ArticlePhysics and imaging in radiation oncology2026
Potential normal tissue sparing in vulvar cancer using intensity modulated proton therapy versus volumetric modulated arc therapy.
Article in Physics and imaging in radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and purpose: Photon radiotherapy, typically volumetric modulated arc therapy (VMAT), is the standard for adjuvant or definitive treatment of vulvar cancer. Here, we explore the potential of intensity modulated proton therapy (IMPT) to further reduce radiation side effects. Materials and methods: Thirty patients treated with VMAT (59.4-64.5 Gy(RBE, relative biological effectiveness)) to boost clinical target volume (CTV), 45-49.5 Gy(RBE) to the elective CTV, in 27-33 fractions) were retrospectively planned with IMPT, using four and six beams with simultaneous integrated boost (SIB) or sequential (SEQ) techniques. Target coverage and organs of interest (OOI) dose constraints were evaluated for bladder, bowel bag, anorectum, femoral heads, pelvic bone and skin. Normal tissue complication probabilities (NTCPs) were calculated for eight endpoints. Skin dose-surface distributions and NTCP-target volume trends were analyzed. Results: The IMPT plans achieved robust target coverage similar to VMAT while significantly reducing OOI doses (p < 0.001; e.g., lower pelvic bone marrow V Conclusions: Besides target coverage, robustly optimized IMPT achieved substantial OOI dose and NTCP reductions versus VMAT in vulvar cancer. Clinical implementation requires attention to high-dose skin regions.
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