Dosimetric comparison of advanced radiotherapy approaches using photon techniques and particle therapy in the postoperative management of thymoma

Authors

  • Matthias Felix Haefner Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; ;Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; ;National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
  • Vivek Verma Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
  • Nina Bougatf Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; ;Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; ;National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
  • Thomas Mielke Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; ;Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; ;National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
  • Eric Tonndorf-Martini Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; ;Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany
  • Laila König Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; ;Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; ;National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
  • Jean-Claude M. Rwigema Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
  • Charles B. Simone 2nd Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
  • Lorenz Uhlmann Institute of Medical Biometry and Informatics (IMBI), Heidelberg, Germany
  • Florian Eichhorn Department of Thoracic Surgery, Thoraxklinik Heidelberg University Hospital, Heidelberg, Germany
  • Hauke Winter Department of Thoracic Surgery, Thoraxklinik Heidelberg University Hospital, Heidelberg, Germany
  • Heidrun Grosch Department of Thoracic Oncology, Thoraxklinik Heidelberg University Hospital, Heidelberg, Germany
  • Thomas Haberer Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; ;National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
  • Klaus Herfarth Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; ;Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; ;National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
  • Jürgen Debus Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; ;Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; ;National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
  • Stefan Rieken Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; ;Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; ;National Center of Radiation Research in Oncology (NCRO) Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany

DOI:

https://doi.org/10.1080/0284186X.2018.1502467

Abstract

Background: The purpose of this study was to compare dosimetric differences related to target volume and organs-at-risk (OAR) using 3D-conformal radiotherapy (3DCRT), volumetric modulated arc therapy (VMAT), TomoTherapy (Tomo), proton radiotherapy (PRT), and carbon ion radiotherapy (CIRT) as part of postoperative thymoma irradiation.

Material and methods: This single-institutional analysis included 10 consecutive patients treated with adjuvant radiotherapy between December 2013 and September 2016. CT-datasets and respective RT-structures were anonymized and plans for all investigated RT modalities (3DCRT, VMAT, Tomo, PRT, CIRT) were optimized for a total dose of 50 Gy in 25 fractions. Comparisons between target volume and OAR dosimetric parameters were performed using the Wilcoxon rank-sum test.

Results: The best target volume coverage (mean PTV V95% for all patients) was observed for Tomo (97.9%), PRT (97.6%), and CIRT (96.6%) followed by VMAT (85.4%) and 3DCRT (74.7%). PRT and CIRT both significantly reduced mean doses to the lungs, breasts, heart, and esophagus, as well as the spinal cord maximum dose compared with photon modalities. Among photon-based techniques, VMAT showed improved OAR sparing over 3DCRT. Tomo was associated with considerable low-dose exposure to the lungs, breasts, and heart.

Conclusions: Particle radiotherapy (PRT, CIRT) showed superior OAR sparing and optimal target volume coverage. The observed dosimetric advantages are expected to reduce toxicity rates. However, their clinical impact must be investigated prospectively.

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Published

2018-12-02

How to Cite

Felix Haefner, M. ., Verma, V. ., Bougatf, N. ., Mielke, T. ., Tonndorf-Martini, E. ., König, L. ., … Rieken, S. . (2018). Dosimetric comparison of advanced radiotherapy approaches using photon techniques and particle therapy in the postoperative management of thymoma. Acta Oncologica, 57(12), 1713–1720. https://doi.org/10.1080/0284186X.2018.1502467

Issue

Vol. 57 No. 12 (2018): Acta Oncologica

Section

Articles