Reirradiation for Recurrent Scalp Angiosarcoma: Dosimetric Advantage of PBT over VMAT and EBT
Purpose: Reirradiation in the scalp area can be challenging given the proximity to organs at risk (OARs), such as the eye and brain. Our aim is to evaluate the dosimetric differences of volumetric modulated arc therapy (VMAT) and electron beam therapy (EBT) compared with 3-dimensional proton beam th...
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Particle Therapy Co-operative Group
2020-02-01
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Online Access: | https://theijpt.org/doi/pdf/10.14338/IJPT-19-00074 |
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doaj-cdedd5e4554e4c30b6755e9ea4c77f742020-11-25T02:33:54ZengParticle Therapy Co-operative GroupInternational Journal of Particle Therapy2331-51802020-02-0163131810.14338/IJPT-19-000742331-5180-6-3-13Reirradiation for Recurrent Scalp Angiosarcoma: Dosimetric Advantage of PBT over VMAT and EBTTal Eitan0Nicholas J. Damico1Rajesh Pidikiti2Michael Z. Kharouta3Donald Dobbins4Frederick B. Jesseph5Mark Smith6Ankit Mangla7Theodoros N. Teknos8David B. Mansur9Mitchell Machtay10Min Yao11Aashish D. Bhatt12Case Western Reserve University School of Medicine, Cleveland, OH, USADepartment of Radiation Oncology, University Hospitals Seidman Cancer Center at Case Western Reserve University, Cleveland, OH, USADepartment of Radiation Oncology, University Hospitals Seidman Cancer Center at Case Western Reserve University, Cleveland, OH, USADepartment of Radiation Oncology, University Hospitals Seidman Cancer Center at Case Western Reserve University, Cleveland, OH, USADepartment of Radiation Oncology, University Hospitals Seidman Cancer Center at Case Western Reserve University, Cleveland, OH, USADepartment of Radiation Oncology, University Hospitals Seidman Cancer Center at Case Western Reserve University, Cleveland, OH, USADepartment of Radiation Oncology, University Hospitals Seidman Cancer Center at Case Western Reserve University, Cleveland, OH, USADepartment of Hematology and Oncology, University Hospitals Seidman Cancer Center at Case Western Reserve University, Cleveland, OH, USADepartment of Otolaryngology- Head and Neck, University Hospitals Seidman Cancer Center at Case Western Reserve University, Cleveland OH, USADepartment of Radiation Oncology, University Hospitals Seidman Cancer Center at Case Western Reserve University, Cleveland, OH, USADepartment of Radiation Oncology, University Hospitals Seidman Cancer Center at Case Western Reserve University, Cleveland, OH, USADepartment of Radiation Oncology, University Hospitals Seidman Cancer Center at Case Western Reserve University, Cleveland, OH, USADepartment of Radiation Oncology, University Hospitals Seidman Cancer Center at Case Western Reserve University, Cleveland, OH, USAPurpose: Reirradiation in the scalp area can be challenging given the proximity to organs at risk (OARs), such as the eye and brain. Our aim is to evaluate the dosimetric differences of volumetric modulated arc therapy (VMAT) and electron beam therapy (EBT) compared with 3-dimensional proton beam therapy (PBT). Patients and Methods: We evaluated a patient with recurrent angiosarcoma of the left temporal scalp after prior surgical resections and radiation therapy to 60 Gy in 30 fractions who needed reirradiation. We generated VMAT, EBT, and PBT plans using the Pinnacle Treatment Planning System (TPS). Both VMAT and EBT plans used a skin bolus, whereas no bolus was used for the proton plan. Doses to the OARs, including cochlea, eyes, lens, lacrimal glands, optic nerves, optic chiasm, pituitary gland, and underlying brain, were compared. Results: The reirradiation treatment dose was 60 Gy(RBE). Target volume coverage was comparable in all plans. Compared with VMAT and EBT, the PBT plan showed reductions in mean and maximum doses to all OARs. Without the use of protons, several OARs would have exceeded dose tolerance utilizing VMAT or electrons. Dose reduction of up to 100% was achieved for central and contralateral OARs. Conclusion: Compared with VMAT and EBT, PBT resulted in dose reductions to all OARs, while maintaining excellent target coverage. PBT showed a significant advantage in treating superficially located skin cancers, such as angiosarcoma, without the need for a bolus. PBT can be considered in the upfront treatment and certainly in the reirradiation setting.https://theijpt.org/doi/pdf/10.14338/IJPT-19-00074proton beam therapybragg peakangiosarcomaorgan at risk preventionperiorbital tumors |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Tal Eitan Nicholas J. Damico Rajesh Pidikiti Michael Z. Kharouta Donald Dobbins Frederick B. Jesseph Mark Smith Ankit Mangla Theodoros N. Teknos David B. Mansur Mitchell Machtay Min Yao Aashish D. Bhatt |
spellingShingle |
Tal Eitan Nicholas J. Damico Rajesh Pidikiti Michael Z. Kharouta Donald Dobbins Frederick B. Jesseph Mark Smith Ankit Mangla Theodoros N. Teknos David B. Mansur Mitchell Machtay Min Yao Aashish D. Bhatt Reirradiation for Recurrent Scalp Angiosarcoma: Dosimetric Advantage of PBT over VMAT and EBT International Journal of Particle Therapy proton beam therapy bragg peak angiosarcoma organ at risk prevention periorbital tumors |
author_facet |
Tal Eitan Nicholas J. Damico Rajesh Pidikiti Michael Z. Kharouta Donald Dobbins Frederick B. Jesseph Mark Smith Ankit Mangla Theodoros N. Teknos David B. Mansur Mitchell Machtay Min Yao Aashish D. Bhatt |
author_sort |
Tal Eitan |
title |
Reirradiation for Recurrent Scalp Angiosarcoma: Dosimetric Advantage of PBT over VMAT and EBT |
title_short |
Reirradiation for Recurrent Scalp Angiosarcoma: Dosimetric Advantage of PBT over VMAT and EBT |
title_full |
Reirradiation for Recurrent Scalp Angiosarcoma: Dosimetric Advantage of PBT over VMAT and EBT |
title_fullStr |
Reirradiation for Recurrent Scalp Angiosarcoma: Dosimetric Advantage of PBT over VMAT and EBT |
title_full_unstemmed |
Reirradiation for Recurrent Scalp Angiosarcoma: Dosimetric Advantage of PBT over VMAT and EBT |
title_sort |
reirradiation for recurrent scalp angiosarcoma: dosimetric advantage of pbt over vmat and ebt |
publisher |
Particle Therapy Co-operative Group |
series |
International Journal of Particle Therapy |
issn |
2331-5180 |
publishDate |
2020-02-01 |
description |
Purpose: Reirradiation in the scalp area can be challenging given the proximity to organs at risk (OARs), such as the eye and brain. Our aim is to evaluate the dosimetric differences of volumetric modulated arc therapy (VMAT) and electron beam therapy (EBT) compared with 3-dimensional proton beam therapy (PBT).
Patients and Methods: We evaluated a patient with recurrent angiosarcoma of the left temporal scalp after prior surgical resections and radiation therapy to 60 Gy in 30 fractions who needed reirradiation. We generated VMAT, EBT, and PBT plans using the Pinnacle Treatment Planning System (TPS). Both VMAT and EBT plans used a skin bolus, whereas no bolus was used for the proton plan. Doses to the OARs, including cochlea, eyes, lens, lacrimal glands, optic nerves, optic chiasm, pituitary gland, and underlying brain, were compared.
Results: The reirradiation treatment dose was 60 Gy(RBE). Target volume coverage was comparable in all plans. Compared with VMAT and EBT, the PBT plan showed reductions in mean and maximum doses to all OARs. Without the use of protons, several OARs would have exceeded dose tolerance utilizing VMAT or electrons. Dose reduction of up to 100% was achieved for central and contralateral OARs.
Conclusion: Compared with VMAT and EBT, PBT resulted in dose reductions to all OARs, while maintaining excellent target coverage. PBT showed a significant advantage in treating superficially located skin cancers, such as angiosarcoma, without the need for a bolus. PBT can be considered in the upfront treatment and certainly in the reirradiation setting. |
topic |
proton beam therapy bragg peak angiosarcoma organ at risk prevention periorbital tumors |
url |
https://theijpt.org/doi/pdf/10.14338/IJPT-19-00074 |
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