Bone marrow sparing in intensity modulated proton therapy for cervical cancer: Efficacy and robustness under range and setup uncertainties

Eric Dinges, Nicole Felderman, Sarah McGuire, Brandie Gross, Sudershan Bhatia, Sarah Mott, John Buatti, Dongxu Wang

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background and purpose This study evaluates the potential efficacy and robustness of functional bone marrow sparing (BMS) using intensity-modulated proton therapy (IMPT) for cervical cancer, with the goal of reducing hematologic toxicity. Material and methods IMPT plans with prescription dose of 45 Gy were generated for ten patients who have received BMS intensity-modulated X-ray therapy (IMRT). Functional bone marrow was identified by 18F-flourothymidine positron emission tomography. IMPT plans were designed to minimize the volume of functional bone marrow receiving 5-40 Gy while maintaining similar target coverage and healthy organ sparing as IMRT. IMPT robustness was analyzed with ±3% range uncertainty errors and/or ±3 mm translational setup errors in all three principal dimensions. Results In the static scenario, the median dose volume reductions for functional bone marrow by IMPT were: 32% for V5Gy, 47% for V10Gy, 54% for V20Gy, and 57% for V40Gy, all with p < 0.01 compared to IMRT. With assumed errors, even the worst-case reductions by IMPT were: 23% for V5Gy, 37% for V10Gy, 41% for V20Gy, and 39% for V40Gy, all with p < 0.01. Conclusions The potential sparing of functional bone marrow by IMPT for cervical cancer is significant and robust under realistic systematic range uncertainties and clinically relevant setup errors.

Original languageEnglish (US)
Pages (from-to)373-378
Number of pages6
JournalRadiotherapy and Oncology
Volume115
Issue number3
DOIs
StatePublished - Jan 1 2015

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Proton Therapy
Uterine Cervical Neoplasms
Uncertainty
Bone Marrow
X-Ray Therapy
Positron-Emission Tomography
Prescriptions

Keywords

  • Bone marrow sparing
  • Cervical cancer
  • Proton
  • Robustness

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Bone marrow sparing in intensity modulated proton therapy for cervical cancer : Efficacy and robustness under range and setup uncertainties. / Dinges, Eric; Felderman, Nicole; McGuire, Sarah; Gross, Brandie; Bhatia, Sudershan; Mott, Sarah; Buatti, John; Wang, Dongxu.

In: Radiotherapy and Oncology, Vol. 115, No. 3, 01.01.2015, p. 373-378.

Research output: Contribution to journalArticle

Dinges, Eric ; Felderman, Nicole ; McGuire, Sarah ; Gross, Brandie ; Bhatia, Sudershan ; Mott, Sarah ; Buatti, John ; Wang, Dongxu. / Bone marrow sparing in intensity modulated proton therapy for cervical cancer : Efficacy and robustness under range and setup uncertainties. In: Radiotherapy and Oncology. 2015 ; Vol. 115, No. 3. pp. 373-378.
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AU - Buatti, John

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AB - Background and purpose This study evaluates the potential efficacy and robustness of functional bone marrow sparing (BMS) using intensity-modulated proton therapy (IMPT) for cervical cancer, with the goal of reducing hematologic toxicity. Material and methods IMPT plans with prescription dose of 45 Gy were generated for ten patients who have received BMS intensity-modulated X-ray therapy (IMRT). Functional bone marrow was identified by 18F-flourothymidine positron emission tomography. IMPT plans were designed to minimize the volume of functional bone marrow receiving 5-40 Gy while maintaining similar target coverage and healthy organ sparing as IMRT. IMPT robustness was analyzed with ±3% range uncertainty errors and/or ±3 mm translational setup errors in all three principal dimensions. Results In the static scenario, the median dose volume reductions for functional bone marrow by IMPT were: 32% for V5Gy, 47% for V10Gy, 54% for V20Gy, and 57% for V40Gy, all with p < 0.01 compared to IMRT. With assumed errors, even the worst-case reductions by IMPT were: 23% for V5Gy, 37% for V10Gy, 41% for V20Gy, and 39% for V40Gy, all with p < 0.01. Conclusions The potential sparing of functional bone marrow by IMPT for cervical cancer is significant and robust under realistic systematic range uncertainties and clinically relevant setup errors.

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