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Volumetric modulated arc therapy versus intensity-modulated proton therapy in the postoperative irradiation of thymoma

  • Original Article – Cancer Research
  • Published:
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Abstract

Background

To investigate the role of intensity-modulated proton therapy (IMPT) compared to volumetric modulated arc therapy (VMAT) for the radiation treatment of thymoma cancer.

Methods

Twenty patients were retrospectively planned for IMPT [with (IMPT_R1 or IMPT_R2 according to the approach adopted) and without robust optimization] and VMAT. The results were compared according to dose-volume metrics on the clinical and planning target volumes (CTV and PTV) and the main organs at risk (heart, breasts, lungs, spinal cord and oesophagus). Estimates of the excess absolute risk (EAR) of secondary cancer induction were determined for the oesophagus, the breasts and the composite lungs. For the heart, the relative risk (RR) of chronic heart failure (CHF) was assessed.

Results

IMPT and VMAT plans resulted equivalent in terms of target coverage for both the CTV and the PTV. The CTV homogeneity index resulted in 0.03 ± 0.01 and 0.04 ± 0.01 for VMAT and all IMPT plans, respectively. The conformality index resulted in 1.1 ± 0.1 and 1.2 ± 0.1 for VMAT and all IMPT plans. The mean dose to the breasts resulted in 10.5 ± 5.0, 4.5 ± 3.4, 4.7 ± 3.5 and 4.6 ± 3.4 Gy for VMAT, IMPT, IMPT_R1 and IMPT_R2. For the lungs, the mean dose was 9.6 ± 2.3, 3.5 ± 1.5, 3.6 ± 1.6 and 3.8 ± 1.4 Gy; for the heart: 8.7 ± 4.4, 4.3 ± 1.9, 4.5 ± 2.0 and 4.4 ± 2.4 Gy and for the oesophagus 8.2 ± 3.5, 2.2 ± 3.4, 2.4 ± 3.6 and 2.5 ± 3.5 Gy. The RR for CHF was 1.6 ± 0.3 for VMAT and 1.3 ± 0.2 for IMPT (R1 or R2). The EAR was 3.6 ± 0.v vs 1.0 ± 0.6 or 1.2 ± 0.6 (excess cases/10,000 patients year) for the oesophagus; 17.4 ± 6.5 vs 5.7 ± 3.2 or 6.1 ± 3.8 for the breasts and 24.8 ± 4.3 vs 8.1 ± 2.7 or 8.7 ± 2.3 for the composite lungs for VMAT and IMPT_R, respectively.

Conclusion

The data from this in-silico study suggest that intensity-modulated proton therapy could be significantly advantageous in the treatment of thymoma patients with particular emphasis to a substantial reduction of the risk of cardiac failure and secondary cancer induction. Robust planning is a technical pre-requisite for the safety of the delivery.

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Authors and Affiliations

  1. Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan, Rozzano, Italy

    Davide Franceschini, Luca Cozzi, Mauro Loi, Ciro Franzese, Giacomo Reggiori, Pietro Mancosu, Antonella Fogliata & Marta Scorsetti

  2. Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy

    Luca Cozzi & Marta Scorsetti

  3. Zentrum für Radiotherapie, Rüti, Switzerland

    Alessandro Clivio

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  1. Davide Franceschini
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  2. Luca Cozzi
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  3. Mauro Loi
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  4. Ciro Franzese
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  5. Giacomo Reggiori
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Correspondence to Luca Cozzi.

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Conflict of interest

L. Cozzi acts as Scientific Advisor to Varian Medical Systems and is Clinical Research Scientist at Humanitas Cancer Center. All other co-authors declare that they have no conflict interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Humanitas research hospital ethical committee approved by notification this retrospective study (study 10.20).

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Informed consent was obtained from all individual participants included in the study.

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Franceschini, D., Cozzi, L., Loi, M. et al. Volumetric modulated arc therapy versus intensity-modulated proton therapy in the postoperative irradiation of thymoma. J Cancer Res Clin Oncol 146, 2267–2276 (2020). https://doi.org/10.1007/s00432-020-03281-z

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  • DOI: https://doi.org/10.1007/s00432-020-03281-z

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