Assessing the robustness of passive scattering proton therapy with regard to local recurrence in stage III non-small cell lung cancer: a secondary analysis of a phase II trial

作者：Zhu Zhengfei; Liu Wei; Gillin Michael; Gomez Daniel R; Komaki Ritsuko; Cox James D; Mohan Radhe; Chang Joe Y^*

来源：Radiation Oncology, 2014, 9(1): 108.

DOI：10.1186/1748-717X-9-108

• Non-small cell lung cancer
• Proton therapy
• Passive scattering proton therapy
• Robustness analysis
• Worst-case scenario method

Background: We assessed the robustness of passive scattering proton therapy (PSPT) plans for patients in a phase II trial of PSPT for stage III non-small cell lung cancer (NSCLC) by using the worst-case scenario method, and compared the worst-case dose distributions with the appearance of locally recurrent lesions.
Methods: Worst-case dose distributions were generated for each of 9 patients who experienced recurrence after concurrent chemotherapy and PSPT to 74 Gy(RBE) for stage III NSCLC by simulating and incorporating uncertainties associated with set-up, respiration-induced organ motion, and proton range in the planning process. The worst-case CT scans were then fused with the positron emission tomography (PET) scans to locate the recurrence.
Results: Although the volumes enclosed by the prescription isodose lines in the worst-case dose distributions were consistently smaller than enclosed volumes in the nominal plans, the target dose coverage was not significantly affected: only one patient had a recurrence outside the prescription isodose lines in the worst-case plan.
Conclusions: PSPT is a relatively robust technique. Local recurrence was not associated with target underdosage resulting from estimated uncertainties in 8 of 9 cases.

• 出版日期2014-5-6