERD = 10 Gy. Conclusions. The low dose bath from highly conformal photon techniques may become relevant for lung toxicity when radiation is combined with cytotoxic chemotherapy as shown here. Proton therapy allows highly conformal delivery while minimizing the low dose bath potentially interacting with chemotherapy. Thus, intensive drug-radiation combinations could be an interesting indication for selecting patients for proton therapy. It is likely that the IMRT plans would perform better if the CERD was accounted for during optimization, but more clinical data is required to facilitate evidence-based plan optimization in the multi-modality setting.",
    author = "Vogelius, {Ivan R.} and Westerly, {David C} and Aznar, {Marianne Camille} and Cannon, {George M.} and Stine Korreman and Mackie, {Thomas R.} and Mehta, {Minesh P.} and Bentzen, {S{\o}ren M.}",
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    doi = "10.3109/0284186X.2011.582519",
    language = "English",
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    journal = "Acta Oncologica",
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    Vogelius, IR, Westerly, DC, Aznar, MC, Cannon, GM, Korreman, S, Mackie, TR, Mehta, MP & Bentzen, SM 2011, 'Estimated radiation pneumonitis risk after photon versus proton therapy alone or combined with chemotherapy for lung cancer', Acta Oncologica, bind 50, nr. 6, s. 772-776 . https://doi.org/10.3109/0284186X.2011.582519

    Estimated radiation pneumonitis risk after photon versus proton therapy alone or combined with chemotherapy for lung cancer. / Vogelius, Ivan R.; Westerly, David C; Aznar, Marianne Camille; Cannon, George M.; Korreman, Stine; Mackie, Thomas R.; Mehta, Minesh P.; Bentzen, Søren M.

    I: Acta Oncologica, Bind 50, Nr. 6, 2011, s. 772-776 .

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    TY - JOUR

    T1 - Estimated radiation pneumonitis risk after photon versus proton therapy alone or combined with chemotherapy for lung cancer

    AU - Vogelius, Ivan R.

    AU - Westerly, David C

    AU - Aznar, Marianne Camille

    AU - Cannon, George M.

    AU - Korreman, Stine

    AU - Mackie, Thomas R.

    AU - Mehta, Minesh P.

    AU - Bentzen, Søren M.

    PY - 2011

    Y1 - 2011

    N2 - Background. Traditionally, radiation therapy plans are optimized without consideration of chemotherapy. Here, we model the risk of radiation pneumonitis (RP) in the presence of a possible interaction between chemotherapy and radiation dose distribution. Material and methods. Three alternative treatment plans are compared in 18 non-small cell lung cancer patients previously treated with helical tomotherapy; the tomotherapy plan, an intensity modulated proton therapy plan (IMPT) and a three dimensional conformal radiotherapy (3D-CRT) plan. All plans are optimized without consideration of the chemotherapy effect. The effect of chemotherapy is modeled as an independent cell killing process using a uniform chemotherapy equivalent radiation dose (CERD) added to the entire organ at risk. We estimate the risk of grade 3 or higher RP (G3RP) using the critical volume model. Results. The mean risk of clinical G3RP at zero CERD is 5% for tomotherapy (range: 1-18 %) and 14% for 3D-CRT (range 2-49%). When the CERD exceeds 9 Gy, however, the risk of RP with the tomotherapy plans become higher than the 3D-CRT plans. The IMPT plans are less toxic both at zero CERD (mean 2%, range 1-5%) and at CERD = 10 Gy (mean 7%, range 1-28%). Tomotherapy yields a lower risk of RP than 3D-CRT for 17/18 patients at zero CERD, but only for 7/18 patients at CERD = 10 Gy. IMPT gives the lowest risk of all plans for 17/18 patients at zero CERD and for all patients with CERD = 10 Gy. Conclusions. The low dose bath from highly conformal photon techniques may become relevant for lung toxicity when radiation is combined with cytotoxic chemotherapy as shown here. Proton therapy allows highly conformal delivery while minimizing the low dose bath potentially interacting with chemotherapy. Thus, intensive drug-radiation combinations could be an interesting indication for selecting patients for proton therapy. It is likely that the IMRT plans would perform better if the CERD was accounted for during optimization, but more clinical data is required to facilitate evidence-based plan optimization in the multi-modality setting.

    AB - Background. Traditionally, radiation therapy plans are optimized without consideration of chemotherapy. Here, we model the risk of radiation pneumonitis (RP) in the presence of a possible interaction between chemotherapy and radiation dose distribution. Material and methods. Three alternative treatment plans are compared in 18 non-small cell lung cancer patients previously treated with helical tomotherapy; the tomotherapy plan, an intensity modulated proton therapy plan (IMPT) and a three dimensional conformal radiotherapy (3D-CRT) plan. All plans are optimized without consideration of the chemotherapy effect. The effect of chemotherapy is modeled as an independent cell killing process using a uniform chemotherapy equivalent radiation dose (CERD) added to the entire organ at risk. We estimate the risk of grade 3 or higher RP (G3RP) using the critical volume model. Results. The mean risk of clinical G3RP at zero CERD is 5% for tomotherapy (range: 1-18 %) and 14% for 3D-CRT (range 2-49%). When the CERD exceeds 9 Gy, however, the risk of RP with the tomotherapy plans become higher than the 3D-CRT plans. The IMPT plans are less toxic both at zero CERD (mean 2%, range 1-5%) and at CERD = 10 Gy (mean 7%, range 1-28%). Tomotherapy yields a lower risk of RP than 3D-CRT for 17/18 patients at zero CERD, but only for 7/18 patients at CERD = 10 Gy. IMPT gives the lowest risk of all plans for 17/18 patients at zero CERD and for all patients with CERD = 10 Gy. Conclusions. The low dose bath from highly conformal photon techniques may become relevant for lung toxicity when radiation is combined with cytotoxic chemotherapy as shown here. Proton therapy allows highly conformal delivery while minimizing the low dose bath potentially interacting with chemotherapy. Thus, intensive drug-radiation combinations could be an interesting indication for selecting patients for proton therapy. It is likely that the IMRT plans would perform better if the CERD was accounted for during optimization, but more clinical data is required to facilitate evidence-based plan optimization in the multi-modality setting.

    U2 - 10.3109/0284186X.2011.582519

    DO - 10.3109/0284186X.2011.582519

    M3 - Journal article

    VL - 50

    SP - 772

    EP - 776

    JO - Acta Oncologica

    JF - Acta Oncologica

    SN - 0284-186X

    IS - 6

    ER -