Bone marrow sparing in intensity modulated proton therapy for cervical cancer: Efficacy and robustness under range and setup uncertainties

Eric Dinges; Nicole Felderman; Sarah McGuire; Brandie Gross; Sudershan Bhatia; Sarah Mott; John Buatti; Dongxu Wang

doi:10.1016/j.radonc.2015.05.005

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Bone marrow sparing in intensity modulated proton therapy for cervical cancer: Efficacy and robustness under range and setup uncertainties

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Bone marrow sparing in intensity modulated proton therapy for cervical cancer: Efficacy and robustness under range and setup uncertainties

Eric Dinges, Nicole Felderman, Sarah McGuire, Brandie Gross, Sudershan Bhatia, Sarah Mott, John Buatti and Dongxu Wang

Radiotherapy and oncology, Vol.115(3), pp.373-378

06/01/2015

DOI: 10.1016/j.radonc.2015.05.005

PMCID: PMC4508248

PMID: 25981130

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https://www.ncbi.nlm.nih.gov/pmc/articles/4508248View

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Abstract

Background and purpose: This study evaluates the potential efficacy and robustness of functional bone marrow sparing (BMS) using intensity-modulated proton therapy (IMPT) for cervical cancer, with the goal of reducing hematologic toxicity. Material and methods: IMPT plans with prescription dose of 45 Gy were generated for ten patients who have received BMS intensity-modulated X-ray therapy (IMRT). Functional bone marrow was identified by F-18-flourothymidine positron emission tomography. IMPT plans were designed to minimize the volume of functional bone marrow receiving 5-40 Gy while maintaining similar target coverage and healthy organ sparing as IMRT. IMPT robustness was analyzed with +/- 3% range uncertainty errors and/or +/- 3 mm translational setup errors in all three principal dimensions. Results: In the static scenario, the median dose volume reductions for functional bone marrow by IMPT were: 32% for V-5Gy, 47% for V-10Gy, 54% for V-20Gy, and 57% for V-40Gy, all with p < 0.01 compared to IMRT. With assumed errors, even the worst-case reductions by IMPT were: 23% for V-5Gy, 37% for V-10Gy, 41% for V-20Gy, and 39% for V-40Gy, all with p < 0.01. Conclusions: The potential sparing of functional bone marrow by IMPT for cervical cancer is significant and robust under realistic systematic range uncertainties and clinically relevant setup errors. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Oncology

Life Sciences & Biomedicine

Radiology, Nuclear Medicine & Medical Imaging

Science & Technology

Details

Title: Subtitle: Bone marrow sparing in intensity modulated proton therapy for cervical cancer: Efficacy and robustness under range and setup uncertainties
Creators: Eric Dinges - University of Iowa
Nicole Felderman - University of Iowa
Sarah McGuire - University of Iowa Hospitals and Clinics
Brandie Gross - University of Iowa
Sudershan Bhatia - University of Iowa
Sarah Mott - University of Iowa
John Buatti - University of Iowa
Dongxu Wang - University of Iowa
Resource Type: Journal article
Publication Details: Radiotherapy and oncology, Vol.115(3), pp.373-378
DOI: 10.1016/j.radonc.2015.05.005
PMID: 25981130
PMCID: PMC4508248
NLM abbreviation: Radiother Oncol
ISSN: 0167-8140
eISSN: 1879-0887
Publisher: Elsevier
Number of pages: 6
Grant note: NIH 3P30CA086862; NIH 1R01CA169336-01 / National Cancer Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI) P30CA086862 / NATIONAL CANCER INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI) Iowa Center for Research by Undergraduates
Language: English
Date published: 06/01/2015
Academic Unit: Radiation Oncology; Neurosurgery; Otolaryngology
Record Identifier: 9984303905602771

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