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Results of a Multicentric In Silico Clinical Trial (ROCOCO): Comparing Radiotherapy with Photons and Protons for Non-small Cell Lung Cancer  Erik Roelofs,

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1 Results of a Multicentric In Silico Clinical Trial (ROCOCO): Comparing Radiotherapy with Photons and Protons for Non-small Cell Lung Cancer  Erik Roelofs, MSc, Martijn Engelsman, PhD, Coen Rasch, MD, PhD, Lucas Persoon, MSc, Sima Qamhiyeh, PhD, Dirk de Ruysscher, MD, PhD, Frank Verhaegen, PhD, Madelon Pijls-Johannesma, PhD, Philippe Lambin, MD, PhD  Journal of Thoracic Oncology  Volume 7, Issue 1, Pages (January 2012) DOI: /JTO.0b013e fc Copyright © 2012 International Association for the Study of Lung Cancer Terms and Conditions

2 FIGURE 1 Comparison of dose distributions of three-dimensional conformal photon radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and passive scattered conformal proton therapy (PSPT) treatment plans (columns) for three cases (rows). The target is shown (red) with isodose lines of 1, 10, 25, 50, and 67 Gy. Journal of Thoracic Oncology 2012 7, DOI: ( /JTO.0b013e fc) Copyright © 2012 International Association for the Study of Lung Cancer Terms and Conditions

3 FIGURE 2 Dose-volume histograms (DVHs) for patient #2 where the prescribed dose of 70 Gy resulted in exceeding the critical mean lung dose (MLD) level (upper). Lowering the dose to the maximum tolerable dose resulted in lower DVH (bottom), showing larger under-dosage for three-dimensional conformal photon radiotherapy (solid) than for intensity-modulated radiotherapy (dashed) or passive scattered conformal proton therapy (dotted). *MLD refers to the DVH of both left and right lung volumes minus the gross tumor volume. Journal of Thoracic Oncology 2012 7, DOI: ( /JTO.0b013e fc) Copyright © 2012 International Association for the Study of Lung Cancer Terms and Conditions

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