title: Optimizing radiotherapy of orbital and paraorbital tumors: intensity-modulated X-ray beams vs. intensity-modulated proton beams.
abstract: OBJECTIVE
  This study presents a dosimetric optimization effort aiming to compare intensity-modulated (IM) X-rays and IM protons in 4 different orbital and paraorbital tumors. These are most challenging targets for standard radiotherapy due to their close relationship with the eyes and related structures.
  
  
  METHODS
  A primary orbital lymphoma, an optic nerve meningioma, a sphenoidal ridge meningioma protruding into the orbit, and a pediatric parameningeal paraorbital rhabdomyosarcoma were selected for the purpose of this study. Planning target volumes (PTVs) and organs at risk (OAR) were defined in each patient CT data set for each tumor site. IM X-ray and IM proton three-dimensional treatment plans were implemented. The following total tumor doses were prescribed: 30 Gy for the orbital lymphoma, 54 Gy for both meningiomas, and 50.4 Gy for the rhabdomyosarcoma case. Dose-volume histograms (DVHs) were obtained for all targets and OAR with both treatment techniques. DVHs were used to predict normal tissue complication probabilities (NTCPs) for the OAR in the vicinity of the tumor.
  
  
  RESULTS
  The PTV coverage was optimal and equally homogeneous with both IM X-rays and IM proton plans in the 4 tumor sites. DVHs for most OAR were better with IM proton beams especially in the low- to mid-dose range region. The integral nontarget dose was lower with IM protons in every case (factor ranging from 1.5 to 1.9). However, predicted NTCPs (for severe late effects) were equally low for both treatment techniques in every tumor site.
  
  
  CONCLUSIONS
  Although IM proton plans optimally decreased the dose to the OAR in all tumor sites, both optimized X-ray and proton beams equally succeeded to reduce severe-toxicity prediction risks to less than 5% while optimally treating the PTV.
authors.affiliation: Division de Radio-Oncologie, Hopitaux Universitaires, Geneve, Switzerland. Raymond.Miralbell@hcuge.ch
authors.forename: R
authors.initials: R
authors.lastname: Miralbell
authors.forename: L
authors.initials: L
authors.lastname: Cella
authors.forename: D
authors.initials: D
authors.lastname: Weber
authors.forename: A
authors.initials: A
authors.lastname: Lomax
mesh_terms: D006801:Humans; D008579:Meningioma / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D019574:Optic Nerve Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D009915:Orbit; D009918:Orbital Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D061766:Proton Therapy; D020266:Radiotherapy, Conformal / Q000379:methods* / Q000592:standards; D012208:Rhabdomyosarcoma / Q000532:radiotherapy*; D012888:Skull Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D013100:Sphenoid Bone / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D011522:Protons
chemical_list: D011522:Protons