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Comparisons of Dose-Volume Histograms for Proton-Beam versus 3-D Conformal X-Ray Therapy in Patients with Stage I Non-Small Cell Lung Cancer

Vergleich von Dosis-Volumen-Histogrammen für Protonenstrahlen versus 3-D konforme Röntgenstrahltherapie bei Patienten mit nichtkleinzelligem Lungenkarzinom im Stadium I

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Purpose:

Dose-volume histograms (DVHs) were reviewed to determine if there is an advantage of the two modalities when treating patients with non-small cell lung cancer (NSCLC).

Patients and Methods:

24 stage I NSCLC patients who underwent proton-beam therapy (PBT) from June 2003 to May 2007 were included in this study. Based on the same clinical target volumes (CTVs), treatment planning was made to cover CTV within 90% isodose lines. Each patient was evaluated by two sets of DVHs, one for PBT and the other for three-dimensional conformal X-ray therapy (3D-CRT).

Results:

For all patients, the 95% isodose line covered 86.4% of the CTV for PBT, and 43.2% for 3D-CRT. PBT was associated with significantly lower mean doses to the ipsilateral lung, total lung, heart, esophagus, and spinal cord than 3D-CRT. PBT offered reduced radiation doses to the lung when evaluated in terms of percentage lung volumes receiving ≥ 5 Gy (V5), ≥ 10 Gy (V10), and ≥ 20 Gy (V20) when compared to 3D-CRT.

Conclusion:

PBT is advantageous over 3D-CRT in reducing doses to the lung, heart, esophagus, and spinal cord in treating stage I NSCLC.

Ziel:

Dosis-Volumen-Histogramme (DVHs) wurden untersucht, um die Vorteile der beiden Modalitäten bei der Behandlung von Patienten mit nichtkleinzelligem Lungenkarzinom (NSCLC) im Stadium I zu ermitteln.

Patienten und Methodik:

Die Studie umfasste 24 Patienten mit NSCLC Stadium I, die im Zeitraum von Juni 2003 bis Mai 2007 mit Protonenstrahltherapie („proton beam therapy“ [PBT]) behandelt wurden. Auf der Basis gleicher klinischer Zielvolumina (CTVs) wurde jeder Patient mit zwei Gruppen von DVHs beurteilt: einer für die PBT und einer für dreidimensionale konforme Röntgenstrahltherapie (3D-CRT).

Ergebnisse:

Bei allen Patienten wurden die CTVs von 90% der Isodosislinien sowohl bei PBT als auch bei 3D-CRT abgedeckt, während 95% der Isodosislinien bei PBT 86,4% und bei 3D-CRT 43,2% der CTVs abdeckten. Die PBT war mit einer signifikant niedrigeren mittleren Strahlendosis für die ipsilaterale Lunge, die gesamte Lunge, das Herz, die Speiseröhre und das Rückenmark assoziiert als die 3D-CRT. Die PBT bot reduzierte Strahlenbelastungen der Lunge, wenn der Prozentsatz des Lungenvolumens bewertet wurde, welches im Vergleich zur 3D-CRT einer Strahlenbelastung von ≥ 5 Gy (V5), ≥ 10 Gy (V10) und ≥ 20 Gy (V20) ausgesetzt war.

Schlussfolgerung:

Die PBT bietet gegenüber der 3D-CRT Vorteile bei der Reduktion der Strahlendosis für die umliegenden Organe und ist die Behandlung der Wahl insbesondere bei in der Nähe des Mediastinums liegenden Tumoren.

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Authors and Affiliations

  1. Proton Medical Research Center, University of Tsukuba, Ibaraki, Japan

    Changlu Wang, Hidetsugu Nakayama MD, PhD, Shinji Sugahara, Takeji Sakae & Koichi Tokuuye

  2. Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai, China

    Changlu Wang

  3. Proton Medical Research Center, University of Tsukuba, 1-1-1 Ten-nou-dai, 305-8576, Tsukuba, Ibaraki, Japan

    Hidetsugu Nakayama MD, PhD

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  1. Changlu Wang
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  2. Hidetsugu Nakayama MD, PhD
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  3. Shinji Sugahara
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  4. Takeji Sakae
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  5. Koichi Tokuuye
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Correspondence to Hidetsugu Nakayama MD, PhD.

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Wang, C., Nakayama, H., Sugahara, S. et al. Comparisons of Dose-Volume Histograms for Proton-Beam versus 3-D Conformal X-Ray Therapy in Patients with Stage I Non-Small Cell Lung Cancer. Strahlenther Onkol 185, 231–234 (2009). https://doi.org/10.1007/s00066-009-1923-x

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  • DOI: https://doi.org/10.1007/s00066-009-1923-x

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