PMID- 24119834
OWN - NLM
STAT- MEDLINE
DCOM- 20140128
LR  - 20191210
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 87
IP  - 5
DP  - 2013 Dec 1
TI  - Intensity modulated proton beam radiation for brachytherapy in patients with 
      cervical carcinoma.
PG  - 897-903
LID - S0360-3016(13)03033-2 [pii]
LID - 10.1016/j.ijrobp.2013.08.027 [doi]
AB  - PURPOSE: To evaluate intensity modulated proton therapy (IMPT) in patients with 
      cervical cancer in terms of coverage, conformity, and dose-volume histogram (DVH) 
      parameters correlated with recommendations from magnetic resonance imaging 
      (MRI)-guided brachytherapy. METHODS AND MATERIALS: Eleven patients with 
      histologically proven cervical cancer underwent primary chemoradiation for the 
      pelvic lymph nodes, the uterus, the cervix, and the parametric region, with a 
      symmetric margin of 1 cm. The prescription was for 50.4 Gy, with 1.8 Gy per 
      fraction. The prescribed dose to the parametria was 2.12 Gy up to 59.36 Gy in 28 
      fractions as a simultaneous boost. For several reasons, the patients were unable 
      to undergo brachytherapy. As an alternative, IMPT was planned with 5 fractions of 
      6 Gy to the cervix, including the macroscopic tumor with an MRI-guided target 
      definition, with an isotropic margin of 5 mm for planning target volume (PTV) 
      definition. Groupe-Europeen de Curietherapie and European society for 
      Radiotherapy and Oncology (GEC-ESTRO) criteria were used for DVH evaluation. 
      Reference comparison plans were optimized for volumetric modulated rapid arc 
      (VMAT) therapy with the RapidArc (RA). RESULTS: The dose to the high-risk volume 
      was calculated with alpha/beta = 10 with 89.6 Gy. For IMPT, the clinical target volume 
      showed a mean dose of 38.2 +/- 5.0 Gy (35.0 +/-1.8 Gy for RA). The D98% was 31.9 +/- 
      2.6 Gy (RA: 30.8 +/- 1.0 Gy). With regard to the organs at risk, the 2Gy Equivalent 
      Dose (EQD2) (alpha/beta = 3) to 2 cm(3) of the rectal wall, sigmoid wall, and bladder 
      wall was 62.2 +/- 6.4 Gy, 57.8 +/- 6.1 Gy, and 80.6 +/- 8.7 Gy (for RA: 75.3 +/- 6.1 Gy, 
      66.9 +/- 6.9 Gy, and 89.0 +/- 7.2 Gy, respectively). For the IMPT boost plans in 
      combination with external beam radiation therapy, all DVH parameters correlated 
      with <5% risk for grades 2 to 4 late gastrointestinal and genitourinary toxicity. 
      CONCLUSION: In patients who are not eligible for brachytherapy, IMPT as a boost 
      technique additionally to external beam radiation therapy provides good target 
      coverage and conformity and superior DVH parameters, compared with 
      recommendations to MRI-guided brachytherapy. For selected patients, IMPT might be 
      a valid alternative to brachytherapy and also superior to reference VMAT plans.
CI  - Copyright (c) 2013 Elsevier Inc. All rights reserved.
FAU - Clivio, Alessandro
AU  - Clivio A
AD  - Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
FAU - Kluge, Anne
AU  - Kluge A
FAU - Cozzi, Luca
AU  - Cozzi L
FAU - Kohler, Christhardt
AU  - Kohler C
FAU - Neumann, Oliver
AU  - Neumann O
FAU - Vanetti, Eugenio
AU  - Vanetti E
FAU - Wlodarczyk, Waldemar
AU  - Wlodarczyk W
FAU - Marnitz, Simone
AU  - Marnitz S
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20131009
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Adenocarcinoma/pathology/radiotherapy
MH  - Adult
MH  - Aged
MH  - *Brachytherapy
MH  - Carcinoma, Squamous Cell/pathology/radiotherapy
MH  - Colon, Sigmoid/radiation effects
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Imaging, Interventional/methods
MH  - Middle Aged
MH  - Organs at Risk/radiation effects
MH  - Proton Therapy/*methods
MH  - Radiotherapy Dosage
MH  - Radiotherapy, Image-Guided/*methods
MH  - Radiotherapy, Intensity-Modulated/*methods
MH  - Rectum/radiation effects
MH  - Urinary Bladder/radiation effects
MH  - Uterine Cervical Neoplasms/pathology/*radiotherapy
EDAT- 2013/10/15 06:00
MHDA- 2014/01/29 06:00
CRDT- 2013/10/15 06:00
PHST- 2013/06/06 00:00 [received]
PHST- 2013/08/22 00:00 [revised]
PHST- 2013/08/23 00:00 [accepted]
PHST- 2013/10/15 06:00 [entrez]
PHST- 2013/10/15 06:00 [pubmed]
PHST- 2014/01/29 06:00 [medline]
AID - S0360-3016(13)03033-2 [pii]
AID - 10.1016/j.ijrobp.2013.08.027 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2013 Dec 1;87(5):897-903. doi: 
      10.1016/j.ijrobp.2013.08.027. Epub 2013 Oct 9.