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Evaluation of the risk for radiation-induced liver disease following photon- or proton-beam radiosurgery of liver metastases
Stockholm University, Faculty of Science, Department of Physics. Eduardo Mondlane University, Mozambique.ORCID iD: 0000-0002-9904-7217
Stockholm University, Faculty of Science, Department of Physics.ORCID iD: 0000-0002-1099-733X
Karolinska Institutet, Sweden.
Södersjukhuset, Sweden; Karolinska Institutet, Sweden.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Radiotherapy of liver metastases is being performed with photon-beam stereotactic body radiation therapy (SBRT). However, the high risk for radiation-induced liver disease (RILD) is the treatment limiting factor. The use of proton beams in these treatments could improve the sparing of the healthy part of the liver. The aim of this study was to evaluate the use of estimations of normal tissue complication probability (NTCP) to identify liver-metastases patients that could benefit from being treated with intensity-modulated proton therapy (IMPT), based on the reduction of the risk for RILD. Methods: Ten liver metastases patients, previously treated with photon-beam radiosurgery, were retrospectively planned with IMPT. A CTV-based robust optimisation (accounting for setup and range uncertainties) combined with PTV-based conventional optimisation, was performed. A robustness criterion was defined for the CTV (V95%>98% for at least 10 of the 12 simulated scenarios). The NTCP was estimated for different endpoints using the Lyman-Kutcher-Burman model. The ΔNTCP (NTCPIMPT - NTCPSBRT) for RILD was registered for each patient. The patients for which the NTCP (RILD) < 5 % were also identified. A generic relative biological effectiveness of 1.1 was assumed for the proton beams. Results: For all patients, the objectives set for the PTV and the robustness criterion set for the CTV were fulfilled with the IMPT plans. An improved sparing of the healthy part of the liver, right kidney, lungs, spinal cord and the skin, was achieved with the IMPT plans. Mean liver doses larger than the threshold value of 32 Gy led to values of NTCP for RILD exceeding 5 % (7 patients for SBRT and 3 patients for IMPT). ΔNTCP values (RILD) ranging between -98% and -17 % (7 patients) and between 0 % and 2 % (3 patients) were estimated. Conclusions: In this study, liver metastases patients that could benefit from being treated with IMPT, based on the NTCP reductions, could be identified. The clinical implementation of such model-based approach to select liver metastases patients to proton therapy needs to be made with caution and considering the uncertainties involved in the NTCP estimations.

Keywords [en]
RILD, liver metastases, SBRT, IMPT, patient selection
National Category
Other Natural Sciences
Research subject
Medical Radiation Physics
Identifiers
URN: urn:nbn:se:su:diva-158223OAI: oai:DiVA.org:su-158223DiVA, id: diva2:1235651
Available from: 2018-07-26 Created: 2018-07-26 Last updated: 2018-08-17
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