Comparison of Intensity-modulated Radiation Therapy (IMRT), Uniform Scanning Proton Therapy (USPT), and Intensity-modulated Proton Therapy (IMPT) for Prostate Cancer: A Treatment Planning Study

Kihong Son; Seungryong Cho; Jin Sung Kim; Youngyih Han; Sang Gyu Ju; Sung Hwan Ahn; Eunhyuk Shin; Jung Suk Shin; Won Park; Hongryul Pyo; Doo Ho Choi

doi:10.14316/pmp.2013.24.3.154

Journal List > Prog Med Phys > v.24(3) > 1098383

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Son, Cho, Kim, Han, Ju, Ahn, Shin, Shin, Park, Pyo, and Choi: Comparison of Intensity-modulated Radiation Therapy (IMRT), Uniform Scanning Proton Therapy (USPT), and Intensity-modulated Proton Therapy (IMPT) for Prostate Cancer: A Treatment Planning Study

Original Article

Progress in Medical Physics 2013;24(3):154-161.

Published online: 17 September 2013

DOI: https://doi.org/10.14316/pmp.2013.24.3.154

Comparison of Intensity-modulated Radiation Therapy (IMRT), Uniform Scanning Proton Therapy (USPT), and Intensity-modulated Proton Therapy (IMPT) for Prostate Cancer: A Treatment Planning Study

Kihong Son^∗,^†, Seungryong Cho^∗, Jin Sung Kim^†,, Youngyih Han^†,, Sang Gyu Ju^†, Sung Hwan Ahn^†, Eunhyuk Shin^†, Jung Suk Shin^†, Won Park^†, Hongryul Pyo^†, Doo Ho Choi^†

^∗Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea

^†Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Corresponding Author: Jin Sung Kim, Department of RadiationOncology, Samsung Medical Center, 50, Ilwon-dong, Gangnam-gu, Seoul 135-710, KoreaTel: 02)3410-3771, Fax: 02)3410-2619E-mail: jinsung.k@gmail.com

Corresponding Author: Youngyih Han, Department of RadiationOncology, Samsung Medical Center, 50, Ilwon-dong, Gangnam-gu, Seoul, 135-710, Republic of KoreaTel: 02)3410-2604, Fax: 02)3410-2619E-mail: youngyih@skku.edu

Received 2 September 2013 Accepted 7 September 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study assessed compared photon and proton treatment techniques, such as intensity modulated radiation therapy (IMRT), uniform scanning proton therapy (USPT), and intensity modulated proton therapy (IMPT), for a total of 10 prostate cancers. All treatment plans delivered 70 Gy to 95% of the planned target volume in 28 fractions. IMRT plans had 7 fields for the step and shoot technique, while USPT and IMPT plans employed two equally weighted, parallel-opposed lateral fields to deliver the prescribed dose to the planned target. Inverse planning was then incorporated to optimize IMPT. The homogeneity index (HI) and conformity index (CI) for the target and the normal tissue complication probability (NTCP) for organ at risk (OAR) were calculated. Although the mean HI and CI for target were not significantly different for each treatment techniques, the NTCP of the rectum was 2.233, 3.326, and 1.707 for IMRT, USPT, and IMPT, respectively. The NTCP of the bladder was 0.008, 0.003, and 0.002 respectively. The NTCP values at the rectum and bladder were significantly lower using IMPT. Our study shows that using proton therapy, particularly IMPT, to treat prostate cancer could be beneficial compared to 7-field IMRT with similar target coverage. Given these results, radiotherapy using protons, particularly optimized IMPT, is a worthwhile treatment option for prostate cancer.

Keywords: IMRT, USPT, IMPT, Prostate cancer, Treatment planning

REFERENCES

1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International J of Cancer. 127(12):2893–2917. 2010.

2. Weber DC, Trofimov AV, Delaney TF, Bortfeld T. A treatment planning comparison of intensity modulated photon and proton therapy for paraspinal sarcomas. Int J Radiat Oncol Biol Phys. 58(5):1596–1606. 2004.

3. Chung JB, Kim TS, Kim IA, Lee JW, Cho W, Suh TS. The effect of photon energy on the intensity-modulated radiation therapy plan for prostate cancer: a planning study. Korean Phys Soc. 59(1):183–188. 2011.

4. Trofimov A, Nguyen PL, Coen JJ, et al. Radiotherapy treatment of early-stage prostate cancer with IMRT and protons: a treatment planning comparison. Int J Radiat Oncol Biol Phys. 69(2):444–453. 2007.

5. Goitein M, Lomax AJ, Pedroni ES. Treating cancer with protons. Physics Today. 55(9):45–50. 2002.

6. Jones B, Burnet N. Radiotherapy for the future - Protons and ions hold much promise. British Medical J. 330(7498):979–980B. 2005.

7. Goitein M, Lomax AJ, Pedroni ES. Weighing proton therapy's clinical readiness and costs. Physics Today. 56(6):13–14. 2003.

8. Kase Y, Yamashita H, Fuji H, et al. A treatment planning comparison of passive-scattering and intensity-modulated proton therapy for typical tumor sites. J of Radiation Research. 2011.

9. Nutting CM, Convery DJ, Cosgrove VP, et al. Reduction of small and large bowel irradiation using an optimized intensity-modulated pelvic radiotherapy technique in patients with prostate cancer. Int J Radiat Oncol Biol Phys. 48(3):649–656. 2000.

10. Lomax A. Intensity modulation methods for proton radiotherapy. Phys Med Biol. 44(1):185–205. 1999.

11. Oelfke U, Bortfeld T. Inverse planning for photon and proton beams. Med Dos. 26(2):113–124. 2001.

12. Cella L, Lomax A, Miralbell R. Potential role of intensity modulated proton beams in prostate cancer radiotherapy. Int J Radiat Oncol Biol Phys. 49(1):217–223. 2001.

13. Steneker M, Lomax A, Schneider U. Intensity modulated photon and proton therapy for the treatment of head and neck tumors. Radiat Oncol. 80(2):263–267. 2006.

14. Huchet A, Caudry M, Belkacemi Y, et al. Volume-effect and radiotherapy [II]. Part II: volume-effect and normal tissue. Cancer Radiotherapie. 7(5):353–362. 2003.

15. Mohan R, Wu Q, Manning M, Schmidt-Ullrich R. Radiobiological considerations in the design of fractionation strategies for intensity-modulated radiation therapy of head and neck cancers. Int J Radiat Oncol Biol Phys. 46(3):619–630. 2000.

16. Dearnaley DP, Hall E, Lawrence D, et al. Phase III pilot study of dose escalation using conformal radiotherapy in prostate cancer: PSA control and side effects. British J of Cancer. 92(3):488–498. 2005.

17. Peeters ST, Heemsbergen WD, Koper PC, et al. Doseresponse in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J of Clinical Oncology. 24(13):1990–1996. 2006.

18. Pollack A, Zagars GK, Starkschall G, et al. Prostate cancer radiation dose response: results of the M. D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys. 53(5):1097–1105. 2002.

19. Michalski JM, Winter K, Purdy JA, et al. Toxicity after three-dimensional radiotherapy for prostate cancer on RTOG 9406 dose Level V. Int J Radiat Oncol Biol Phys. 62(3):706–713. 2005.

20. Rossi CJ Jr, Slater JD, Yonemoto LT, et al. Influence of patient age on biochemical freedom from disease in patients undergoing conformal proton radiotherapy of organ-confined prostate cancer. Urology. 64(4):729–732. 2004.

21. Vargas C, Fryer A, Mahajan C, et al. Dose-volume comparison of proton therapy and intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 70(3):744–751. 2008.

Fig. 1.

Color wash IMRT (a), USPT (b), and IMPT (c) dose distribution for the PTV for patient (patient 3) with a prostate cancer. It shows the dose distributions of IMRT, USPT, and IMPT plans for CT image on axial, frontal, and sagittal planes, respectively. IMPT and USPT dose distributions delivered by right lateral (270°) and left lateral (90°) beams.

Fig. 2.

Mean DVHs of 10 prostate patients for OARs at IMPT, USPT, and IMRT.

Table 1.

Characteristics of the 10 prostate patients.

Patient	Age	Stage	Target volume
1	61	T3bN0	83.64
2	64	T3bN0	52.98
3	76	T3cN0	81.31
4	64	T3aN0	96.34
5	81	T3aN0	111.98
6	77	T2aN0	137.5
7	60	T3aN0	50.04
8	72	T1cN0	121.52
9	74	T3bN0	89.37
10	65	T3aN0	89.71

Table 2.

Optimization constraints for IMRT and IMPT.

ROI	Description
PTV	Uniform Dose 7,000 cGy
	Max Dose 7,100 cGy
Right femoral head	Max Dose 3,700 cGy
	Max DVH 3,000 cGy to 60% volume
	Max DVH 900 cGy to 40% volume
Left femoral head	Max Dose 3,700 cGy
	Max DVH 3,000 cGy to 60% volume
	Max DVH 900 cGy to 40% volume
Bladder	Max Dose 6,900 cGy
	Max DVH 2,500 cGy to 40% volume
Rectum	Max DVH 4,250 cGy to 20% volume
	Max DVH 1,890 cGy to 55% volume

PTV: planning target volume, DVH: dose volume histogram.

Table 3.

Conformity indexes (CI) and homogeneity indexes (HI) were represented for IMPT, USPT, and IMRT at PTV.

Patient	CI			HI
Patient	IMRT	USPT	IMPT	IMRT	USPT	IMPT
1	1.40	1.31	1.16	1.09	1.05	1.04
2	1.18	1.32	1.19	1.09	1.05	1.04
3	1.05	1.16	1.19	1.04	1.06	1.04
4	1.13	1.25	1.12	1.05	1.05	1.02
5	1.08	1.30	1.12	1.05	1.05	1.03
6	1.10	1.51	1.14	1.05	1.04	1.04
7	1.05	1.07	1.18	1.05	1.08	1.05
8	1.18	1.92	1.27	1.06	1.05	1.04
9	1.02	1.15	1.19	1.06	1.08	1.03
10	1.18	1.12	1.34	1.05	1.06	1.07
Mean	1.14	1.31	1.19	1.06	1.06	1.04

Table 4.

NTCP values for the rectum and bladder of 10 patients.

Patient	Rectum (%)			Bladder (%)
Patient	IMRT	USPT	IMPT	IMRT	USPT	IMPT
1	3.823	5.510	2.460	0.000	0.001	0.000
2	3.598	4.492	1.429	0.000	0.000	0.000
3	1.387	1.429	1.243	0.000	0.000	0.000
4	2.919	4.710	2.106	0.000	0.000	0.000
5	2.192	5.042	2.403	0.000	0.000	0.000
6	2.523	2.888	1.946	0.000	0.000	0.000
7	0.388	0.718	0.593	0.000	0.000	0.000
8	0.388	0.718	0.593	0.000	0.000	0.000
9	1.380	3.926	1.739	0.074	0.028	0.023
10	3.728	3.822	2.498	0.000	0.000	0.000
Mean	2.233	3.326	1.701	0.008	0.003	0.002

NTCP: normal tissue complication probability.

TOOLS

Similar articles