title: Potential advantages of protons over conventional radiation beams for paraspinal tumours.
abstract: OBJECTIVE
  Conformal treatment planning with megavoltage X-rays and protons was studied in an attempt to determine if there are advantage of boost therapy with protons instead of X-rays for a patient with a tumour growing around the cervical spinal cord.
  
  
  METHODS
  A patient with a Ewing sarcoma was selected for the model study. The proton boost plan was realised with a six beam patched technique. Several X-ray boost techniques were planned, some not yet practically realisable. The techniques giving the best dose distributions and the best tumour control probabilities in the absence of significant late toxicity were looked for. The boost techniques were added to two large lateral X-ray beams covering the planning target volume (PTV) and the main risk organ, the spinal cord. The evaluation was made with two biological models, i.e. the tumour control probability (TCP) model, proposed by Webb and Nahum (Webb, S. and Nahum, A.E. A model for calculating tumour control probability in radiotherapy including the effect of inhomogeneous distributions of dose and clonogenic cell density. Phys. Med. Biol. 38: 653-666, 1993), and the normal tissue complication probability (NTCP) model, first derived by Lyman (Lyman, J.T. Complication probability as assessed from dose-volume histograms. Radiat. Res. 104: s13-s19, 1985).
  
  
  RESULTS
  The comparison showed small but clear advantages of protons for the boost. At 1% NTCP in the spinal cord, the calculated TCP was on average 5% higher. However, depending on the values of the parameters chosen in the biological models, the gain for protons varied from 0-10%. The smallest gains were seen in radiosensitive tumours for which the TCP was close to 100% with any of the techniques and in radioresistant tumours for which neither technique resulted in any appreciable probability of local cure.
  
  
  CONCLUSIONS
  Protons appear to have therapeutic advantages over conventional radiotherapy in tumours with relatively high radiosensitivity situated close to the spinal cord.
authors.affiliation: Department of Oncology, University of Uppsala, Akademiska sjukhuset, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Isacsson
authors.forename: H
authors.initials: H
authors.lastname: Hagberg
authors.forename: K A
authors.initials: KA
authors.lastname: Johansson
authors.forename: A
authors.initials: A
authors.lastname: Montelius
authors.forename: B
authors.initials: B
authors.lastname: Jung
authors.forename: B
authors.initials: B
authors.lastname: Glimelius
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods*; D061766:Proton Therapy; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy / Q000295:instrumentation / Q000379:methods*; D012512:Sarcoma, Ewing / Q000532:radiotherapy*; D013125:Spinal Neoplasms / Q000532:radiotherapy*; D011522:Protons
chemical_list: D011522:Protons