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

Zhengfei Zhu, Wei Liu, Michael Gillin, Daniel R. Gomez, Ritsuko Komaki, James D. Cox, Radhe Mohan, Joe Y. Chang

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article number108
JournalRadiation Oncology
Volume9
Issue number1
DOIs
StatePublished - May 6 2014

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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