Top

Journal of Cancer Research and Clinical Oncology

Published in:

01-09-2020 | Thymoma | Original Article – Cancer Research

Volumetric modulated arc therapy versus intensity-modulated proton therapy in the postoperative irradiation of thymoma

Authors: Davide Franceschini, Luca Cozzi, Mauro Loi, Ciro Franzese, Giacomo Reggiori, Pietro Mancosu, Alessandro Clivio, Antonella Fogliata, Marta Scorsetti

Published in: Journal of Cancer Research and Clinical Oncology | Issue 9/2020

Abstract

Background

To investigate the role of intensity-modulated proton therapy (IMPT) compared to volumetric modulated arc therapy (VMAT) for the radiation treatment of thymoma cancer.

Methods

Twenty patients were retrospectively planned for IMPT [with (IMPT_R1 or IMPT_R2 according to the approach adopted) and without robust optimization] and VMAT. The results were compared according to dose-volume metrics on the clinical and planning target volumes (CTV and PTV) and the main organs at risk (heart, breasts, lungs, spinal cord and oesophagus). Estimates of the excess absolute risk (EAR) of secondary cancer induction were determined for the oesophagus, the breasts and the composite lungs. For the heart, the relative risk (RR) of chronic heart failure (CHF) was assessed.

Results

IMPT and VMAT plans resulted equivalent in terms of target coverage for both the CTV and the PTV. The CTV homogeneity index resulted in 0.03 ± 0.01 and 0.04 ± 0.01 for VMAT and all IMPT plans, respectively. The conformality index resulted in 1.1 ± 0.1 and 1.2 ± 0.1 for VMAT and all IMPT plans. The mean dose to the breasts resulted in 10.5 ± 5.0, 4.5 ± 3.4, 4.7 ± 3.5 and 4.6 ± 3.4 Gy for VMAT, IMPT, IMPT_R1 and IMPT_R2. For the lungs, the mean dose was 9.6 ± 2.3, 3.5 ± 1.5, 3.6 ± 1.6 and 3.8 ± 1.4 Gy; for the heart: 8.7 ± 4.4, 4.3 ± 1.9, 4.5 ± 2.0 and 4.4 ± 2.4 Gy and for the oesophagus 8.2 ± 3.5, 2.2 ± 3.4, 2.4 ± 3.6 and 2.5 ± 3.5 Gy. The RR for CHF was 1.6 ± 0.3 for VMAT and 1.3 ± 0.2 for IMPT (R1 or R2). The EAR was 3.6 ± 0.v vs 1.0 ± 0.6 or 1.2 ± 0.6 (excess cases/10,000 patients year) for the oesophagus; 17.4 ± 6.5 vs 5.7 ± 3.2 or 6.1 ± 3.8 for the breasts and 24.8 ± 4.3 vs 8.1 ± 2.7 or 8.7 ± 2.3 for the composite lungs for VMAT and IMPT_R, respectively.

Conclusion

The data from this in-silico study suggest that intensity-modulated proton therapy could be significantly advantageous in the treatment of thymoma patients with particular emphasis to a substantial reduction of the risk of cardiac failure and secondary cancer induction. Robust planning is a technical pre-requisite for the safety of the delivery.

AA.VV (2010) Prescribing recording and reporting photon beam intensity modulated radiation therapy (IMRT), vol 10, issue 1. ICRU Report 83

Ahmad U, Yao X, Detterbeck F, Huang J, Antonicalli A, Filosso P et al (2015) Thymic carcinoma outcomes and prognosis: results of an international analysis. J Thorac Cardiovasc Surg 149:95–100PubMed

Björk-Eriksson T, Bjelkengren G, Glimelius B (2005) The potentials of proton beam radiation therapy in malignant lymphoma, thymoma and sarcoma. Acta Oncol 44:913–917PubMed

Darby S, Ewertz M, McGale P, Bennet A, Blom-Goldman U, Brønnum D et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368:987–998PubMed

Detterbeck F, Youssed S, Ruffini E, Okumura M (2011) A review of prognostic factors in thymic malignancies. J Thorac Oncol 6:S1698–S1704PubMed

Engels A (2010) Epidemiology of thymoma and associated malignancies. J Thorac Oncol 5:S260–S265PubMedPubMedCentral

Feng M, Moran JM, Koelling T et al (2011) Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys 79:10–18PubMed

Fracchiolla F, Dionisi F, Giacomelli I, Hild S, Esposito P, Lorenzini S et al (2019) Implementation of proton therapy treatments with pencil beam scanning of targets with limited intrafraction motion. Phys Med 57:215–220PubMed

Giannopoulou A, Gkiozos I, Harrington K, Syrigos K (2013) Thymoma and radiation therapy: a systematic review of medical treatment. Expert Rev Anticancer Ther 13:759–766PubMed

Girard N, Mornex F (2011) The role of radiotherapy in the management of thymic tumors. Thorac Surg Clin 21:99–105PubMed

Girard N, Ruffini E, Marz A, Faivre-Finn C, Peters S (2015) ESMO guidelines committee. Thymic epithelial tumours: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26:v40–v55PubMed

Gomez D, Komaki R (2010) Technical advances of radiation therapy for thymic malignancies. J Thorac Oncol 5:S336–S343PubMed

Gomez D, Komaki R, Yu J, Ikushima H, Bezjak A (2011) Radiation therapy definitions and reporting guidelines for thymic malignancies. J Thorac Oncol 6:S1743–S1748PubMed

Haefner M, Verma V, Bougatf N, Mielke T, Tonndorf-Martini E, König L et al (2018) Dosimetric comparison of advanced radiotherapy approaches using photon techniques and particle therapy in the postoperative management of thymoma. Acta Oncol 57:1713–1720PubMed

Hishida T, Nomura S, Yano M, Asamura H, Yamashita M et al (2016) Long term outcome and prognostic factors of surgically treated thymic carcinoma: results of 306 cases from a Japanese nationwide database study. Eur J Cardiothorac Surg 49:835–841PubMed

Imbimbo M, Ottaviano M, Vitali M, Fabbri A, Leuzzi G, Fiore M et al (2018) Best practices for the management of thymic epithelial tumors: a position paper by the Italian collaborative group for thymic malignancies (TYME). Cancer Treat Rev 71:76–87PubMed

Jackson M, Palma D, Camidge D, Jones B, Robin T, Sher D et al (2017) The impact of postoperative radiotherapy for thymoma and thymic carcinoma. J Thorac Oncol 12:734–744PubMed

Jones B (2017) Proton radiobiology and its clinical implications. Ecancer 11:777

Komaki R, Gomez D (2014) Radiotherapy for thymic carcinoma: adjuvant, inductive, and definitive. Front Oncol 3:330PubMedPubMedCentral

Korst R, Kansler A, Christos P, Mandal S (2009) Adjuvant radiotherapy for thymic epithelial tumors: a systematic review and meta analysis. Ann Thorac Surg 87:1641–1647PubMed

Kumar V, Gark M, Goyal A, Chaudhari N, Soni P et al (2018) Changing pattern of secondary cancers among patients with malignant thymoma in the USA. Future Oncol 14:1943–1951PubMed

Levis M, Filippi A, Fiandra C, De Luca V, Bartoncini S, Vella D et al (2019) Inclusion of heart substructures in the optimization process of volumetric modulated arc therapy techniques may reduce the risk of heart disease in Hodgkin’s lymphoma patients. Radiother Oncol 138:52–58PubMed

Li Y, Niemela P, Liao L, Jiang S, Li H, Poenish F et al (2015) Selective robust optimization: a new intensity-modulated proton therapy optimization strategy. Med Phys 42:4840–4847PubMed

Liao J, Liu T, Zhang H, Cai F, Chen J, Dang J (2018) The role of postoperative radiation therapy for completely resected stage III thymoma and effect of higher heart radiation dose on risk of cardiovascular disease: a retrospective cohort study. Int J Surg 53:345–349PubMed

Lim Y, Kim E, Kim H, Wu H, Yan J, Liu Q, Patel S (2016) Survival impact of adjuvant radiation therapy in Masaoka stage II to IV thymomas: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys 94:1129–1136PubMed

Liu W, Zhang X, Li Y, Mohan R (2012) Robust optimization of intensity modulated proton therapy. Med Phys 39:1079–1091PubMedPubMedCentral

Maggi G, Casadio C, Cavallo A, Cianci R, Molinatti M, Ruffini E (1991) Thymoma: results of 241 operated cases. Ann Thorac Surg 51:152–156PubMed

McNamara A, Willers H, Paganeti H (2020) Modelling variable proton relative biological effectiveness for treatment planning. Br J Radiol 93:20190334

Mercado C, Hartsell W, Simone C, Tsai H, Vargas C, Zhu H et al (2019) Proton therapy for thymic malignancies: multi-institutional patterns-of-care and early clinical outcomes from the proton collaborative group and the University of Florida prospective registries. Acta Oncol 58:1036–1040PubMed

Pan C, Chen P, Wang L, Chi K, Chiang H (2001) Thymoma is associated with an increased risk of second malignancy. Cancer 92:2406–2411PubMed

Parikh R, Rhome R, Hug E, Tsai H, Cahlon O, Chon B et al (2016) Adjuvant proton beam therapy in the management of thymoma: a dosimetric comparison and acute toxicities. Clin Lung Cancer 17:362–366PubMed

Preston D, Ron E, Tokuoka S, Funamoto S, Nishi N, Soda M et al (2007) Solid cancer incidence in atomic bomb survivors: 1958–1998. Radiat Res 168:1–64PubMed

Ruffini E, Mancuso M, Oliaro A, Casadio C, Cavallo A, Cianci R et al (1997) Recurrence of thymoma: analysis of clinicopathologic features, treatment and outcome. J Thorac Cardiovasc Surg 113:55–63PubMed

Schneider U, Sumila M, Robotka J (2011a) Site-specific dose–response relationships for cancer induction from the combined Japanese A-bomb and Hodgkin cohorts for doses relevant to radiotherapy. Theor Biol Med Mod 8:27

Schneider U, Sumila M, Robotka J, Gruber G, Mack A, Besserer J (2011b) Dose–response relationship for breast cancer induction at radiotherapy dose. Radiat Oncol 6:67PubMedPubMedCentral

Siesling S, van de Zwan J, Izarzugaza I, Jaal J, Treasure T et al (2012) Rare thoracic cancers, including peritoneum mesothelioma. Eur J Cancer 48:949–960PubMed

Song Z, Zhang Y (2014) Outcomes after surgical resection of thymic carcinoma: a study from a single tertiary referral center. Eur J Rug Oncol 40:1523–1527

Travis L, Boice J, Travis W (2003) Second primary cancers after thymoma. Int J Cancer 107:869–870

van Nimwegen F, Schaapveld M, Cutter D, Janus C, Krol A, Hauptmann M et al (2016) Radiation dose–response relationship for risk of coronary heart disease in survivors of Hodgkin lymphoma. J Clin Oncol 34:235–243PubMed

van Nimwegen F, Ntentas G, Darby S, Schaapveld M, Hauptmann M, Lugtenburg P et al (2018) Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines. Blood 129:2257–2265

Vogel J, Berman A, Lin L, Pechet T, Levin W, Gabriel P et al (2016) Prospective study of proton beam radiation therapy for adjuvant and definitive treatment of thymoma and thymic carcinoma: early response and toxicity assessment. Radiother Oncol 118:504–509PubMed

Vogel J, Lin L, Litzky L, Berman A, Simone C (2017) Predicted rate of secondary malignancies following adjuvant proton versus photon radiation therapy for thymoma. Int J Radiat Oncol Biol Phys 99:427–433PubMed

Willmann J, Rimner A (2018) The expanding role of radiation therapy for thymic malignancies. J Thorac Dis 10:S2555–2564PubMedPubMedCentral

Zhou D, Deng X, Liu Q, Zheng H, Min J, Dai J (2016) The effectiveness of postoperative radiotherapy in patients with completely resected thymoma: a meta-analysis. Ann Thorac Surg 101:305–310PubMed

Zhu H, Hoppe B, Flampouri S, Louis D, Pirris J, Nichols R et al (2018) Rationale and early outcomes for the management of thymoma with proton therapy. Transl Lung Cancer Res 7:106–113PubMedPubMedCentral

Title: Volumetric modulated arc therapy versus intensity-modulated proton therapy in the postoperative irradiation of thymoma
Authors: Davide Franceschini
Luca Cozzi
Mauro Loi
Ciro Franzese
Giacomo Reggiori
Pietro Mancosu
Alessandro Clivio
Antonella Fogliata
Marta Scorsetti
Publication date: 01-09-2020
Publisher: Springer Berlin Heidelberg
Keywords: Thymoma
Thymoma
Published in: Journal of Cancer Research and Clinical Oncology / Issue 9/2020
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-020-03281-z

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Volumetric modulated arc therapy versus intensity-modulated proton therapy in the postoperative irradiation of thymoma

Abstract

Background

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2020

Targeted deep sequencing helps distinguish independent primary tumors from intrapulmonary metastasis for lung cancer diagnosis

Prostaglandin E2 receptor 3 (EP3) signaling promotes migration of cervical cancer via urokinase-type plasminogen activator receptor (uPAR)

Mutational profiling of lung adenocarcinoma in China detected by next-generation sequencing

MYC/BCL2/BCL6 triple hit lymphoma of the pericardium: a case report and review of the literature

Gemcitabine and cisplatin versus docetaxel and cisplatin as induction chemotherapy followed by concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma from non-endemic area of China

Non-small cell lung cancer patients with ex19del or exon 21 L858R mutation: distinct mechanisms, different efficacies to treatments

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page