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Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2022 Apr 26. pii: S0167-8140(22)00227-4. doi: 10.1016/j.radonc.2022.04.021

Improving Organs-at-Risk Sparing for Choroidal Melanoma Patients: A CT-based Two-Beam Strategy in Ocular Proton Therapy with a Dedicated Eyeline.

Fleury E¹, Trnková P², van Rij C³, Rodrigues M⁴, Klaver Y⁵, Spruijt K⁶, Naus N⁷, Zolnay A⁸, Pignol JP⁹, Kiliç E¹⁰, Hoogeman MS¹¹

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¹Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands. Electronic address: e.fleury@erasmusmc.nl.
²Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria.
³Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands.
⁴Holland Proton Therapy Center, Delft, The Netherlands.
⁵Holland Proton Therapy Center, Delft, The Netherlands.
⁶Holland Proton Therapy Center, Delft, The Netherlands.
⁷Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands.
⁸Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands.
⁹Dalhousie University, Radiation Oncology, Halifax, Canada.
¹⁰Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands; Erasmus Medical Center, Department of Clinical Genetics, Rotterdam, The Netherlands.
¹¹Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands.

Abstract

PURPOSE: To investigate the potential clinical benefit of a two-beam arrangement technique using three-dimensional (3D) imaging of uveal melanoma (UM) patients treated with proton therapy and a dedicated eyeline.

MATERIAL/METHODS: Retrospective CT-based treatment plans of 39 UM patients performed using a single beam (SB) were compared to plans with two beams (TB) optimized for better trade-offs in organs-at-risk sparing. The RBE-weighted prescribed dose was 60 Gy (D = 60 Gy) in four fractions, assuming an RBE of 1.1. Dosimetric findings were analyzed for three patient groups based on tumor-optic nerve distance and UM staging (group GrA: ≤ 3 mm, T1 T2 UM; GrB: ≤ 3 mm, T3 UM; GrC: > 3 mm, T1 T2 T3 UM). Finally, two schedules were compared on biologically effective dose (BED): both beams being delivered either the same day (TB) or on alternate days (TBalter).

RESULTS: All strategies resulted in dosimetrically acceptable plans. A dose reduction to the anterior structures was achieved in 23/39 cases with the two-beam plans. D was significantly lowered compared to SB plans by 12.4 and 15.4 Gy RBE-weighted median dose in GrA and GrB, respectively. D was reduced by 18.6 and 6.0 Gy RBE-weighted median dose in GrA and GrB, respectively. A cost to the optic nerve was observed with a median difference up to 3.8 Gy RBE-weighted dose in GrB. BED differences were statistically significant for all considered parameters in favor of two beams delivered the same day.

CONCLUSION: A two-beam strategy appears beneficial for posterior tumors abutting the optic nerve. This strategy might have a positive impact on the risk of ocular complications.

KEYWORDS: Uveal melanoma, eyeline, imaging-based, multi-beam, proton therapy

Publikations ID: 35487435
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