Clinical oncology (Royal College of Radiologists (Great Britain)) · 2025
Effectiveness of Intensity Modulate Proton Therapy in Managing Complex Multiple Meningiomas: A Dosimetric and Radiobiological Comparative Study with Helical Tomotherapy on Neurological Risk.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Singh G, Sharma D, Gayen S, Krishnan G, Krishna U, Aishwarya G, Mary Mathew J, Jalali R
Аннотация
PURPOSE: This study addresses the challenges of sparing neurological organs at risk (OARs) in radiation therapy for multiple meningiomas (MM) by introducing a novel, robust intensity-modulated proton therapy (IMPT) plan and assessing its dosimetric and radiobiological outcomes relative to helical tomotherapy (HT).
METHODS: CT and MRI datasets from 24 MM patients were used to generate competing IMPT and HT plans. IMPT employed a spot-assignment strategy with five static fields and was robustly optimized for CTV-sum, considering 2-3 mm setup and 2% range uncertainty, while HT was optimized on PTV-sum. The median prescribed dose was 50.2 GyRBE in 28 fractions.
RESULTS: The number of isolated CTVs per patient ranged from 2 to 9, with total target volumes of 27.69-1153.61 cc (CTV-sum) and 62.5-1415.25 cc (PTV-sum). The mean±SD dose difference in D95% between PTV-sum in HT and CTV-sum in the IMPT worst-case scenario (-0.58 ± 0.57 GyRBE, p = 0.03) was clinically acceptable. While Dmean to PTV-sum showed no significant difference (p = 0.06), D2% was significantly higher in IMPT (p = 0.006) than in HT. IMPT significantly reduced both Dmax and Dmean for most OARs (p < 0.05) and lowered integral dose to normal brain tissue (p < 0.0001) by a factor of 1.37-6.97 compared to HT. Significant NTCP reductions (p < 0.05) were observed for the lenses, eyes, brainstem, optic nerves, and cochlea.
CONCLUSIONS: IMPT ensures robust target coverage while significantly lowering Dmax, Dmean, and NTCP for several OARs compared to HT. Its reduced integral dose to normal brain tissue may benefit re-irradiation and lower second cancer risk.
METHODS: CT and MRI datasets from 24 MM patients were used to generate competing IMPT and HT plans. IMPT employed a spot-assignment strategy with five static fields and was robustly optimized for CTV-sum, considering 2-3 mm setup and 2% range uncertainty, while HT was optimized on PTV-sum. The median prescribed dose was 50.2 GyRBE in 28 fractions.
RESULTS: The number of isolated CTVs per patient ranged from 2 to 9, with total target volumes of 27.69-1153.61 cc (CTV-sum) and 62.5-1415.25 cc (PTV-sum). The mean±SD dose difference in D95% between PTV-sum in HT and CTV-sum in the IMPT worst-case scenario (-0.58 ± 0.57 GyRBE, p = 0.03) was clinically acceptable. While Dmean to PTV-sum showed no significant difference (p = 0.06), D2% was significantly higher in IMPT (p = 0.006) than in HT. IMPT significantly reduced both Dmax and Dmean for most OARs (p < 0.05) and lowered integral dose to normal brain tissue (p < 0.0001) by a factor of 1.37-6.97 compared to HT. Significant NTCP reductions (p < 0.05) were observed for the lenses, eyes, brainstem, optic nerves, and cochlea.
CONCLUSIONS: IMPT ensures robust target coverage while significantly lowering Dmax, Dmean, and NTCP for several OARs compared to HT. Its reduced integral dose to normal brain tissue may benefit re-irradiation and lower second cancer risk.