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Open Access Case report

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

Whoon Jong Kil1, R Charles Nichols1*, John W Kilkenny2, Soon Y Huh1, Meng Wei Ho1, Pratibha Gupta3, Robert B Marcus1 and Daniel J Indelicato1

Author Affiliations

1 University of Florida Proton Therapy Institute, Jacksonville, FL, USA

2 Department of Surgery University of Florida Shands Hospital, Jacksonville, FL, USA

3 Department of Radiology University of Florida Shands Hospital, Jacksonville, FL, USA

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Radiation Oncology 2012, 7:178  doi:10.1186/1748-717X-7-178

Published: 26 October 2012

Abstract

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.

Keywords:
Proton therapy; Intensity-modulated radiotherapy; Benign tumors; Case report