Multifield Optimization Intensity Modulated Proton Therapy for Head and Neck Tumors: A Translation to Practice
Background We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2014-07, Vol.89 (4), p.846-853 |
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| creator | Frank, Steven J., MD Cox, James D., MD Gillin, Michael, PhD Mohan, Radhe, PhD Garden, Adam S., MD Rosenthal, David I., MD Gunn, G. Brandon, MD Weber, Randal S., MD Kies, Merrill S., MD Lewin, Jan S., PhD Munsell, Mark F., MS Palmer, Matthew B., BS Sahoo, Narayan, PhD Zhang, Xiaodong, PhD Liu, Wei, PhD Zhu, X. Ronald, PhD |
| description | Background We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment “spot by spot” and “layer by layer.” Results Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials. |
| doi_str_mv | 10.1016/j.ijrobp.2014.04.019 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_osti_</sourceid><recordid>TN_cdi_osti_scitechconnect_22420371</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0360301614004908</els_id><sourcerecordid>24867532</sourcerecordid><originalsourceid>FETCH-LOGICAL-c627t-d33eff8af98c6a6ed27d5a595cddc50cdb99c0cd184c4d3dfa7ddbbfebf401fd3</originalsourceid><addsrcrecordid>eNqFkV1rFTEQhoMo9lj9ByIBr_eYr_3yQihFbaG1gkfwLmSTCc12T7Ik2cLx15tl1QtvhIG5yPO-mXkHodeU7Cmhzbtx78YYhnnPCBV7Uor2T9COdm1f8br-8RTtCG9IxQt8hl6kNBJCKG3Fc3TGRNe0NWc75G-XKTvrYDL4bs7u6H6q7ILH1z6DTy6f8G0wy6QyGPw1hlyeDvcQ1XzCNkR8Bcpg5Q3-AvoBH5ZjiOk9vsCHqHyaNqscilLp7DS8RM-smhK8-t3P0fdPHw-XV9XN3efry4ubSjeszZXhHKztlO073agGDGtNreq-1sbommgz9L0ujXZCC8ONVa0xw2BhsIJQa_g5erv5hpSdTNpl0Pc6eA86S8YEI7ylhRIbpWNIKYKVc3RHFU-SErmGLEe5hSzXkCUpRfsie7PJ5mU4gvkr-pNqAT5sAJQVHx3EdQLwGoyL6wAmuP_98K-Bnpx3Wk0PcII0hiX6Ep-kMjFJ5Lf10OudqSBE9KTjvwB7ladz</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Multifield Optimization Intensity Modulated Proton Therapy for Head and Neck Tumors: A Translation to Practice</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Frank, Steven J., MD ; Cox, James D., MD ; Gillin, Michael, PhD ; Mohan, Radhe, PhD ; Garden, Adam S., MD ; Rosenthal, David I., MD ; Gunn, G. Brandon, MD ; Weber, Randal S., MD ; Kies, Merrill S., MD ; Lewin, Jan S., PhD ; Munsell, Mark F., MS ; Palmer, Matthew B., BS ; Sahoo, Narayan, PhD ; Zhang, Xiaodong, PhD ; Liu, Wei, PhD ; Zhu, X. Ronald, PhD</creator><creatorcontrib>Frank, Steven J., MD ; Cox, James D., MD ; Gillin, Michael, PhD ; Mohan, Radhe, PhD ; Garden, Adam S., MD ; Rosenthal, David I., MD ; Gunn, G. Brandon, MD ; Weber, Randal S., MD ; Kies, Merrill S., MD ; Lewin, Jan S., PhD ; Munsell, Mark F., MS ; Palmer, Matthew B., BS ; Sahoo, Narayan, PhD ; Zhang, Xiaodong, PhD ; Liu, Wei, PhD ; Zhu, X. Ronald, PhD</creatorcontrib><description>Background We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment “spot by spot” and “layer by layer.” Results Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2014.04.019</identifier><identifier>PMID: 24867532</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Carcinoma, Adenoid Cystic - drug therapy ; Carcinoma, Adenoid Cystic - radiotherapy ; Carcinoma, Squamous Cell - drug therapy ; Carcinoma, Squamous Cell - radiotherapy ; CARCINOMAS ; Chemoradiotherapy ; CLINICAL TRIALS ; Female ; Follow-Up Studies ; HEAD ; Head and Neck Neoplasms - drug therapy ; Head and Neck Neoplasms - radiotherapy ; Hematology, Oncology and Palliative Medicine ; Humans ; Male ; MEV RANGE 10-100 ; MEV RANGE 100-1000 ; Middle Aged ; Nasopharyngeal Neoplasms - drug therapy ; Nasopharyngeal Neoplasms - radiotherapy ; NECK ; OPTIMIZATION ; Oropharyngeal Neoplasms - drug therapy ; Oropharyngeal Neoplasms - radiotherapy ; PATIENTS ; Pilot Projects ; PLANNING ; PROTON BEAMS ; Proton Therapy - adverse effects ; Proton Therapy - methods ; Quality Assurance, Health Care ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy Setup Errors ; Radiotherapy, Intensity-Modulated - adverse effects ; Radiotherapy, Intensity-Modulated - methods ; SKULL ; Stomatitis - etiology ; Tongue Neoplasms - drug therapy ; Tongue Neoplasms - radiotherapy ; TOXICITY ; Uncertainty ; Xerostomia - etiology</subject><ispartof>International journal of radiation oncology, biology, physics, 2014-07, Vol.89 (4), p.846-853</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c627t-d33eff8af98c6a6ed27d5a595cddc50cdb99c0cd184c4d3dfa7ddbbfebf401fd3</citedby><cites>FETCH-LOGICAL-c627t-d33eff8af98c6a6ed27d5a595cddc50cdb99c0cd184c4d3dfa7ddbbfebf401fd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0360301614004908$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24867532$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22420371$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Frank, Steven J., MD</creatorcontrib><creatorcontrib>Cox, James D., MD</creatorcontrib><creatorcontrib>Gillin, Michael, PhD</creatorcontrib><creatorcontrib>Mohan, Radhe, PhD</creatorcontrib><creatorcontrib>Garden, Adam S., MD</creatorcontrib><creatorcontrib>Rosenthal, David I., MD</creatorcontrib><creatorcontrib>Gunn, G. Brandon, MD</creatorcontrib><creatorcontrib>Weber, Randal S., MD</creatorcontrib><creatorcontrib>Kies, Merrill S., MD</creatorcontrib><creatorcontrib>Lewin, Jan S., PhD</creatorcontrib><creatorcontrib>Munsell, Mark F., MS</creatorcontrib><creatorcontrib>Palmer, Matthew B., BS</creatorcontrib><creatorcontrib>Sahoo, Narayan, PhD</creatorcontrib><creatorcontrib>Zhang, Xiaodong, PhD</creatorcontrib><creatorcontrib>Liu, Wei, PhD</creatorcontrib><creatorcontrib>Zhu, X. Ronald, PhD</creatorcontrib><title>Multifield Optimization Intensity Modulated Proton Therapy for Head and Neck Tumors: A Translation to Practice</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Background We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment “spot by spot” and “layer by layer.” Results Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.</description><subject>Adult</subject><subject>Aged</subject><subject>Carcinoma, Adenoid Cystic - drug therapy</subject><subject>Carcinoma, Adenoid Cystic - radiotherapy</subject><subject>Carcinoma, Squamous Cell - drug therapy</subject><subject>Carcinoma, Squamous Cell - radiotherapy</subject><subject>CARCINOMAS</subject><subject>Chemoradiotherapy</subject><subject>CLINICAL TRIALS</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>HEAD</subject><subject>Head and Neck Neoplasms - drug therapy</subject><subject>Head and Neck Neoplasms - radiotherapy</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Male</subject><subject>MEV RANGE 10-100</subject><subject>MEV RANGE 100-1000</subject><subject>Middle Aged</subject><subject>Nasopharyngeal Neoplasms - drug therapy</subject><subject>Nasopharyngeal Neoplasms - radiotherapy</subject><subject>NECK</subject><subject>OPTIMIZATION</subject><subject>Oropharyngeal Neoplasms - drug therapy</subject><subject>Oropharyngeal Neoplasms - radiotherapy</subject><subject>PATIENTS</subject><subject>Pilot Projects</subject><subject>PLANNING</subject><subject>PROTON BEAMS</subject><subject>Proton Therapy - adverse effects</subject><subject>Proton Therapy - methods</subject><subject>Quality Assurance, Health Care</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy Dosage</subject><subject>Radiotherapy Planning, Computer-Assisted</subject><subject>Radiotherapy Setup Errors</subject><subject>Radiotherapy, Intensity-Modulated - adverse effects</subject><subject>Radiotherapy, Intensity-Modulated - methods</subject><subject>SKULL</subject><subject>Stomatitis - etiology</subject><subject>Tongue Neoplasms - drug therapy</subject><subject>Tongue Neoplasms - radiotherapy</subject><subject>TOXICITY</subject><subject>Uncertainty</subject><subject>Xerostomia - etiology</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkV1rFTEQhoMo9lj9ByIBr_eYr_3yQihFbaG1gkfwLmSTCc12T7Ik2cLx15tl1QtvhIG5yPO-mXkHodeU7Cmhzbtx78YYhnnPCBV7Uor2T9COdm1f8br-8RTtCG9IxQt8hl6kNBJCKG3Fc3TGRNe0NWc75G-XKTvrYDL4bs7u6H6q7ILH1z6DTy6f8G0wy6QyGPw1hlyeDvcQ1XzCNkR8Bcpg5Q3-AvoBH5ZjiOk9vsCHqHyaNqscilLp7DS8RM-smhK8-t3P0fdPHw-XV9XN3efry4ubSjeszZXhHKztlO073agGDGtNreq-1sbommgz9L0ujXZCC8ONVa0xw2BhsIJQa_g5erv5hpSdTNpl0Pc6eA86S8YEI7ylhRIbpWNIKYKVc3RHFU-SErmGLEe5hSzXkCUpRfsie7PJ5mU4gvkr-pNqAT5sAJQVHx3EdQLwGoyL6wAmuP_98K-Bnpx3Wk0PcII0hiX6Ep-kMjFJ5Lf10OudqSBE9KTjvwB7ladz</recordid><startdate>20140715</startdate><enddate>20140715</enddate><creator>Frank, Steven J., MD</creator><creator>Cox, James D., MD</creator><creator>Gillin, Michael, PhD</creator><creator>Mohan, Radhe, PhD</creator><creator>Garden, Adam S., MD</creator><creator>Rosenthal, David I., MD</creator><creator>Gunn, G. Brandon, MD</creator><creator>Weber, Randal S., MD</creator><creator>Kies, Merrill S., MD</creator><creator>Lewin, Jan S., PhD</creator><creator>Munsell, Mark F., MS</creator><creator>Palmer, Matthew B., BS</creator><creator>Sahoo, Narayan, PhD</creator><creator>Zhang, Xiaodong, PhD</creator><creator>Liu, Wei, PhD</creator><creator>Zhu, X. Ronald, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>OTOTI</scope></search><sort><creationdate>20140715</creationdate><title>Multifield Optimization Intensity Modulated Proton Therapy for Head and Neck Tumors: A Translation to Practice</title><author>Frank, Steven J., MD ; Cox, James D., MD ; Gillin, Michael, PhD ; Mohan, Radhe, PhD ; Garden, Adam S., MD ; Rosenthal, David I., MD ; Gunn, G. Brandon, MD ; Weber, Randal S., MD ; Kies, Merrill S., MD ; Lewin, Jan S., PhD ; Munsell, Mark F., MS ; Palmer, Matthew B., BS ; Sahoo, Narayan, PhD ; Zhang, Xiaodong, PhD ; Liu, Wei, PhD ; Zhu, X. Ronald, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c627t-d33eff8af98c6a6ed27d5a595cddc50cdb99c0cd184c4d3dfa7ddbbfebf401fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Carcinoma, Adenoid Cystic - drug therapy</topic><topic>Carcinoma, Adenoid Cystic - radiotherapy</topic><topic>Carcinoma, Squamous Cell - drug therapy</topic><topic>Carcinoma, Squamous Cell - radiotherapy</topic><topic>CARCINOMAS</topic><topic>Chemoradiotherapy</topic><topic>CLINICAL TRIALS</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>HEAD</topic><topic>Head and Neck Neoplasms - drug therapy</topic><topic>Head and Neck Neoplasms - radiotherapy</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Male</topic><topic>MEV RANGE 10-100</topic><topic>MEV RANGE 100-1000</topic><topic>Middle Aged</topic><topic>Nasopharyngeal Neoplasms - drug therapy</topic><topic>Nasopharyngeal Neoplasms - radiotherapy</topic><topic>NECK</topic><topic>OPTIMIZATION</topic><topic>Oropharyngeal Neoplasms - drug therapy</topic><topic>Oropharyngeal Neoplasms - radiotherapy</topic><topic>PATIENTS</topic><topic>Pilot Projects</topic><topic>PLANNING</topic><topic>PROTON BEAMS</topic><topic>Proton Therapy - adverse effects</topic><topic>Proton Therapy - methods</topic><topic>Quality Assurance, Health Care</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy Dosage</topic><topic>Radiotherapy Planning, Computer-Assisted</topic><topic>Radiotherapy Setup Errors</topic><topic>Radiotherapy, Intensity-Modulated - adverse effects</topic><topic>Radiotherapy, Intensity-Modulated - methods</topic><topic>SKULL</topic><topic>Stomatitis - etiology</topic><topic>Tongue Neoplasms - drug therapy</topic><topic>Tongue Neoplasms - radiotherapy</topic><topic>TOXICITY</topic><topic>Uncertainty</topic><topic>Xerostomia - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Frank, Steven J., MD</creatorcontrib><creatorcontrib>Cox, James D., MD</creatorcontrib><creatorcontrib>Gillin, Michael, PhD</creatorcontrib><creatorcontrib>Mohan, Radhe, PhD</creatorcontrib><creatorcontrib>Garden, Adam S., MD</creatorcontrib><creatorcontrib>Rosenthal, David I., MD</creatorcontrib><creatorcontrib>Gunn, G. Brandon, MD</creatorcontrib><creatorcontrib>Weber, Randal S., MD</creatorcontrib><creatorcontrib>Kies, Merrill S., MD</creatorcontrib><creatorcontrib>Lewin, Jan S., PhD</creatorcontrib><creatorcontrib>Munsell, Mark F., MS</creatorcontrib><creatorcontrib>Palmer, Matthew B., BS</creatorcontrib><creatorcontrib>Sahoo, Narayan, PhD</creatorcontrib><creatorcontrib>Zhang, Xiaodong, PhD</creatorcontrib><creatorcontrib>Liu, Wei, PhD</creatorcontrib><creatorcontrib>Zhu, X. Ronald, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Frank, Steven J., MD</au><au>Cox, James D., MD</au><au>Gillin, Michael, PhD</au><au>Mohan, Radhe, PhD</au><au>Garden, Adam S., MD</au><au>Rosenthal, David I., MD</au><au>Gunn, G. Brandon, MD</au><au>Weber, Randal S., MD</au><au>Kies, Merrill S., MD</au><au>Lewin, Jan S., PhD</au><au>Munsell, Mark F., MS</au><au>Palmer, Matthew B., BS</au><au>Sahoo, Narayan, PhD</au><au>Zhang, Xiaodong, PhD</au><au>Liu, Wei, PhD</au><au>Zhu, X. Ronald, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multifield Optimization Intensity Modulated Proton Therapy for Head and Neck Tumors: A Translation to Practice</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2014-07-15</date><risdate>2014</risdate><volume>89</volume><issue>4</issue><spage>846</spage><epage>853</epage><pages>846-853</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Background We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment “spot by spot” and “layer by layer.” Results Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24867532</pmid><doi>10.1016/j.ijrobp.2014.04.019</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0360-3016 |
| ispartof | International journal of radiation oncology, biology, physics, 2014-07, Vol.89 (4), p.846-853 |
| issn | 0360-3016 1879-355X |
| language | eng |
| recordid | cdi_osti_scitechconnect_22420371 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adult Aged Carcinoma, Adenoid Cystic - drug therapy Carcinoma, Adenoid Cystic - radiotherapy Carcinoma, Squamous Cell - drug therapy Carcinoma, Squamous Cell - radiotherapy CARCINOMAS Chemoradiotherapy CLINICAL TRIALS Female Follow-Up Studies HEAD Head and Neck Neoplasms - drug therapy Head and Neck Neoplasms - radiotherapy Hematology, Oncology and Palliative Medicine Humans Male MEV RANGE 10-100 MEV RANGE 100-1000 Middle Aged Nasopharyngeal Neoplasms - drug therapy Nasopharyngeal Neoplasms - radiotherapy NECK OPTIMIZATION Oropharyngeal Neoplasms - drug therapy Oropharyngeal Neoplasms - radiotherapy PATIENTS Pilot Projects PLANNING PROTON BEAMS Proton Therapy - adverse effects Proton Therapy - methods Quality Assurance, Health Care Radiology RADIOLOGY AND NUCLEAR MEDICINE RADIOTHERAPY Radiotherapy Dosage Radiotherapy Planning, Computer-Assisted Radiotherapy Setup Errors Radiotherapy, Intensity-Modulated - adverse effects Radiotherapy, Intensity-Modulated - methods SKULL Stomatitis - etiology Tongue Neoplasms - drug therapy Tongue Neoplasms - radiotherapy TOXICITY Uncertainty Xerostomia - etiology |
| title | Multifield Optimization Intensity Modulated Proton Therapy for Head and Neck Tumors: A Translation to Practice |
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