A dosimetric comparison of proton and intensity modulated radiation therapy in pediatric rhabdomyosarcoma patients enrolled on a prospective phase II proton study

Matthew Ladra, Samantha K. Edgington, Anita Mahajan, David Grosshans, Jackie Szymonifka, Fazal Khan, Maryam Moteabbed, Alison M. Friedmann, Shannon M. MacDonald, Nancy J. Tarbell, Torunn I. Yock

Research output: Contribution to journalArticle

Abstract

Background: Pediatric rhabdomyosarcoma (RMS) is highly curable, however, cure may come with significant radiation related toxicity in developing tissues. Proton therapy (PT) can spare excess dose to normal structures, potentially reducing the incidence of adverse effects. Methods: Between 2005 and 2012, 54 patients were enrolled on a prospective multi-institutional phase II trial using PT in pediatric RMS. As part of the protocol, intensity modulated radiation therapy (IMRT) plans were generated for comparison with clinical PT plans. Results: Target coverage was comparable between PT and IMRT plans with a mean CTV V95 of 100% for both modalities (p = 0.82). However, mean integral dose was 1.8 times higher for IMRT (range 1.0-4.9). By site, mean integral dose for IMRT was 1.8 times higher for H&N (p < 0.01) and GU (p = 0.02), 2.0 times higher for trunk/extremity (p < 0.01), and 3.5 times higher for orbit (p < 0.01) compared to PT. Significant sparing was seen with PT in 26 of 30 critical structures assessed for orbital, head and neck, pelvic, and trunk/extremity patients. Conclusions: Proton radiation lowers integral dose and improves normal tissue sparing when compared to IMRT for pediatric RMS. Correlation with clinical outcomes is necessary once mature long-term toxicity data are available.

Original languageEnglish (US)
Pages (from-to)77-83
Number of pages7
JournalRadiotherapy and Oncology
Volume113
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Proton Therapy
Rhabdomyosarcoma
Protons
Radiotherapy
Pediatrics
Extremities
Radiation
Orbit
Neck
Head
Incidence

Keywords

  • Pediatrics
  • Protons
  • Rhabdomyosarcoma

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology
  • Medicine(all)

Cite this

A dosimetric comparison of proton and intensity modulated radiation therapy in pediatric rhabdomyosarcoma patients enrolled on a prospective phase II proton study. / Ladra, Matthew; Edgington, Samantha K.; Mahajan, Anita; Grosshans, David; Szymonifka, Jackie; Khan, Fazal; Moteabbed, Maryam; Friedmann, Alison M.; MacDonald, Shannon M.; Tarbell, Nancy J.; Yock, Torunn I.

In: Radiotherapy and Oncology, Vol. 113, No. 1, 2014, p. 77-83.

Research output: Contribution to journalArticle

Ladra, M, Edgington, SK, Mahajan, A, Grosshans, D, Szymonifka, J, Khan, F, Moteabbed, M, Friedmann, AM, MacDonald, SM, Tarbell, NJ & Yock, TI 2014, 'A dosimetric comparison of proton and intensity modulated radiation therapy in pediatric rhabdomyosarcoma patients enrolled on a prospective phase II proton study', Radiotherapy and Oncology, vol. 113, no. 1, pp. 77-83. https://doi.org/10.1016/j.radonc.2014.08.033
Ladra, Matthew ; Edgington, Samantha K. ; Mahajan, Anita ; Grosshans, David ; Szymonifka, Jackie ; Khan, Fazal ; Moteabbed, Maryam ; Friedmann, Alison M. ; MacDonald, Shannon M. ; Tarbell, Nancy J. ; Yock, Torunn I. / A dosimetric comparison of proton and intensity modulated radiation therapy in pediatric rhabdomyosarcoma patients enrolled on a prospective phase II proton study. In: Radiotherapy and Oncology. 2014 ; Vol. 113, No. 1. pp. 77-83.
@article{b91ab358a47e4663a64186adf50c602c,
title = "A dosimetric comparison of proton and intensity modulated radiation therapy in pediatric rhabdomyosarcoma patients enrolled on a prospective phase II proton study",
abstract = "Background: Pediatric rhabdomyosarcoma (RMS) is highly curable, however, cure may come with significant radiation related toxicity in developing tissues. Proton therapy (PT) can spare excess dose to normal structures, potentially reducing the incidence of adverse effects. Methods: Between 2005 and 2012, 54 patients were enrolled on a prospective multi-institutional phase II trial using PT in pediatric RMS. As part of the protocol, intensity modulated radiation therapy (IMRT) plans were generated for comparison with clinical PT plans. Results: Target coverage was comparable between PT and IMRT plans with a mean CTV V95 of 100{\%} for both modalities (p = 0.82). However, mean integral dose was 1.8 times higher for IMRT (range 1.0-4.9). By site, mean integral dose for IMRT was 1.8 times higher for H&N (p < 0.01) and GU (p = 0.02), 2.0 times higher for trunk/extremity (p < 0.01), and 3.5 times higher for orbit (p < 0.01) compared to PT. Significant sparing was seen with PT in 26 of 30 critical structures assessed for orbital, head and neck, pelvic, and trunk/extremity patients. Conclusions: Proton radiation lowers integral dose and improves normal tissue sparing when compared to IMRT for pediatric RMS. Correlation with clinical outcomes is necessary once mature long-term toxicity data are available.",
keywords = "Pediatrics, Protons, Rhabdomyosarcoma",
author = "Matthew Ladra and Edgington, {Samantha K.} and Anita Mahajan and David Grosshans and Jackie Szymonifka and Fazal Khan and Maryam Moteabbed and Friedmann, {Alison M.} and MacDonald, {Shannon M.} and Tarbell, {Nancy J.} and Yock, {Torunn I.}",
year = "2014",
doi = "10.1016/j.radonc.2014.08.033",
language = "English (US)",
volume = "113",
pages = "77--83",
journal = "Radiotherapy and Oncology",
issn = "0167-8140",
publisher = "Elsevier Ireland Ltd",
number = "1",

}

TY - JOUR

T1 - A dosimetric comparison of proton and intensity modulated radiation therapy in pediatric rhabdomyosarcoma patients enrolled on a prospective phase II proton study

AU - Ladra, Matthew

AU - Edgington, Samantha K.

AU - Mahajan, Anita

AU - Grosshans, David

AU - Szymonifka, Jackie

AU - Khan, Fazal

AU - Moteabbed, Maryam

AU - Friedmann, Alison M.

AU - MacDonald, Shannon M.

AU - Tarbell, Nancy J.

AU - Yock, Torunn I.

PY - 2014

Y1 - 2014

N2 - Background: Pediatric rhabdomyosarcoma (RMS) is highly curable, however, cure may come with significant radiation related toxicity in developing tissues. Proton therapy (PT) can spare excess dose to normal structures, potentially reducing the incidence of adverse effects. Methods: Between 2005 and 2012, 54 patients were enrolled on a prospective multi-institutional phase II trial using PT in pediatric RMS. As part of the protocol, intensity modulated radiation therapy (IMRT) plans were generated for comparison with clinical PT plans. Results: Target coverage was comparable between PT and IMRT plans with a mean CTV V95 of 100% for both modalities (p = 0.82). However, mean integral dose was 1.8 times higher for IMRT (range 1.0-4.9). By site, mean integral dose for IMRT was 1.8 times higher for H&N (p < 0.01) and GU (p = 0.02), 2.0 times higher for trunk/extremity (p < 0.01), and 3.5 times higher for orbit (p < 0.01) compared to PT. Significant sparing was seen with PT in 26 of 30 critical structures assessed for orbital, head and neck, pelvic, and trunk/extremity patients. Conclusions: Proton radiation lowers integral dose and improves normal tissue sparing when compared to IMRT for pediatric RMS. Correlation with clinical outcomes is necessary once mature long-term toxicity data are available.

AB - Background: Pediatric rhabdomyosarcoma (RMS) is highly curable, however, cure may come with significant radiation related toxicity in developing tissues. Proton therapy (PT) can spare excess dose to normal structures, potentially reducing the incidence of adverse effects. Methods: Between 2005 and 2012, 54 patients were enrolled on a prospective multi-institutional phase II trial using PT in pediatric RMS. As part of the protocol, intensity modulated radiation therapy (IMRT) plans were generated for comparison with clinical PT plans. Results: Target coverage was comparable between PT and IMRT plans with a mean CTV V95 of 100% for both modalities (p = 0.82). However, mean integral dose was 1.8 times higher for IMRT (range 1.0-4.9). By site, mean integral dose for IMRT was 1.8 times higher for H&N (p < 0.01) and GU (p = 0.02), 2.0 times higher for trunk/extremity (p < 0.01), and 3.5 times higher for orbit (p < 0.01) compared to PT. Significant sparing was seen with PT in 26 of 30 critical structures assessed for orbital, head and neck, pelvic, and trunk/extremity patients. Conclusions: Proton radiation lowers integral dose and improves normal tissue sparing when compared to IMRT for pediatric RMS. Correlation with clinical outcomes is necessary once mature long-term toxicity data are available.

KW - Pediatrics

KW - Protons

KW - Rhabdomyosarcoma

UR - http://www.scopus.com/inward/record.url?scp=84922669253&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84922669253&partnerID=8YFLogxK

U2 - 10.1016/j.radonc.2014.08.033

DO - 10.1016/j.radonc.2014.08.033

M3 - Article

C2 - 25443861

AN - SCOPUS:84922669253

VL - 113

SP - 77

EP - 83

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

SN - 0167-8140

IS - 1

ER -