Improving organs-at-risk sparing for choroidal melanoma patients: A CT-based two-beam strategy in ocular proton therapy with a dedicated eyeline

Emmanuelle Fleury; Petra Trnková; Caroline van Rij; Myra Rodrigues; Yvonne Klaver; Kees Spruijt; Nicole Naus; Andras Zolnay; Jean Philippe Pignol; Emine Kiliç; Mischa S. Hoogeman

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

Emmanuelle Fleury^*, Petra Trnková, Caroline van Rij, Myra Rodrigues, Yvonne Klaver, Kees Spruijt, Nicole Naus, Andras Zolnay, Jean Philippe Pignol, Emine Kiliç, Mischa S. Hoogeman

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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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_{RBE, GTV} = 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_25% was significantly lowered compared to SB plans by 12.4 and 15.4 Gy RBE-weighted median dose in GrA and GrB, respectively. D_2% 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.

Original language	English
Pages (from-to)	173-181
Number of pages	9
Journal	Radiotherapy and Oncology
Volume	171
Early online date	26 Apr 2022
DOIs	https://doi.org/10.1016/j.radonc.2022.04.021
Publication status	Published - 1 Jun 2022

Bibliographical note

Funding Information:
This research was co-funded by the research program PROTONS4Vision (Grant NWO 14654), which is financed by the Netherlands Organization for Scientific Research (NWO), Technology Foundation STW, the Top consortium for Knowledge & Innovation (TKI-HTSM), and Varian Medical Systems Particle Therapy GmbH & Co. KG, Troisdorf, Germany.

Publisher Copyright:
© 2022 The Author(s)

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Improving organs-at-risk sparing for choroidal melanoma patients A CT-based two-beam strategy in ocular proton therapy with a dedicated eyelineFinal published version, 1.5 MBLicence: CC BY

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Fleury, E., Trnková, P., van Rij, C., Rodrigues, M., Klaver, Y., Spruijt, K., Naus, N., Zolnay, A., Pignol, J. P., Kiliç, E., & Hoogeman, M. S. (2022). Improving organs-at-risk sparing for choroidal melanoma patients: A CT-based two-beam strategy in ocular proton therapy with a dedicated eyeline. Radiotherapy and Oncology, 171, 173-181. https://doi.org/10.1016/j.radonc.2022.04.021

@article{a39216b51ab7465a801f861a7a22242f,

title = "Improving organs-at-risk sparing for choroidal melanoma patients: A CT-based two-beam strategy in ocular proton therapy with a dedicated eyeline",

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 (DRBE, GTV = 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. D25% was significantly lowered compared to SB plans by 12.4 and 15.4 Gy RBE-weighted median dose in GrA and GrB, respectively. D2% 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.",

author = "Emmanuelle Fleury and Petra Trnkov{\'a} and {van Rij}, Caroline and Myra Rodrigues and Yvonne Klaver and Kees Spruijt and Nicole Naus and Andras Zolnay and Pignol, {Jean Philippe} and Emine Kili{\c c} and Hoogeman, {Mischa S.}",

note = "Funding Information: This research was co-funded by the research program PROTONS4Vision (Grant NWO 14654), which is financed by the Netherlands Organization for Scientific Research (NWO), Technology Foundation STW, the Top consortium for Knowledge & Innovation (TKI-HTSM), and Varian Medical Systems Particle Therapy GmbH & Co. KG, Troisdorf, Germany. Publisher Copyright: {\textcopyright} 2022 The Author(s)",

year = "2022",

month = jun,

day = "1",

doi = "10.1016/j.radonc.2022.04.021",

language = "English",

volume = "171",

pages = "173--181",

journal = "Radiotherapy and Oncology",

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publisher = "Elsevier Ireland Ltd",

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Fleury, E, Trnková, P , van Rij, C, Rodrigues, M, Klaver, Y, Spruijt, K, Naus, N, Zolnay, A, Pignol, JP , Kiliç, E & Hoogeman, MS 2022, 'Improving organs-at-risk sparing for choroidal melanoma patients: A CT-based two-beam strategy in ocular proton therapy with a dedicated eyeline', Radiotherapy and Oncology, vol. 171, pp. 173-181. https://doi.org/10.1016/j.radonc.2022.04.021

TY - JOUR

T1 - Improving organs-at-risk sparing for choroidal melanoma patients

T2 - A CT-based two-beam strategy in ocular proton therapy with a dedicated eyeline

AU - Fleury, Emmanuelle

AU - Trnková, Petra

AU - van Rij, Caroline

AU - Rodrigues, Myra

AU - Klaver, Yvonne

AU - Spruijt, Kees

AU - Naus, Nicole

AU - Zolnay, Andras

AU - Pignol, Jean Philippe

AU - Kiliç, Emine

AU - Hoogeman, Mischa S.

N1 - Funding Information: This research was co-funded by the research program PROTONS4Vision (Grant NWO 14654), which is financed by the Netherlands Organization for Scientific Research (NWO), Technology Foundation STW, the Top consortium for Knowledge & Innovation (TKI-HTSM), and Varian Medical Systems Particle Therapy GmbH & Co. KG, Troisdorf, Germany. Publisher Copyright: © 2022 The Author(s)

PY - 2022/6/1

Y1 - 2022/6/1

N2 - 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 (DRBE, GTV = 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. D25% was significantly lowered compared to SB plans by 12.4 and 15.4 Gy RBE-weighted median dose in GrA and GrB, respectively. D2% 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.

AB - 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 (DRBE, GTV = 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. D25% was significantly lowered compared to SB plans by 12.4 and 15.4 Gy RBE-weighted median dose in GrA and GrB, respectively. D2% 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.

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U2 - 10.1016/j.radonc.2022.04.021

DO - 10.1016/j.radonc.2022.04.021

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AN - SCOPUS:85129764511

VL - 171

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JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

SN - 0167-8140

ER -

Improving organs-at-risk sparing for choroidal melanoma patients: A CT-based two-beam strategy in ocular proton therapy with a dedicated eyeline

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