Abstract
Proton therapy for cervical esophageal cancer has many issues to be considered, such
as the physiological curvature of the spine and the large range change from the neck
to the trunk. We clarified the dosimetric characteristics of intensity modulated proton
therapy (IMPT) for cervical esophageal cancer by comparing with volumetric modulated
arc therapy (VMAT). Ten patients with cervical esophageal cancer were retrospectively
planned for VMAT, 2-field IMPT (2F-IMPT), and 3-field IMPT (3F-IMPT). All plans were
optimized to reach clinically acceptable levels. For planning target volume (PTV)
coverage, 95% of the PTV should be covered by 95% of the prescription dose, unless
the spinal cord limit is violated. The organs at risk included the lung, spinal cord,
larynx, skin, and whole body. The prescription dose was 60 Gy relative biological
effectiveness (RBE) in 30 fractions to the PTV. We compared the results according
to dose–volume metrics. Significant dose reductions were achieved at lung doses, especially
at low dose volumes of 20 Gy RBE or less in IMPT plans compared with VMAT plans (p < 0.05). Although the spinal cord PRV was below the tolerance level, the results
were also significantly higher in VMAT plans than in IMPT plans (p < 0.001). Spinal cord PRV Dmean was significantly higher in 3F-IMPT than in 2F-IMPT (p < 0.001). In addition, it was confirmed that the integral whole body dose can be
dramatically reduced in IMPT plans compared with VMAT plans. Both of 2F-IMPT and 3F-IMPT
could effectively reduce spinal cord dose, as well as low integral whole body dose
to a certain extent, while maintaining similar target coverage compared to VMAT. IMPT
could be a promising treatment technique for patients with cervical esophageal cancer.
Keywords
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Article info
Publication history
Published online: March 25, 2022
Accepted:
February 25,
2022
Received in revised form:
February 18,
2022
Received:
November 7,
2021
Identification
Copyright
© 2022 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
