1
|
Sterpin E, Widesott L, Poels K, Hoogeman M, Korevaar EW, Lowe M, Molinelli S, Fracchiolla F. Robustness evaluation of pencil beam scanning proton therapy treatment planning: A systematic review. Radiother Oncol 2024; 197:110365. [PMID: 38830538 DOI: 10.1016/j.radonc.2024.110365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 04/30/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024]
Abstract
Compared to conventional radiotherapy using X-rays, proton therapy, in principle, allows better conformity of the dose distribution to target volumes, at the cost of greater sensitivity to physical, anatomical, and positioning uncertainties. Robust planning, both in terms of plan optimization and evaluation, has gained high visibility in publications on the subject and is part of clinical practice in many centers. However, there is currently no consensus on the methods and parameters to be used for robust optimization or robustness evaluation. We propose to overcome this deficiency by following the modified Delphi consensus method. This method first requires a systematic review of the literature. We performed this review using the PubMed and Web Of Science databases, via two different experts. Potential conflicts were resolved by a third expert. We then explored the different methods before focusing on clinical studies that evaluate robustness on a significant number of patients. Many robustness assessment methods are proposed in the literature. Some are more successful than others and their implementation varies between centers. Moreover, they are not all statistically or mathematically equivalent. The most sophisticated and rigorous methods have seen more limited application due to the difficulty of their implementation and their lack of widespread availability.
Collapse
Affiliation(s)
- E Sterpin
- KU Leuven - Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium; UCLouvain - Institution de Recherche Expérimentale et Clinique, Center of Molecular Imaging Radiotherapy and Oncology (MIRO), Brussels, Belgium; Particle Therapy Interuniversity Center Leuven - PARTICLE, Leuven, Belgium.
| | - L Widesott
- Proton Therapy Center - UO Fisica Sanitaria, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - K Poels
- Particle Therapy Interuniversity Center Leuven - PARTICLE, Leuven, Belgium; UZ Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - M Hoogeman
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, the Netherlands; HollandPTC, Delft, the Netherlands
| | - E W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - M Lowe
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - S Molinelli
- Fondazione CNAO - Medical Physics Unit, Pavia, Italy
| | - F Fracchiolla
- Proton Therapy Center - UO Fisica Sanitaria, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| |
Collapse
|
2
|
Mein S, Wuyckens S, Li X, Both S, Carabe A, Vera MC, Engwall E, Francesco F, Graeff C, Gu W, Hong L, Inaniwa T, Janssens G, de Jong B, Li T, Liang X, Liu G, Lomax A, Mackie T, Mairani A, Mazal A, Nesteruk KP, Paganetti H, Moreno JMP, Schreuder N, Soukup M, Tanaka S, Tessonnier T, Volz L, Zhao L, Ding X. Particle arc therapy: Status and potential. Radiother Oncol 2024:110434. [PMID: 39009306 DOI: 10.1016/j.radonc.2024.110434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 06/23/2024] [Accepted: 07/10/2024] [Indexed: 07/17/2024]
Abstract
There is a rising interest in developing and utilizing arc delivery techniques with charged particle beams, e.g., proton, carbon or other ions, for clinical implementation. In this work, perspectives from the European Society for Radiotherapy and Oncology (ESTRO) 2022 physics workshop on particle arc therapy are reported. This outlook provides an outline and prospective vision for the path forward to clinically deliverable proton, carbon, and other ion arc treatments. Through the collaboration among industry, academic, and clinical research and development, the scientific landscape and outlook for particle arc therapy are presented here to help our community understand the physics, radiobiology, and clinical principles. The work is presented in three main sections: (i) treatment planning, (ii) treatment delivery, and (iii) clinical outlook.
Collapse
Affiliation(s)
- Stewart Mein
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA; Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), Heidelberg, Germany and German Cancer Consortium (DKTK), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Sophie Wuyckens
- UCLouvain, Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
| | - Xiaoqiang Li
- Department of Radiation Oncology, Corewell Health, William Beaumont University Hospital, Proton Therapy Center, Royal Oak, MI, USA
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Macarena Chocan Vera
- UCLouvain, Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
| | | | | | - Christian Graeff
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany; Technische Universität Darmstadt, Institut für Physik Kondensierter Materie, Darmstadt, Germany
| | - Wenbo Gu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Liu Hong
- Ion Beam Applications SA, Louvain-la-Neuve, Belgium
| | - Taku Inaniwa
- Department of Accelerator and Medical Physics, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba, Japan; Department of Medical Physics and Engineering, Graduate School of Medicine, Division of Health Sciences, Osaka University, Osaka, Japan
| | | | - Bas de Jong
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Taoran Li
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaoying Liang
- Department of Radiation Oncology, Mayo Clinic Jacksonville, Jacksonville, FL, USA
| | - Gang Liu
- Department of Radiation Oncology, Corewell Health, William Beaumont University Hospital, Proton Therapy Center, Royal Oak, MI, USA; Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Antony Lomax
- Centre for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland; ETH, Department of Physics, Zürich, Switzerland
| | - Thomas Mackie
- Department of Human Oncology, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Andrea Mairani
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; National Centre of Oncological Hadrontherapy (CNAO), Medical Physics, Pavia, Italy
| | | | - Konrad P Nesteruk
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | | | | | | | - Sodai Tanaka
- Department of Accelerator and Medical Physics, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba, Japan
| | | | - Lennart Volz
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany; Technische Universität Darmstadt, Institut für Physik Kondensierter Materie, Darmstadt, Germany
| | - Lewei Zhao
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Xuanfeng Ding
- Department of Radiation Oncology, Corewell Health, William Beaumont University Hospital, Proton Therapy Center, Royal Oak, MI, USA.
| |
Collapse
|
3
|
Dionisi F, Landoni V, Widesott L, Nardangeli A, Fracchiolla F, Siniscalchi B, Soriani A, Turkaj A, Righetto R, Amelio D, Farace P, Goanta L, Trianni A, Lorentini S, Cianchetti M, Sanguineti G. Dosimetric and NTCP advantages of robust proton therapy over robust VMAT for Stage III NSCLC in the immunotherapy era. Phys Med 2024; 123:103410. [PMID: 38878630 DOI: 10.1016/j.ejmp.2024.103410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/29/2024] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
AIMS To assess the robustness and to define the dosimetric and NTCP advantages of pencil-beam-scanning proton therapy (PBSPT) compared with VMAT for unresectable Stage III non-small lung cancer (NSCLC) in the immunotherapy era. MATERIAL AND METHODS 10 patients were re-planned with VMAT and PBSPT using: 1) ITV-based robust optimization with 0.5 cm setup uncertainties and (for PBSPT) 3.5 % range uncertainties on free-breathing CT 2) CTV-based RO including all 4DCTs anatomies. Target coverage (TC), organs at risk dose and TC robustness (TCR), set at V95%, were compared. The NTCP risk for radiation pneumonitis (RP), 24-month mortality (24MM), G2 + acute esophageal toxicity (ET), the dose to the immune system (EDIC) and the left anterior descending (LAD) coronary artery V15 < 10 % were registered. Wilcoxon test was used. RESULTS Both PBSPT methods improved TC and TCR (p < 0.01). The mean lung dose and lung V20 were lower with PBSPT (p < 0.01). Median mean heart dose reduction with PBSPT was 8 Gy (p < 0.001). PT lowered median LAD V15 (p = 0.004). ΔNTCP > 5 % with PBSPT was observed for two patients for RP and for five patients for 24 MM. ΔNTCP for ≥ G2 ET was not in favor of PBSPT for all patients. PBSPT halved median EDIC (4.9/5.1 Gy for ITV/CTV-based VMAT vs 2.3 Gy for both ITV/CTV-based PBSPT, p < 0.01). CONCLUSIONS PBSPT is a robust approach with significant dosimetric and NTCP advantages over VMAT; the EDIC reduction could allow for a better integration with immunotherapy. A clinical benefit for a subset of NSCLC patients is expected.
Collapse
Affiliation(s)
- F Dionisi
- Department of Research and Advanced Technology, Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute-Rome, Italy.
| | - V Landoni
- Laboratory of Medical Physics and Expert Systems, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - L Widesott
- Medical Physics Department, APSS, Trento, Italy
| | - A Nardangeli
- Department of Research and Advanced Technology, Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute-Rome, Italy
| | | | | | - A Soriani
- Laboratory of Medical Physics and Expert Systems, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Turkaj
- Proton Therapy Unit, APSS, Trento, Italy
| | - R Righetto
- Medical Physics Department, APSS, Trento, Italy
| | - D Amelio
- Proton Therapy Unit, APSS, Trento, Italy
| | - P Farace
- Medical Physics Department, APSS, Trento, Italy
| | - L Goanta
- Department of Research and Advanced Technology, Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute-Rome, Italy
| | - A Trianni
- Medical Physics Department, APSS, Trento, Italy
| | - S Lorentini
- Medical Physics Department, APSS, Trento, Italy
| | | | - G Sanguineti
- Department of Research and Advanced Technology, Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute-Rome, Italy
| |
Collapse
|
4
|
Canters R, van der Klugt K, Trier Taasti V, Buijsen J, Ta B, Steenbakkers I, Houben R, Vilches-Freixas G, Berbee M. Robustness of intensity modulated proton treatment of esophageal cancer for anatomical changes and breathing motion. Radiother Oncol 2024; 198:110409. [PMID: 38917884 DOI: 10.1016/j.radonc.2024.110409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/26/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND AND PURPOSE In this study, we assessed the robustness of intensity modulated proton therapy (IMPT) in esophageal cancer for anatomical variations during treatment. METHODS The first sixty esophageal cancer patients, treated clinically with chemoradiotherapy were included. The treatment planning strategy was based on an internal target volume (ITV) approach, where the ITV was created from the clinical target volumes (CTVs) delineated on all phases of a 4DCT. For optimization, a 3 mm isotropic margin was added to the ITV, combined with robust optimization using 5 mm setup and 3 % range uncertainty. Each patient received weekly repeat CTs (reCTs). Robust plan re-evaluation on all reCTs, and a robust dose summation was performed. To assess the factors influencing ITV coverage, a multivariate linear regression analysis was performed. Additionally, clinical adaptations were evaluated. RESULTS The target coverage was adequate (ITV V94%>98 % on the robust voxel-wise minimum dose) on most reCTs (91 %), and on the summed dose in 92 % of patients. Significant predictors for ITV coverage in the multivariate analysis were diaphragm baseline shift and water equivalent depth (WED) of the ITV in the beam direction. Underdosage of the ITV mainly occurred in week 1 and 4, leading to treatment adaptation of eight patients, all on the first reCT. CONCLUSION Our IMPT treatment of esophageal cancer is robust for anatomical variations. Adaptation appears to be most effective in the first week of treatment. Diaphragm baseline shifts and WED are predictive factors for ITV underdosage, and should be incorporated in an adaptation protocol.
Collapse
Affiliation(s)
- Richard Canters
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Kim van der Klugt
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Vicki Trier Taasti
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands; Aarhus University, Danish Centre for Particle Therapy, Denmark
| | - Jeroen Buijsen
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bastiaan Ta
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Inge Steenbakkers
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ruud Houben
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Gloria Vilches-Freixas
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Maaike Berbee
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
5
|
Liu CW, Kolano AM, Gray T, Stephans KL, Videtic GMM, Farr JB, Xia P. Cyclotron and linear accelerator generated scanning proton beams for lung cancer SBRT: Interplay effects and mitigations. Med Phys 2024; 51:3985-3994. [PMID: 38683935 DOI: 10.1002/mp.17082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/23/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Pencil beam scanning (PBS) proton therapy for moving targets is known to be impacted by interplay effects between the scanning beam and organ motion. While respiratory motion in the thoracic region is the major cause for organ motion, interplay effects depend on the delivery characteristics of proton accelerators. PURPOSE To evaluate the impact of different types of PBS proton accelerators and spot sizes on interplay effects, mitigations, and plan quality for Stereotactic Body Radiation Therapy (SBRT) treatment of non-small cell lung cancer (NSCLC). METHODS Twenty NSCLC patients treated with photon SBRT were selected to represent varying tumor volumes and respiratory motion amplitudes (median: 0.6 cm with abdominal compression) for this retrospective study. For each patient, plans were created using: (1) cyclotron-generated proton beams (CPB) with spot sizes of σ = 2.7-7.0 mm; (2) linear accelerator proton beams (LPB) (σ = 2.9-5.5 mm); and (3) linear accelerator proton minibeams (LPMB) (σ = 0.9-3.9 mm). The energy switching time is one second for CPB, and 0.005 s for LPMB and LPB. Plans were robustly optimized on the gross tumor volume (GTV) using each individual phase of four-dimensional computed tomography (4DCT) scans. Initially, single-field optimization (SFO) plans were evaluated; if the plan quality did not meet the dosimetric requirement, multi-field optimization (MFO) was used. MFO plans were created for all patients for comparisons. For each patient, all plans were normalized to have the same dose received by 99% of the GTV. Interplay effects were evaluated by computing the dose on 10 breathing phases, based on the spot distribution. Volumetric repainting (VR) was performed 2-6 times for each plan. We compared volume receiving 100% of the prescribed dose (V100%RX) of the GTV, and normal lung V20Gy. RESULTS Twelve of 20 plans can be optimized sufficiently with SFO. SFO plans were less sensitive to the interplay effect compared to MFO plans in terms of target coverage for both LPB and LPMB. The following comparisons showed results utilizing the MFO technique. In the interplay evaluation without repainting, the mean V100%RX of the GTV were 99.42 ± 0.6%, 97.52 ± 3.9%, and 94.49 ± 7.3% for CPB, LPB, and LPMB plans, respectively. Following VR (2 × for CPB; 3 × for LPB; 5 × for LPMB), V100%RX of the GTV were improved (on average) by 0.13%, 1.84%, and 4.63%, respectively, achieving the acceptance criteria of V100%RX > 95%. Because of fast energy switch in linear accelerator proton machines, the delivery time for VR plans was the lowest for LPB plans, while delivery time for LPMB was on average 1 min longer than CPB plans. The advantage of small spot machines was better sparing in normal lung V20Gy, even when VR was applied. CONCLUSION In the absence of repainting, proton machines with large spot sizes generated more robust plans against interplay effects. The number of VR increased with decreasing spot sizes to achieve the acceptance criteria. VR improved the plan robustness against interplay effects for modalities with small spot sizes and fast energy changes, preserving the low dose sparing aspect of the LPMB, even when motion is included.
Collapse
Affiliation(s)
- Chieh-Wen Liu
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anna M Kolano
- Applications of Detectors and Accelerators to Medicine (ADAM) SA, Meyrin, Switzerland
- Advanced Oncotherapy (AVO) plc, London, UK
| | - Tara Gray
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin L Stephans
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gregory M M Videtic
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jonathan B Farr
- Applications of Detectors and Accelerators to Medicine (ADAM) SA, Meyrin, Switzerland
- Advanced Oncotherapy (AVO) plc, London, UK
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
6
|
Tan HQ, Koh CWY, Lew KS, Yeap PL, Chua CGA, Lee JKH, Wibawa A, Master Z, Lee JCL, Park SY. Real-time gated proton therapy with a reduced source to imager distance: Commissioning and quality assurance. Phys Med 2024; 122:103380. [PMID: 38805761 DOI: 10.1016/j.ejmp.2024.103380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/12/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Real-time gated proton therapy (RGPT) is a motion management technique unique to the Hitachi particle therapy system. It uses pulsed fluoroscopy to track an implanted fiducial marker. There are currently no published guidelines on how to conduct the commissioning and quality assurance. In this work we reported on our centre's commissioning workflow and our daily and monthly QA procedures. METHODS Six commissioning measurements were designed for RGPT. The measurements include imaging qualities, fluoroscopic exposures, RGPT marker tracking accuracy, temporal gating latency, fiducial marker tracking fidelity and an end-to-end proton dosimetry measurement. Daily QA consists of one measurement on marker localization accuracy. Four months daily QA trends are presented. Monthly QA consists of three measurementson the gating latency, fluoroscopy imaging quality and dosimetry verification of gating operation with RGPT. RESULTS The RGPT was successfully commissioned in our centre. The air kerma rates were within 15 % from specifications and the marker tracking accuracies were within 0.245 mm. The gating latencies for turning the proton beam on and off were 119.5 and 50.0 ms respectively. The 0.4x10.0 mm2 Gold AnchorTM gave the best tracking results with visibility up to 30 g/cm2. Gamma analysis showed that dose distribution of a moving and static detectors had a passing rate of more than 95 % at 3 %/3mm. The daily marker localization QA results were all less than 0.2 mm. CONCLUSION This work could serve as a good reference for other upcoming Hitachi particle therapy centres who are interested to use RGPT as their motion management solution.
Collapse
Affiliation(s)
- Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore.
| | | | - Kah Seng Lew
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Ping Lin Yeap
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | | | | | - Andrew Wibawa
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Zubin Master
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | | | - Sung Yong Park
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore
| |
Collapse
|
7
|
Thwaites DI, Prokopovich DA, Garrett RF, Haworth A, Rosenfeld A, Ahern V. The rationale for a carbon ion radiation therapy facility in Australia. J Med Radiat Sci 2024; 71 Suppl 2:59-76. [PMID: 38061984 PMCID: PMC11011608 DOI: 10.1002/jmrs.744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/17/2023] [Indexed: 04/13/2024] Open
Abstract
Australia has taken a collaborative nationally networked approach to achieve particle therapy capability. This supports the under-construction proton therapy facility in Adelaide, other potential proton centres and an under-evaluation proposal for a hybrid carbon ion and proton centre in western Sydney. A wide-ranging overview is presented of the rationale for carbon ion radiation therapy, applying observations to the case for an Australian facility and to the clinical and research potential from such a national centre.
Collapse
Affiliation(s)
- David I. Thwaites
- Institute of Medical Physics, School of PhysicsUniversity of SydneySydneyNew South WalesAustralia
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
- Radiotherapy Research Group, Institute of Medical ResearchSt James's Hospital and University of LeedsLeedsUK
| | | | - Richard F. Garrett
- Australian Nuclear Science and Technology OrganisationLucas HeightsNew South WalesAustralia
| | - Annette Haworth
- Institute of Medical Physics, School of PhysicsUniversity of SydneySydneyNew South WalesAustralia
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, School of PhysicsUniversity of WollongongSydneyNew South WalesAustralia
| | - Verity Ahern
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
- Westmead Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| |
Collapse
|
8
|
Yahya N, Manan HA. Quality of Life and Patient-Reported Outcomes Following Proton Therapy for Oropharyngeal Carcinoma: A Systematic Review. Cancers (Basel) 2023; 15:cancers15082252. [PMID: 37190180 DOI: 10.3390/cancers15082252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Complex anatomy surrounding the oropharynx makes proton therapy (PT), especially intensity-modulated PT (IMPT), a potentially attractive option due to its ability to reduce the volume of irradiated healthy tissues. Dosimetric improvement may not translate to clinically relevant benefits. As outcome data are emerging, we aimed to evaluate the evidence of the quality of life (QOL) and patient-reported outcomes (PROs) following PT for oropharyngeal carcinoma (OC). MATERIALS AND METHODS We searched PubMed and Scopus electronic databases (date: 15 February 2023) to identify original studies on QOL and PROs following PT for OC. We employed a fluid strategy in the search strategy by tracking citations of the initially selected studies. Reports were extracted for information on demographics, main results, and clinical and dose factor correlates. Quality assessment was performed using the NIH's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The PRISMA guidelines were followed in the preparation of this report. RESULTS Seven reports were selected, including one from a recently published paper captured from citation tracking. Five compared PT and photon-based therapy, although none were randomized controlled trials. Most endpoints with significant differences favored PT, including xerostomia, cough, need for nutritional supplements, dysgeusia, food taste, appetite, and general symptoms. However, some endpoints favored photon-based therapy (sexual symptoms) or showed no significant difference (e.g., fatigue, pain, sleep, mouth sores). The PROs and QOL improve following PT but do not appear to return to baseline. CONCLUSION Evidence suggests that PT causes less QOL and PRO deterioration than photon-based therapy. Biases due to the non-randomized study design remain obstacles to a firm conclusion. Whether or not PT is cost-effective should be the subject of further investigation.
Collapse
Affiliation(s)
- Noorazrul Yahya
- Diagnostic Imaging and Radiotherapy, Center for Diagnostic, Therapeutic and Investigative Studies (CODTIS), Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, Kuala Lumpur 50300, Malaysia
| | - Hanani Abdul Manan
- Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur 56000, Malaysia
| |
Collapse
|
9
|
Steinsberger T, Donetti M, Lis M, Volz L, Wolf M, Durante M, Graeff C. Experimental Validation of a Real-Time Adaptive 4D-Optimized Particle Radiotherapy Approach to Treat Irregularly Moving Tumors. Int J Radiat Oncol Biol Phys 2023; 115:1257-1268. [PMID: 36462690 DOI: 10.1016/j.ijrobp.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Treatment of locally advanced lung cancer is limited by toxicity and insufficient local control. Particle therapy could enable more conformal treatment than intensity modulated photon therapy but is challenged by irregular tumor motion, associated range changes, and tumor deformations. We propose a new strategy for robust, online adaptive particle therapy, synergizing 4-dimensional optimization with real-time adaptive beam tracking. The strategy was tested and the required motion monitoring precision was determined. METHODS AND MATERIALS In multiphase 4-dimensional dose delivery (MP4D), a dedicated quasistatic treatment plan is delivered to each motion phase of periodic 4-dimensional computed tomography (4DCT). In the new extension, "MP4D with residual tracking" (MP4DRT), lateral beam tracking compensates for the displacement of the tumor center-of-mass relative to the current phase in the planning 4DCT. We implemented this method in the dose delivery system of a clinical carbon facility and tested it experimentally for a lung cancer plan based on a periodic subset of a virtual lung 4DCT (planned motion amplitude 20 mm). Treatments were delivered in a quality assurance-like setting to a moving ionization chamber array. We considered variable motion amplitudes and baseline drifts. The required motion monitoring precision was evaluated by adding noise to the motion signal. Log-file-based dose reconstructions were performed in silico on the entire 4DCT phantom data set capable of simulating nonperiodic motion. MP4DRT was compared with MP4D, rescanned beam tracking, and internal target volume plans. Treatment quality was assessed in terms of target coverage (D95), dose homogeneity (D5-D95), conformity number, and dose to heart and lung. RESULTS For all considered motion scenarios and metrics, MP4DRT produced the most favorable metrics among the tested motion mitigation strategies and delivered high-quality treatments. The conformity was similar to static treatments. The motion monitoring precision required for D95 >95% was 1.9 mm. CONCLUSIONS With clinically feasible motion monitoring, MP4DRT can deliver highly conformal dose distributions to irregularly moving targets.
Collapse
Affiliation(s)
- Timo Steinsberger
- Biophysics, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany; Institute for Condensed Matter Physics, Technical University of Darmstadt, Darmstadt, Germany
| | - Marco Donetti
- Research and Development Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Michelle Lis
- Biophysics, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany; Physics Research, Leo Cancer Care, Middleton, Wisconsin; Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana
| | - Lennart Volz
- Biophysics, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Moritz Wolf
- Biophysics, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Marco Durante
- Biophysics, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany; Institute for Condensed Matter Physics, Technical University of Darmstadt, Darmstadt, Germany
| | - Christian Graeff
- Biophysics, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany; Department of Electrical Engineering and Information Technology, Technical University, Darmstadt, Germany.
| |
Collapse
|
10
|
Knopf AC, Czerska K, Fracchiolla F, Graeff C, Molinelli S, Rinaldi I, Rucincki A, Sterpin E, Stützer K, Trnkova P, Zhang Y, Chang JY, Giap H, Liu W, Schild SE, Simone CB, Lomax AJ, Meijers A. Clinical necessity of multi-image based (4DMIB) optimization for targets affected by respiratory motion and treated with scanned particle therapy – a comprehensive review. Radiother Oncol 2022; 169:77-85. [DOI: 10.1016/j.radonc.2022.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 12/28/2022]
|
11
|
Rana S, Rosenfeld AB. Small spot size versus large spot size: Effect on plan quality for lung cancer in pencil beam scanning proton therapy. J Appl Clin Med Phys 2022; 23:e13512. [PMID: 34989458 PMCID: PMC8833272 DOI: 10.1002/acm2.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/26/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of the current study was to evaluate the impact of spot size on the interplay effect, plan robustness, and dose to the organs at risk for lung cancer plans in pencil beam scanning (PBS) proton therapy Methods The current retrospective study included 13 lung cancer patients. For each patient, small spot (∼3 mm) plans and large spot (∼8 mm) plans were generated. The Monte Carlo algorithm was used for both robust plan optimization and final dose calculations. Each plan was normalized, such that 99% of the clinical target volume (CTV) received 99% of the prescription dose. Interplay effect was evaluated for treatment delivery starting in two different breathing phases (T0 and T50). Plan robustness was investigated for 12 perturbed scenarios, which combined the isocenter shift and range uncertainty. The nominal and worst‐case scenario (WCS) results were recorded for each treatment plan. Equivalent uniform dose (EUD) and normal tissue complication probability (NTCP) were evaluated for the total lung, heart, and esophagus. Results In comparison to large spot plans, the WCS values of small spot plans at CTV D95%, D96%, D97%, D98%, and D99% were higher with the average differences of 2.2% (range, 0.3%–3.7%), 2.3% (range, 0.5%–4.0%), 2.6% (range, 0.6%–4.4%), 2.7% (range, 0.9%–5.2%), and 2.7% (range, 0.3%–6.0%), respectively. The nominal and WCS mean dose and EUD for the esophagus, heart, and total lung were higher in large spot plans. The difference in NTCP between large spot and small spot plans was up to 1.9% for the total lung, up to 0.3% for the heart, and up to 32.8% for the esophagus. For robustness acceptance criteria of CTV D95% ≥ 98% of the prescription dose, seven small spot plans had all 12 perturbed scenarios meeting the criteria, whereas, for 13 large spot plans, there were ≥2 scenarios failing to meet the criteria. Interplay results showed that, on average, the target coverage in large spot plans was higher by 1.5% and 0.4% in non‐volumetric and volumetric repainting plans, respectively. Conclusion For robustly optimized PBS lung cancer plans in our study, a small spot machine resulted in a more robust CTV against the setup and range errors when compared to a large spot machine. In the absence of volumetric repainting, large spot PBS lung plans were more robust against the interplay effect. The use of a volumetric repainting technique in both small and large spot PBS lung plans led to comparable interplay target coverage.
Collapse
Affiliation(s)
- Suresh Rana
- Department of Medical Physics, The Oklahoma Proton Center, Oklahoma City, Oklahoma, USA.,Department of Radiation Oncology, Boca Raton Regional Hospital, Lynn Cancer Institute, Baptist Health South Florida, Boca Raton, Florida, USA.,Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Anatoly B Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| |
Collapse
|
12
|
Rana S, Rosenfeld AB. Impact of errors in spot size and spot position in robustly optimized pencil beam scanning proton-based stereotactic body radiation therapy (SBRT) lung plans. J Appl Clin Med Phys 2021; 22:147-154. [PMID: 34101334 PMCID: PMC8292703 DOI: 10.1002/acm2.13293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/22/2021] [Accepted: 04/29/2021] [Indexed: 11/08/2022] Open
Abstract
Purpose The purpose of the current study was threefold: (a) investigate the impact of the variations (errors) in spot sizes in robustly optimized pencil beam scanning (PBS) proton‐based stereotactic body radiation therapy (SBRT) lung plans, (b) evaluate the impact of spot sizes and position errors simultaneously, and (c) assess the overall effect of spot size and position errors occurring simultaneously in conjunction with either setup or range errors. Methods In this retrospective study, computed tomography (CT) data set of five lung patients was selected. Treatment plans were regenerated for a total dose of 5000 cGy(RBE) in 5 fractions using a single‐field optimization (SFO) technique. Monte Carlo was used for the plan optimization and final dose calculations. Nominal plans were normalized such that 99% of the clinical target volume (CTV) received the prescription dose. The analysis was divided into three groups. Group 1: The increasing and decreasing spot sizes were evaluated for ±10%, ±15%, and ±20% errors. Group 2: Errors in spot size and spot positions were evaluated simultaneously (spot size: ±10%; spot position: ±1 and ±2 mm). Group 3: Simulated plans from Group 2 were evaluated for the setup (±5 mm) and range (±3.5%) errors. Results Group 1: For the spot size errors of ±10%, the average reduction in D99% for −10% and +10% errors was 0.7% and 1.1%, respectively. For −15% and +15% spot size errors, the average reduction in D99% was 1.4% and 1.9%, respectively. The average reduction in D99% was 2.1% for −20% error and 2.8% for +20% error. The hot spot evaluation showed that, for the same magnitude of error, the decreasing spot sizes resulted in a positive difference (hotter plan) when compared with the increasing spot sizes. Group 2: For a 10% increase in spot size in conjunction with a −1 mm (+1 mm) shift in spot position, the average reduction in D99% was 1.5% (1.8%). For a 10% decrease in spot size in conjunction with a −1 mm (+1 mm) shift in spot position, the reduction in D99% was 0.8% (0.9%). For the spot size errors of ±10% and spot position errors of ±2 mm, the average reduction in D99% was 2.4%. Group 3: Based on the results from 160 plans (4 plans for spot size [±10%] and position [±1 mm] errors × 8 scenarios × 5 patients), the average D99% was 4748 cGy(RBE) with the average reduction of 5.0%. The isocentric shift in the superior–inferior direction yielded the least homogenous dose distributions inside the target volume. Conclusion The increasing spot sizes resulted in decreased target coverage and dose homogeneity. Similarly, the decreasing spot sizes led to a loss of target coverage, overdosage, and degradation of dose homogeneity. The addition of spot size and position errors to plan robustness parameters (setup and range uncertainties) increased the target coverage loss and decreased the dose homogeneity.
Collapse
Affiliation(s)
- Suresh Rana
- Department of Medical Physics, The Oklahoma Proton Center, Oklahoma City, Oklahoma, USA.,Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.,Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, New South Wales, Australia
| | - Anatoly B Rosenfeld
- Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
13
|
Rana S, Rosenfeld AB. Impact of proton dose calculation algorithms on the interplay effect in PBS proton based SBRT lung plans. Biomed Phys Eng Express 2021; 7. [PMID: 34029212 DOI: 10.1088/2057-1976/abfea8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/06/2021] [Indexed: 01/02/2023]
Abstract
Purpose. The purpose of the current study was to investigate the impact of RayStation analytical pencil beam (APB) and Monte Carlo (MC) algorithms on the interplay effect in pencil beam scanning (PBS) proton-based stereotactic body radiation therapy (SBRT) lung plans.Methods. The currentin-silicoplanning study was designed for a total dose of 5000 cGy(RBE) with a fractional dose of 1000 cGy(RBE). First, three sets of nominal plans were generated for each patient: (a) APB optimization followed by APB dose calculation (PB-PB), (b) APB optimization followed by MC dose calculation (PB-MC), and (c) MC optimization followed by MC dose calculation (MC-MC). Second, for each patient, two sets of volumetric repainting plans (five repaintings) - PB-MCVR5and MC-MCVR5were generated based on PB-MC and MC-MC, respectively. Dosimetric differences between APB and MC algorithms were calculated on the nominal and interplay dose-volume-histograms (DVHs).Results. Interplay evaluation in non-volumetric repainting plans showed that APB algorithm overestimated the target coverage by up to 8.4% for D95%and 10.5% for D99%, whereas in volumetric repainting plans, APB algorithm overestimated by up to 5.3% for D95%and 7.0% for D99%. Interplay results for MC calculations showed a decrease in D95%and D99%by average differences of 3.5% and 4.7%, respectively, in MC-MC plans and by 1.8% and 3.0% in MC-MCVR5plans.Conclusion. In PBS proton-based SBRT lung plans, the combination of APB algorithm and interplay effect reduced the target coverage. This may result in inferior local control. The use of MC algorithm for both optimization and final dose calculations in conjunction with the volumetric repainting technique yielded superior target coverage.
Collapse
Affiliation(s)
- Suresh Rana
- Department of Medical Physics, The Oklahoma Proton Center, Oklahoma City, OK, United States of America.,Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States of America.,Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States of America.,Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, NSW, Australia
| | - Anatoly B Rosenfeld
- Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, NSW, Australia
| |
Collapse
|