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Dose escalation with proton or photon radiation treatment for pancreatic cancer
Radiotherapy and Oncology, 08/06/09

Bouchard M et al. - In a study to determine the optimal radiation therapy modality (3-dimensional conformal photon-radiation therapy [3DCRT], intensity-modulated photon-radiation therapy [IMRT], or passive-scattering proton therapy [PT]) for safe dose escalation (72 Gy) in pancreatic tumors in different positions relative to organs at risk (OAR) anatomy, it was shown that the optimal radiation therapy modality for safe dose escalation depends on pancreatic tumor position in relation to OAR anatomy.

Methods

A 3-cm pancreatic tumor was virtually translated every 5 mm over 5 cm laterally.
2 plans were generated for each of the 3 techniques (3DCRT, IMRT, and PT), 1 that adhered to target coverage objectives and another to meet OAR sparing constraints with best coverage.
Distances between gross tumor volumes and isodoses were evaluated and dose–volume histograms were compared.

Results

IMRT was more conformal in higher gradient dose regions circumferentially, but tumor positions with anteriorly located small bowel benefited more from PT.
3DCRT plans resulted in inadequate target coverage.
The V15Gy (mean ± SD) were as follows for the IMRT and PT plans, respectively: stomach, 48% ± 4% vs 5% ± 3%; and small bowel, 61% ± 8% vs 9% ± 4%.

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