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Martell K, Poirier Y, Zhang T, Hudson A, Spencer D, Jacso F, Hayashi R, Banerjee R, Khan R, Wolfe N, Voroney JP. Radiation therapy for deep periocular cancer treatments when protons are unavailable: is combining electrons and orthovoltage therapy beneficial? JOURNAL OF RADIATION RESEARCH 2018; 59:593-603. [PMID: 30053071 PMCID: PMC6151628 DOI: 10.1093/jrr/rry045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/31/2018] [Indexed: 06/08/2023]
Abstract
Deep periocular cancers can be difficult to plan and treat with radiation, given the difficulties in apposing bolus to skin, and the proximity to the retina and other optic structures. We sought to compare the combination of electrons and orthovoltage therapy (OBE) with existing modalities for these lesions. Four cases-a retro-orbital melanoma (Case 1) and basal cell carcinomas, extending across the eyelid (Case 2) or along the medial canthus (Cases 3-4)-were selected for comparison. In each case, radiotherapy plans for electron only, 70% electron and 30% orthovoltage (OBE), volumetric-modulated arc therapy (VMAT), conformal arc, and protons were compared. Dose-volume histograms for planning target volume coverage and selected organs at risk (OARs) were then calculated. The V90% coverage of the planning target volume was >98% for electrons, VMAT, conformal arc and proton plans and 90.2% and 89.5% in OBE plans for Cases 2 and 3, respectively. The retinal V80% was >98% in electron, VMAT and proton plans and 79.4%; and 87.1% in OBE and conformal arcs for Case 2 and 91.3%, 36.4%, 56.9%, 52.4% and 43.7% for Case 3 in electrons, OBE, VMAT, conformal arc and proton plans, respectively. Protons provided superior coverage, homogeneity and OAR sparing, compared with all other modalities. However, given its simplicity and widespread availability, OBE is a potential alternative treatment option for moderately deep lesions where bolus placement is difficult.
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Affiliation(s)
- Kevin Martell
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre 1331 29 Street Northwest, Calgary, Alberta, Canada
- Calgary Zone, Alberta Health Services, Foothills Medical Centre, 1331-29 ST NW, Calgary, Alberta, Canada
| | - Yannick Poirier
- Department of Radiation Oncology, University of Maryland, 22 S Greene St, Baltimore, MD, USA
| | - Tiezhi Zhang
- Department of Radiation Oncology, Washington University in St. Louis, 660 S. Euclid Ave., CB, St. Louis, MO, USA
| | - Alana Hudson
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre 1331 29 Street Northwest, Calgary, Alberta, Canada
- Calgary Zone, Alberta Health Services, Foothills Medical Centre, 1331-29 ST NW, Calgary, Alberta, Canada
| | - David Spencer
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre 1331 29 Street Northwest, Calgary, Alberta, Canada
- Calgary Zone, Alberta Health Services, Foothills Medical Centre, 1331-29 ST NW, Calgary, Alberta, Canada
| | - Ferenc Jacso
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre 1331 29 Street Northwest, Calgary, Alberta, Canada
- Calgary Zone, Alberta Health Services, Foothills Medical Centre, 1331-29 ST NW, Calgary, Alberta, Canada
| | - Richard Hayashi
- Calgary Zone, Alberta Health Services, Foothills Medical Centre, 1331-29 ST NW, Calgary, Alberta, Canada
| | - Robyn Banerjee
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre 1331 29 Street Northwest, Calgary, Alberta, Canada
- Calgary Zone, Alberta Health Services, Foothills Medical Centre, 1331-29 ST NW, Calgary, Alberta, Canada
| | - Rao Khan
- Department of Radiation Oncology, Washington University in St. Louis, 660 S. Euclid Ave., CB, St. Louis, MO, USA
| | - Nathan Wolfe
- Calgary Zone, Alberta Health Services, Foothills Medical Centre, 1331-29 ST NW, Calgary, Alberta, Canada
| | - Jon-Paul Voroney
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre 1331 29 Street Northwest, Calgary, Alberta, Canada
- Calgary Zone, Alberta Health Services, Foothills Medical Centre, 1331-29 ST NW, Calgary, Alberta, Canada
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