| Chen Jian,Ma Ningyi,Lu Yan,Kambiz Shahnazi,Zhao Jingfang,Lu Jiade,Jiang Guoliang,Mao Jingfang.Dosimetric comparison study and short-term clinical outcomes of proton and carbon ion radiotherapy for thymic malignancies[J].Chinese Journal of Radiological Medicine and Protection,2020,40(3):221-226 |
| Dosimetric comparison study and short-term clinical outcomes of proton and carbon ion radiotherapy for thymic malignancies |
| Received:April 11, 2019 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.03.011 |
| KeyWords:Thymic malignancies Proton Carbon ion Radiotherapy Pencil beam scanning |
| FundProject:上海市"科技创新行动计划"医学和农业领域科技支撑项目（15411950100）；上海市自然科学基金项目（16ZR1433600、18ZR1436300）；上海市卫生和计划生育委员会项目（201840155） |
| Author Name | Affiliation | E-mail | | Chen Jian | Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 201315 | | | Ma Ningyi | Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 201315 | | | Lu Yan | Department of Medical Physics, Shanghai Proton and Heavy Ion Center
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 201315 | | | Kambiz Shahnazi | Department of Medical Physics, Shanghai Proton and Heavy Ion Center
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 201315 | | | Zhao Jingfang | Department of Medical Physics, Shanghai Proton and Heavy Ion Center
Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 201315 | | | Lu Jiade | Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 201315 | | | Jiang Guoliang | Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center
Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 201315 | | | Mao Jingfang | Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center
Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, 201315 | jingfang.mao@sphic.org.cn |
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| Abstract:: |
| Objective To compare dose distributions between photon versus proton and carbon ion radiotherapy (particle therapy, PT) among patients with gross tumors, and to evaluate the safety and efficacy of PT for thymic malignancies (TM). Methods From Sept 2015 to Aug 2018, 19 patients with TM who underwent non-palliative PT using pencil beam scanning technique in our hospital and had at least one follow-up were retrospectively analyzed. Diseases staged from Ⅰ-ⅣB including 15 Ⅲ-ⅣB. All the patients had pathological diagnosis with 10 thymomas, 6 carcinomas and 3 neuroendocrine tumors of the thymus. A set of dosimetric comparisons were conducted in patients with gross tumors at a total dose of 66 GyE, in 33 fractions for photon or proton beams and in 22 fractions for carbon ion beams. Five patients without any local treatment and 7 patients after R2 resection received radical radiotherapy of proton 44.0-48.4 GyE in 20-22 fractions plus carbon ion 21.0-23.1 GyE in 7 fractions, 1 case after complete resection (R0 resection) had proton 45 GyE in 25 fractions, 5 cases after R1 resection had proton 60.0-61.6 GyE in 28-30 fractions and 1 case of recurrence after postoperative radiotherapy had only carbon ion 60 GyE in 20 fractions. Results The median follow up time was 19.0 (2.4-42.9) months. There were 13 patients with gross tumors, with a median largest diameter of 5.7 (2.7-12.8) cm. The dosimetric study showed that proton and carbon-ion plans significantly reduced the maximum dose to the spinal cord, the mean doses to the organs at risk (OARs) including the lung/heart/esophagus, and the integral dose of the exposed area about 25%-65% compared to photon plans. No other toxicities ≥ grade 3 were observed except one myocardial infarction (grade 4 late toxicity). There was no local failure observed. Metastasis to regional lymph node, lung, pleura, skull base, bone or liver occurred in 4 patients with Ⅲ-ⅣB stage disease in 6.1-22.8 months after treatment. The 2-year local control and overall survival rates were 100%, disease free survival and distant metastasis free survival rates were 64.6%. Conclusions For TMs, PT has significant advantages over photon in terms of sparing OARs, and is safe and effective in patients with TMs after short-time follow-up. |
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