Effect of anatomical change on dose distribution during radiotherapy for maxillary sinus carcinoma: passive scattering proton therapy versus volumetric-modulated arc therapy

Br J Radiol. 2018 Nov 15;92(1093):20180273. doi: 10.1259/bjr.20180273. Online ahead of print.


Objective:: Maxillary sinus carcinomas are anatomically situated next to many organs at risk (OARs), and anatomical change is often observed during radiotherapy. We analyzed the effect of anatomical change on dose distribution of passive scattering proton therapy (PSPT) and volumetric-modulated arc therapy (VMAT) for 20 patients.

Methods:: The first plans were generated based on the first CT images. The second CT images were acquired after 3 weeks, and the second plans were generated by copying the first plans to the second CT images. The effect of anatomical change was estimated by comparing both plans.

Results:: Target volume change was observed in all cases, however, the influence on dose coverage of clinical target volume tended to be small. Alternatively, the doses to almost all OARs were increased. In particular, the increase in the dose to brainstem (p < 0.001) and optic chiasm (p < 0.001) was significantly higher in the second PSPT plan than in the first PSPT plan. Although PSPT is sensitive to anatomical change, the dose to OARs remained significantly lower in PSPT plans than that in VMAT plans.

Conclusion:: PSPT was confirmed to be more effective than VMAT even the effect of anatomical change was taken into account. Therefore, it is expected that the contralateral vision can be preserved reliably while optimal target coverage is provided.

Advances in knowledge:: PSPT allowed significant sparing of OARs even in the result of the second plans affected by the anatomical change. PSPT offers benefits over VMAT in reducing dose to several OARs.