title: Early experience with intensity modulated proton therapy for lung-intact mesothelioma: A case series.
abstract: OBJECTIVE
  The purpose of this study was to describe our experience implementing intensity modulated proton therapy (IMPT) for lung-intact malignant pleural mesothelioma (MPM), including patient selection, treatment planning, dose verification, and process optimization.
  
  
  METHODS
  Seven patients with epithelioid MPM were reviewed; 6 underwent pleurectomy, whereas 1 had biopsy alone. Four patients received IMPT and 3 received intensity modulated radiation therapy. Treatment plans for the other modality were created for dosimetric comparisons. Quality assurance processes included dose verification and robustness analysis. Image-guided setup was performed with the first isocenter, and couch shifts were applied to reposition to the second isocenter.
  
  
  RESULTS
  Treatment with IMPT was well tolerated and completed without breaks. IMPT plans were designed with 2 isocenters, 4 beams, and ≤64 energy layers per beam. Dose verification processes were completed in 3 hours. Total daily treatment time was approximately 45 minutes (20 minutes for setup and 25 minutes for delivery). IMPT produced lower mean doses to the contralateral lung, heart, esophagus, liver, and ipsilateral kidney, with increased contralateral lung sparing when mediastinal boost was required for nodal disease.
  
  
  CONCLUSIONS
  Our initial experience showed that IMPT was feasible for routine care of patients with lung-intact MPM.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Hubert Y
authors.initials: HY
authors.lastname: Pan
authors.affiliation: Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
authors.forename: Shengpeng
authors.initials: S
authors.lastname: Jiang
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jordan
authors.initials: J
authors.lastname: Sutton
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: William W
authors.initials: WW
authors.lastname: Chance
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: X Ronald
authors.initials: XR
authors.lastname: Zhu
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Heng
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Hiral P
authors.initials: HP
authors.lastname: Fontanilla
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: DGomez@mdanderson.org.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Gomez
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008654:Mesothelioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed