Analysis of dosimetric characteristics of proton radiotherapy in 3 cases of abdominal and pelvic tumors

doi:10.3760/cma.j.cn371439-20250217-00079

Journal of International Oncology ›› 2025, Vol. 52 ›› Issue (7): 455-461.doi: 10.3760/cma.j.cn371439-20250217-00079

• Dosimetric characteristics of proton radiotherapy • Previous Articles Next Articles

Analysis of dosimetric characteristics of proton radiotherapy in 3 cases of abdominal and pelvic tumors

Duan Jinghao¹^,², Yue Jinbo³, Tao Cheng¹^,², Wu Shizhang¹^,², Li Chengqiang¹^,², Dai Tianyuan¹^,², Chen Jinhu¹^,², Bai Tong¹^,², Zhu Jian¹^,²()

¹Department of Radiological Physics，Shandong Cancer Hospital and Institute，Shandong First Medical University and Shandong Academy of Medical Sciences，Jinan 250117，China
²Shandong Provincial Key Medical and Health Laboratory of Pediatric Cancer Precision Radiotherapy （Shandong Cancer Hospital），Jinan 250117，China
³Department of Radiation Oncology （Abdominal Section 1），Shandong Cancer Hospital and Institute，Shandong First Medical University and Shandong Academy of Medical Sciences，Jinan 250117，China

Received:2025-02-17 Revised:2025-05-05 Online:2025-07-08 Published:2025-07-23
Contact: Zhu Jian E-mail:zhujian@sdfmu.edu.cn
Supported by:
National Science and Technology Major Project of China(2024ZD0519901);National Natural Science Foundation of China(12105160);National Natural Science Foundation of China(82172072);Key R＆D Program of Shandong Province，China(2024CXPT084);Natural Science Foundation of Shandong Province of China(ZR2021QA099);Natural Science Foundation of Shandong Province of China(ZR2022QH188);Youth Innovation Team Development Plan of Shandong Universities(2024KJJ013);Shandong Provincial Young Science and Technology Talent Support Project(SDAST2024QTB034)

Abstract

Abstract:

Objective To explore the dosimetric characteristics of intensity modulated proton therapy （IMPT） and intensity modulated radiation therapy （IMRT） for typical abdominal and pelvic tumors. Methods Three patients with abdominal and pelvic tumors （one case each of liver cancer，cervical cancer，and prostate cancer） admitted to Shandong Cancer Hospital and Institute from January to June 2024 were selected as the research subjects. IMPT and IMRT plans were designed for each case based on clinical target volume （CTV） and organs at risk （OARs） constraints. Dosimetric parameters，including conformity index （CI），homogeneity index （HI），and gradient index （GI） for target coverage，as well as OARs dose metrics，were evaluated. The volume of additional dose deposition in the body was compared by assessing regions receiving 10%，30%，and 50% of the prescription dose. Results For all three cases，IMRT plan demonstrated higher CI values （0.82，0.81，and 0.86） compared to IMPT plan （0.61，0.62，and 0.43）. IMPT plan yielded lower HI values （0.053，0.075，and 0.020） than IMRT plan （0.060，0.120，and 0.080） and lower GI values （3.45，2.63，and 3.80 vs. 7.28，4.76，and 4.66 for IMRT plan）. In liver cancer，IMPT plan reduced the D_mean of normal liver tissues and right kidney by 37.8% and 78.5%，respectively，and decreased the D_max of spinal cord by 13.2%. For cervical cancer，IMPT plan reduced the V₃₀ of the small bowel by 22.0%，D_mean of the bladder，rectum and bone marrow by 15.7%，14.3% and 12.6%，and spinal cord D_max by 4.8%. In prostate cancer，IMPT plan lowered bladder and rectal D_mean by 14.9% and 36.5%，respectively，but resulted in an increase of 35.3% and 6.1% in the D_meanand V₄₀ of the left femoral head，respectively，and an increase of 23.6% and 10.8% in the D_mean and V₄₀ of the right femoral head，respectively. IMPT plan reduced the volumes receiving 10%，30%，and 50% of the prescription dose by 48.9%-64.8%，22.0%-47.0%，and 22.0%-57.7%，respectively，compared to IMRT plan. Conclusions Comparison between IMPT and IMRT plans for abdominopelvic tumors： IMPT plan offers advantages in reducing doses to normal organs such as the liver，kidneys，spinal cord，small intestine，rectum，and bladder. However，its advantage is less pronounced regarding the dose to the femoral heads. IMPT plan notably minimizes additional dose deposition within the body.

Key words: Abdominal neoplasms, Pelvic neoplasms, Radiotherapy, Proton therapy, Radiotherapy dosage

Duan Jinghao, Yue Jinbo, Tao Cheng, Wu Shizhang, Li Chengqiang, Dai Tianyuan, Chen Jinhu, Bai Tong, Zhu Jian. Analysis of dosimetric characteristics of proton radiotherapy in 3 cases of abdominal and pelvic tumors[J]. Journal of International Oncology, 2025, 52(7): 455-461.

Figures/Tables 8

References 8

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患者	病种	年龄（岁）	KPS评分（分）	靶区部位	处方剂量^a	放疗计划类型	危及器官限制标准
1	肝癌	71	90	肿瘤原发灶、门脉癌栓区域和转移淋巴结	50 Gy/25 f	IMPT+IMRT	正常肝组织D_mean<25 Gy；脊髓D_max<45 Gy；单侧肾脏V₂₅<33%
2	宫颈癌	56	90	肿瘤原发灶和淋巴引流区	50.4 Gy/28 f	IMPT+IMRT	膀胱V₄₀<53%；直肠V₄₀<55%；股骨头V₄₀<5%；小肠V₁₅<120 cm³，V₄₅<195 cm³；骨髓V₃₀<55%；乙状结肠D_{2 ml}<53 Gy；脊髓D_max<45 Gy；单侧肾脏V₂₅<33%
3	前列腺癌	67	90	肿瘤原发灶	72 Gy/36 f	IMPT+IMRT	膀胱V₅₀<40%，V₇₀<20%；直肠V₅₀<30%， V₇₀<15%；股骨头V₅₀<5%

病例	剂量学指标^a	IMPT	IMRT	病例	剂量学指标^a	IMPT	IMRT
肝癌	正常肝D_mean	11.21	18.03		小肠
	左肾D_mean	0.00	1.33		V₃₀	8.22%	30.20%
	右肾D_mean	1.40	6.50		D_max	53.50	54.74
	脊髓D_max	33.74	38.87		脊髓D_max	41.64	43.74
	body（cm³）				body（cm³）
	10%D_处方剂量	5 491	12 968		10%D_处方剂量	10 342	20 236
	30%D_处方剂量	4 050	7 547		30%D_处方剂量	7 688	9 861
	50%D_处方剂量	1 971	4 656		50%D_处方剂量	2 662	5 722
宫颈癌	膀胱			前列腺癌	膀胱
	D_mean	28.21	33.46		D_mean	29.93	35.15
	V₄₀	42.0%	41.3%		V₄₀	38.30%	43.72%
	直肠				直肠
	D_mean	32.10	37.45		D_mean	18.48	29.08
	V₄₀	45.9%	46.7%		V₄₀	20.4%	38.0%
	股骨头（左侧）				股骨头（左侧）
	D_mean	19.42	19.83		D_mean	17.14	12.67
	V₄₀	0.05%	1.40%		V₄₀	6.33%	0.23%
	股骨头（右侧）				股骨头（右侧）
	D_mean	20.38	21.01		D_mean	17.47	14.14
	V₄₀	0.05%	1.40%		V₄₀	10.79%	0.005%
	骨髓				body（cm³）
	D_mean	23.43	26.81		10%D_处方剂量	1 398	3 973
	V₃₀	36.4%	36.4%		30%D_处方剂量	892	1 683
	乙状结肠D_max	53.58	56.44		50%D_处方剂量	497	637

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Analysis of dosimetric characteristics of proton radiotherapy in 3 cases of abdominal and pelvic tumors

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靶区	剂量学参数	IMPT	IMRT
肝癌靶区	CI	0.61	0.82
	HI	0.053	0.060
	GI	3.45	7.28
宫颈癌靶区	CI	0.62	0.81
	HI	0.075	0.120
	GI	2.63	4.76
前列腺癌靶区	CI	0.43	0.86
	HI	0.020	0.080
	GI	3.80	4.66