Comparative In Silico Analysis of Ultra-Hypofractionated Intensity-Modulated Photon Radiotherapy (IMRT) Versus Intensity-Modulated Proton Therapy (IMPT) in the Pre-Operative Treatment of Retroperitoneal Sarcoma

Author:

Gogineni Emile12ORCID,Chen Hao2,Istl Alexandra C.3,Johnston Fabian M.4,Narang Amol2,Deville Curtiland2ORCID

Affiliation:

1. Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA

2. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA

3. Department of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA

4. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA

Abstract

Background: While pre-operative radiation did not improve abdominal recurrence-free survival for retroperitoneal sarcoma (RPS) in the randomized STRASS trial, it did reduce rates of local recurrence. However, the risk of toxicity was substantial and the time to surgery was prolonged. A combination of hypofractionation and proton therapy may reduce delays from the initiation of radiation to surgery and limit the dose to surrounding organs at risk (OARs). We conducted a dosimetric comparison of the pre-operative ultra-hypofractionated intensity-modulated photon (IMRT) and proton radiotherapy (IMPT). Methods: Pre-operative IMRT and IMPT plans were generated on 10 RPS patients. The prescription was 25 Gy radiobiological equivalents (GyEs) (radiobiological effective dose of 1.1) to the clinical target volume and 30 GyEs to the margin at risk, all in five fractions. Comparisons were made using student T-tests. Results: The following endpoints were significantly lower with IMPT than with IMRT: mean doses to liver, bone, and all genitourinary and gastrointestinal OARs; bowel, kidney, and bone V5–V20; stomach V15; liver V5; maximum doses to stomach, spinal canal, and body; and whole-body integral dose. Conclusions: IMPT maintained target coverage while significantly reducing the dose to adjacent OARs and integral dose compared to IMRT. A prospective trial treating RPS with pre-operative ultra-hypofractionated IMPT at our institution is currently being pursued.

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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