Multifield optimization intensity modulated proton therapy for head and neck tumors: A translation to practice

Steven J. Frank; James D. Cox; Michael Gillin; Radhe Mohan; Adam S. Garden; David I. Rosenthal; G. Brandon Gunn; Randal S. Weber; Merrill S. Kies; Jan S. Lewin; Mark F. Munsell; Matthew B. Palmer; Narayan Sahoo; Xiaodong Zhang; Wei Liu; X. Ronald Zhu

doi:10.1016/j.ijrobp.2014.04.019

Multifield optimization intensity modulated proton therapy for head and neck tumors: A translation to practice

Steven J. Frank, James D. Cox, Michael Gillin, Radhe Mohan, Adam S. Garden, David I. Rosenthal, G. Brandon Gunn, Randal S. Weber, Merrill S. Kies, Jan S. Lewin, Mark F. Munsell, Matthew B. Palmer, Narayan Sahoo, Xiaodong Zhang, Wei Liu, X. Ronald Zhu

Radiation Oncology

Research output: Contribution to journal › Article › peer-review

73 Scopus citations

Abstract

Background We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment "spot by spot" and "layer by layer." Results Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.

Original language	English (US)
Pages (from-to)	846-853
Number of pages	8
Journal	International Journal of Radiation Oncology Biology Physics
Volume	89
Issue number	4
DOIs	https://doi.org/10.1016/j.ijrobp.2014.04.019
State	Published - Jul 15 2014

ASJC Scopus subject areas

Radiation
Oncology
Radiology Nuclear Medicine and imaging
Cancer Research

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Frank, S. J., Cox, J. D., Gillin, M., Mohan, R., Garden, A. S., Rosenthal, D. I., Gunn, G. B., Weber, R. S., Kies, M. S., Lewin, J. S., Munsell, M. F., Palmer, M. B., Sahoo, N., Zhang, X., Liu, W., & Zhu, X. R. (2014). Multifield optimization intensity modulated proton therapy for head and neck tumors: A translation to practice. International Journal of Radiation Oncology Biology Physics, 89(4), 846-853. https://doi.org/10.1016/j.ijrobp.2014.04.019

Frank, SJ, Cox, JD, Gillin, M, Mohan, R, Garden, AS, Rosenthal, DI, Gunn, GB, Weber, RS, Kies, MS, Lewin, JS, Munsell, MF, Palmer, MB, Sahoo, N, Zhang, X, Liu, W & Zhu, XR 2014, 'Multifield optimization intensity modulated proton therapy for head and neck tumors: A translation to practice', International Journal of Radiation Oncology Biology Physics, vol. 89, no. 4, pp. 846-853. https://doi.org/10.1016/j.ijrobp.2014.04.019

@article{89ecd5f5ff4445e5a7096a8398fac74d,

title = "Multifield optimization intensity modulated proton therapy for head and neck tumors: A translation to practice",

abstract = "Background We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment {"}spot by spot{"} and {"}layer by layer.{"} Results Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.",

author = "Frank, {Steven J.} and Cox, {James D.} and Michael Gillin and Radhe Mohan and Garden, {Adam S.} and Rosenthal, {David I.} and Gunn, {G. Brandon} and Weber, {Randal S.} and Kies, {Merrill S.} and Lewin, {Jan S.} and Munsell, {Mark F.} and Palmer, {Matthew B.} and Narayan Sahoo and Xiaodong Zhang and Wei Liu and Zhu, {X. Ronald}",

note = "Funding Information: Supported by P01CA021239 and P30CA016672 from the National Cancer Institute . ",

year = "2014",

month = jul,

day = "15",

doi = "10.1016/j.ijrobp.2014.04.019",

language = "English (US)",

volume = "89",

pages = "846--853",

journal = "International Journal of Radiation Oncology Biology Physics",

issn = "0360-3016",

publisher = "Elsevier Inc.",

number = "4",

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TY - JOUR

T1 - Multifield optimization intensity modulated proton therapy for head and neck tumors

T2 - A translation to practice

AU - Frank, Steven J.

AU - Cox, James D.

AU - Gillin, Michael

AU - Mohan, Radhe

AU - Garden, Adam S.

AU - Rosenthal, David I.

AU - Gunn, G. Brandon

AU - Weber, Randal S.

AU - Kies, Merrill S.

AU - Lewin, Jan S.

AU - Munsell, Mark F.

AU - Palmer, Matthew B.

AU - Sahoo, Narayan

AU - Zhang, Xiaodong

AU - Liu, Wei

AU - Zhu, X. Ronald

N1 - Funding Information: Supported by P01CA021239 and P30CA016672 from the National Cancer Institute .

PY - 2014/7/15

Y1 - 2014/7/15

N2 - Background We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment "spot by spot" and "layer by layer." Results Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.

AB - Background We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment "spot by spot" and "layer by layer." Results Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.

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Multifield optimization intensity modulated proton therapy for head and neck tumors: A translation to practice

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