Proton therapy versus photon radiation therapy for the management of a recurrent desmoid tumor of the right flank: a case report

• Main Authors: Kil Whoon, Nichols R, Kilkenny John W, Huh Soon Y, Ho Meng, Gupta Pratibha, Marcus Robert B, Indelicato Daniel J
• Format: Article
• Language: English
• Published: BMC 2012-10-01
• Series: Radiation Oncology
• Subjects: Proton therapy; Intensity-modulated radiotherapy; Benign tumors; Case report
• Online Access: http://www.ro-journal.com/content/7/1/178

<p>Abstract</p> <p>Desmoid tumors are benign mesenchymal tumors with a strong tendency for local recurrence after surgery. Radiotherapy improves local control following incomplete resection, but nearby organs at risk may limit the dose to the target volume. The patient in this report presented with a recurrent desmoid tumor of the right flank and underwent surgery with microscopically positive margins. Particular problems presented in this case included that the tumor bed was situated in close proximity to the liver and the right kidney and that the right kidney was responsible for 65% of the patient’s renal function. Intensity-modulated radiation therapy plans delivering 54 Gy necessarily exposed the right kidney to a V₁₈ of 98% and the liver to a V₃₀ of 55%. Proton therapy plans significantly reduced the right kidney V₁₈ to 32% and the liver V₃₀ to 28%. In light of this, the proton plan was utilized for treatment of this patient. Proton therapy was tolerated without gastrointestinal discomfort or other complaints. Twenty-four months after initiation of proton therapy, the patient is without clinical or radiographic evidence of disease recurrence. In this setting, the improved dose distribution associated with proton therapy allowed for curative treatment of a patient who arguably could not have been safely treated with intensity-modulated radiation therapy or other methods of conventional radiotherapy.</p>