gms | German Medical Science

48th Meeting of the Particle Therapy Co-Operative Group

Particle Therapy Co-Operative Group (PTCOG)

28.09. - 03.10.2009, Heidelberg

Surgical Organ Displacement for Proton Radiotherapy

Meeting Abstract

  • J. Jesseph - Midwest Proton Radiotherapy Institute, Indiana University School of Medicine, Bloomington, Indiana, USA
  • M. Fitzek - Midwest Proton Radiotherapy Institute, Indiana University School of Medicine, Bloomington, Indiana, USA
  • K. Shahnazi - Simon Cancer Center, Midwest Proton Radiotherapy Institute (MPRI), Bloomington, Indiana, USA
  • A. Chang - Midwest Proton Radiotherapy Institute, Indiana University School of Medicine, Bloomington, Indiana, USA
  • A. Thornton - Simon Cancer Center, Midwest Proton Radiotherapy Institute (MPRI), Bloomington, Indiana, USA

PTCOG 48. Meeting of the Particle Therapy Co-Operative Group. Heidelberg, 28.09.-03.10.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09ptcog098

DOI: 10.3205/09ptcog098, URN: urn:nbn:de:0183-09ptcog0989

Veröffentlicht: 24. September 2009

© 2009 Jesseph et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: Despite the precise dose distributions possible with proton radiotherapy, successful treatment of some tumors is still limited by the dosages delivered to adjacent structures. Proton treatment provides many novel opportunities for surgical organ displacement. Herein we present our ongoing experience with abdominal and pelvic organ displacement at MPRI.

Materials/methods: With IRB approval we reviewed CT and MRI images along with treatment plans of our patients referred for unresectable or recurrent tumors of the abdomen and pelvis who were determined initially to be untreatable to curative doses because of proximity of the tumors to bowel and other critical structures. Our series includes those patients who underwent surgical organ displacement and subsequent successful treatment with protons. Treatment planning comparisons were made before and after organ displacement. Our patients ranged from 16 to 81 years of age, and included: a recurrent bladder cancer after radical cystectomy, a thrice recurrent desmoid tumor of the rectus sheath, a previously irradiated and locally recurrent rectal cancer after abdominoperineal resection, a previously irradiated recurrent cholangiocarcinoma of the liver, a four times recurrent chondrosarcoma of the pelvis, two unresectabe hepatocellular carcinomas and an enlarging unresectable cholangiocarcinoma of the liver. In addition, we performed organ displacement for a 21 year old female with a T3 low rectal cancer who then underwent subsequent preoperative (neoadjuvant) treatment using protons. This is, to our knowledge, the first patient ever to undergo such treatment.

Results: All patents underwent open organ displacement using either autologous omentum or breast prostheses. No surgical complications were encountered. All patients were successfully planned and treated with protons. The mean target dose was 63 Gray-Equivalent (GyE) with a range of 35 to 72 GyE. No patient experienced grade two or greater toxicity and there have been no deaths.

Conclusions: We have shown that joint planning with surgeons and radiation oncologists holds great promise for improved treatments with protons. The benefits of organ displacement appear more beneficial for proton treatment than for conventional X-ray treatments. By creating anatomy more conducive to proton radiotherapy, these procedures can make otherwise untreatable tumors treatable and, on occasion, incurable lesions curable.