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Ebadi M, Pankuch M, Boyer S, Chang J, Stevens C, Hall MD, Hasan S, Bates JE, Flampouri S, Kole AJ, Mohindra P, Rossi C, Sanghvi P, McGee L, Rana Z, Tseng YD. Proton Pencil Beam Scanning Facilitates the Safe Treatment of Extended Radiation Targets for Hodgkin Lymphoma: A Report from the Proton Collaborative Group Registry. Cancers (Basel) 2024; 16:2736. [PMID: 39123464 PMCID: PMC11311484 DOI: 10.3390/cancers16152736] [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: 06/29/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Because proton beam therapy (PBT) can lower the dose of radiation to the heart, lungs, and breast, it is an established radiation modality for patients with Hodgkin lymphoma (HL). Pencil beam scanning (PBS) PBT facilitates the treatment of more extensive targets. This may be especially of value for lymphoma patients who require RT to both mediastinal and axillary targets, defined here as extended target RT (ETRT), given the target distribution and need to minimize the lung, heart, and breast dose. Using the Proton Collaborative Group registry, we identified patients with HL treated with PBT to both their mediastinum and axilla, for which DICOM-RT was available. All patients were treated with PBS. To evaluate the dosimetric impact of PBS, we compared delivered PBS plans with VMAT butterfly photon plans optimized to have the same target volume coverage, when feasible. Between 2016 and 2021, twelve patients (median 26 years) received PBS ETRT (median 30.6 Gy (RBE)). Despite the large superior/inferior (SI, median 22.2 cm) and left/right (LR, median 22.8 cm) extent of the ETRT targets, all patients were treated with one isocenter except for two patients (both with SI and LR > 30 cm). Most commonly, anterior beams, with or without posterior beams, were used. Compared to photons, PBS had greater target coverage, better conformity, and lower dose heterogeneity while achieving lower doses to the lungs and heart, but not to the breast. No acute grade 3+ toxicities were reported, including pneumonitis. Proton ETRT in this small cohort was safely delivered with PBS and was associated with an improved sparing of the heart and lungs compared to VMAT.
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Affiliation(s)
- Maryam Ebadi
- Department of Radiation Oncology, University of Washington and Radiation Oncology Division, Fred Hutch Cancer Center, Seattle, WA 98195, USA;
| | - Mark Pankuch
- Northwestern Medicine Proton Center, Warrenville, IL 60555, USA; (M.P.); (S.B.)
| | - Sean Boyer
- Northwestern Medicine Proton Center, Warrenville, IL 60555, USA; (M.P.); (S.B.)
| | - John Chang
- The Oklahoma Proton Center, Oklahoma City, OK 73142, USA;
| | - Craig Stevens
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48073, USA;
| | - Matthew D. Hall
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA;
| | | | - James E. Bates
- Emory University Hospital Midtown, Atlanta, GA 30308, USA;
| | | | - Adam J. Kole
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Pranshu Mohindra
- University Hospitals Seidman Cancer Center, Cleveland, OH 44106, USA
| | - Carl Rossi
- California Protons Cancer Therapy Center, San Diego, CA 92121, USA;
| | - Parag Sanghvi
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, La Jolla, CA 92093, USA;
| | - Lisa McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA;
| | - Zaker Rana
- Maryland Proton Treatment Center, Baltimore, MD 21201, USA;
| | - Yolanda D. Tseng
- Department of Radiation Oncology, University of Washington and Radiation Oncology Division, Fred Hutch Cancer Center, Seattle, WA 98195, USA;
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Trnková P, Dasu A, Placidi L, Stock M, Toma-Dasu I, Brouwer CL, Gosling A, Jouglar E, Kristensen I, Martin V, Moinuddin S, Pasquie I, Peters S, Pica A, Plaude S, Righetto R, Rombi B, Thariat J, van der Weide H, Hoffmann A, Bolsi A. Patterns of practice of image guided particle therapy for cranio-spinal irradiation: A site specific multi-institutional survey of European Particle Therapy Network. Phys Med 2024; 123:103407. [PMID: 38906046 DOI: 10.1016/j.ejmp.2024.103407] [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: 02/19/2024] [Revised: 04/22/2024] [Accepted: 06/07/2024] [Indexed: 06/23/2024] Open
Abstract
PURPOSE To investigate the current practice patterns in image-guided particle therapy (IGPT) for cranio-spinal irradiation (CSI). METHODS A multi-institutional survey was distributed to European particle therapy centres to analyse all aspects of IGPT. Based on the survey results, a Delphi consensus analysis was developed to define minimum requirements and optimal workflow for clinical practice. The centres participating in the institutional survey were invited to join the Delphi process. RESULTS Eleven centres participated in the survey. Imaging for treatment planning was rather similar among the centres with Computed Tomography (CT) being the main modality. For positioning verification, 2D IGPT was more commonly used than 3D IGPT. Two centres performed routinely imaging for plan adaptation, by the rest ad hoc. Eight centres participated in the Delphi consensus analysis. The full consensus was reached on the use of CT imaging without contrast for treatment planning and the role of magnetic resonance imaging (MRI) in target and organs-at-risk delineation. There was an agreement on the necessity to perform patient position verification and correction before each isocentre. The most important outcome was the clear need for standardization and harmonization of the workflow. CONCLUSION There were differences in CSI IGPT clinical practice among the European particle therapy centres. Moreover, the optimal workflow as identified by experts was not yet reached. There is a strong need for consensus guidelines. The state-of-the-art imaging technology and protocols need to be implemented into clinical practice to improve the quality of IGPT for CSI.
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Affiliation(s)
- Petra Trnková
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria.
| | - Alexandru Dasu
- The Skandion Clinic, Uppsala, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Rome, Italy
| | - Markus Stock
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria; Karl Landsteiner University of Health Sciences, Wiener Neustadt, Austria
| | - Iuliana Toma-Dasu
- Medical Radiation Physics, Department of Physics, Stockholm University, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Charlotte L Brouwer
- University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, the Netherlands
| | - Andrew Gosling
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Emmanuel Jouglar
- Department of Radiation Oncology, Institute Curie, PSL Research University, Orsay, Paris, France
| | - Ingrid Kristensen
- Radiation Physics, Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | - Valentine Martin
- Department of Radiation Oncology, Institute Gustave Roussy, Villejuif, France
| | - Syed Moinuddin
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Isabelle Pasquie
- Department of Radiation Oncology, Institute Curie, PSL Research University, Orsay, Paris, France
| | - Sarah Peters
- Department of Particle Therapy, University Hospital Essen, Germany; West German Proton Therapy Centre Essen (WPE), Essen, Germany
| | - Alessia Pica
- Centre for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Sandija Plaude
- West German Proton Therapy Centre Essen (WPE), Essen, Germany
| | - Roberto Righetto
- Medical Physics Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Barbara Rombi
- Proton Therapy Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Juliette Thariat
- Department of Radiotherapy, Centre François Baclesse, Caen, France
| | - Hiske van der Weide
- University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, the Netherlands
| | - Aswin Hoffmann
- OncoRay - National Centre for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alessandra Bolsi
- Centre for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
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Hu L, Zhai A, Chen Q, Puri V, Chen CC, Yu F, Fox J, Wolden S, Yang J, Simone CB, Lin H. Proton pencil beam scanning craniospinal irradiation (CSI) with a single posterior brain beam: Dosimetry and efficiency. Med Dosim 2023; 49:25-29. [PMID: 38040549 DOI: 10.1016/j.meddos.2023.10.010] [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: 09/08/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/03/2023]
Abstract
This study explores the feasibility and potential dosimetric and time efficiency benefit of proton Pencil Beam Scanning (PBS) craniospinal irradiation with a single posterior-anterior (SPA) brain field. The SPA approach was compared to our current clinical protocol using Bilateral Posterior Oblique brain fields (BPO). Ten consecutive patients were simulated in the head-first supine position on a long BOS frame and scanned using 3 mm CT slice thickness. A customized thermoplastic mask immobilized the patient's head, neck, and shoulders. A vac-lock was used to secure the legs. PBS proton plans were robustly optimized with 3mm setup errors and 3.5% range uncertainties in the Eclipse V15.6 treatment planning system (n = 12 scenarios). In order to achieve a smooth gradient dose match at the junction area, at least 5 cm overlap region was maintained between the segments and 5 mm uncertainty along the cranial-cauda direction was applied to each segment independently as additional robust optimization scenarios. The brain doses were planned by SPA or BPO fields. All spine segments were planned with a single PA field. Dosimetric differences between the BPO and SPA approaches were compared, and the treatment efficiency was analyzed according to timestamps of beam delivery. Results: The maximum brain dose increases to 111.1 ± 2.1% for SPA vs. 109.0 ± 1.7% for BPO (p < 0.01). The dose homogeneity index (D5/D95) in brain CTV was comparable between techniques (1.037 ± 0.010 for SPA and 1.033 ± 0.008 for BPO). Lens received lower maximum doses by 2.88 ± 1.58 Gy (RBE) (left) and 2.23 ± 1.37 Gy (RBE) (right) in the SPA plans (p < 0.01). No significant cochlea dose change was observed. SPA reduced the treatment time by more than 4 minutes on average and ranged from 2 to 10 minutes, depending on the beam waiting and allocation time. SPA is dosimetrically comparable to BPO, with reduced lens doses at the cost of slightly higher dose inhomogeneity and hot spots. Implementation of SPA is feasible and can help to improve the treatment efficiency of PBS CSI treatment.
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Affiliation(s)
- Lei Hu
- New York Proton Center, New York, NY, USA; Department of Radiation Oncology, Inova Schar Cancer Institute, FairFax, VA, USA.
| | - Anna Zhai
- New York Proton Center, New York, NY, USA
| | - Qing Chen
- New York Proton Center, New York, NY, USA
| | | | - Chin-Cheng Chen
- New York Proton Center, New York, NY, USA; St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Francis Yu
- New York Proton Center, New York, NY, USA
| | - Jana Fox
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Suzanne Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles B Simone
- New York Proton Center, New York, NY, USA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Haibo Lin
- New York Proton Center, New York, NY, USA; Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Hrinivich WT, Li H, Tran A, Acharya S, Ladra MM, Sheikh K. Clinical Characterization of a Table Mounted Range Shifter Board for Synchrotron-Based Intensity Modulated Proton Therapy for Pediatric Craniospinal Irradiation. Cancers (Basel) 2023; 15:cancers15112882. [PMID: 37296845 DOI: 10.3390/cancers15112882] [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: 03/28/2023] [Revised: 05/13/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
Purpose: To report our design, manufacturing, commissioning and initial clinical experience with a table-mounted range shifter board (RSB) intended to replace the machine-mounted range shifter (MRS) in a synchrotron-based pencil beam scanning (PBS) system to reduce penumbra and normal tissue dose for image-guided pediatric craniospinal irradiation (CSI). Methods: A custom RSB was designed and manufactured from a 3.5 cm thick slab of polymethyl methacrylate (PMMA) to be placed directly under patients, on top of our existing couch top. The relative linear stopping power (RLSP) of the RSB was measured using a multi-layer ionization chamber, and output constancy was measured using an ion chamber. End-to-end tests were performed using the MRS and RSB approaches using an anthropomorphic phantom and radiochromic film measurements. Cone beam CT (CBCT) and 2D planar kV X-ray image quality were compared with and without the RSB present using image quality phantoms. CSI plans were produced using MRS and RSB approaches for two retrospective pediatric patients, and the resultant normal tissue doses were compared. Results: The RLSP of the RSB was found to be 1.163 and provided computed penumbra of 6.9 mm in the phantom compared to 11.8 mm using the MRS. Phantom measurements using the RSB demonstrated errors in output constancy, range, and penumbra of 0.3%, -0.8%, and 0.6 mm, respectively. The RSB reduced mean kidney and lung dose compared to the MRS by 57.7% and 46.3%, respectively. The RSB decreased mean CBCT image intensities by 86.8 HU but did not significantly impact CBCT or kV spatial resolution providing acceptable image quality for patient setup. Conclusions: A custom RSB for pediatric proton CSI was designed, manufactured, modeled in our TPS, and found to significantly reduce lateral proton beam penumbra compared to a standard MRS while maintaining CBCT and kV image-quality and is in routine use at our center.
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Affiliation(s)
- William T Hrinivich
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- The Johns Hopkins Proton Therapy Center, Johns Hopkins University School of Medicine, Washington, DC 20016, USA
| | - Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- The Johns Hopkins Proton Therapy Center, Johns Hopkins University School of Medicine, Washington, DC 20016, USA
| | - Anh Tran
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- The Johns Hopkins Proton Therapy Center, Johns Hopkins University School of Medicine, Washington, DC 20016, USA
| | - Sahaja Acharya
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- The Johns Hopkins Proton Therapy Center, Johns Hopkins University School of Medicine, Washington, DC 20016, USA
| | - Matthew M Ladra
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- The Johns Hopkins Proton Therapy Center, Johns Hopkins University School of Medicine, Washington, DC 20016, USA
| | - Khadija Sheikh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- The Johns Hopkins Proton Therapy Center, Johns Hopkins University School of Medicine, Washington, DC 20016, USA
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5
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Yang JT, Wijetunga NA, Pentsova E, Wolden S, Young RJ, Correa D, Zhang Z, Zheng J, Steckler A, Bucwinska W, Bernstein A, Betof Warner A, Yu H, Kris MG, Seidman AD, Wilcox JA, Malani R, Lin A, DeAngelis LM, Lee NY, Powell SN, Boire A. Randomized Phase II Trial of Proton Craniospinal Irradiation Versus Photon Involved-Field Radiotherapy for Patients With Solid Tumor Leptomeningeal Metastasis. J Clin Oncol 2022; 40:3858-3867. [PMID: 35802849 PMCID: PMC9671756 DOI: 10.1200/jco.22.01148] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/26/2022] [Accepted: 06/14/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Photon involved-field radiotherapy (IFRT) is the standard-of-care radiotherapy for patients with leptomeningeal metastasis (LM) from solid tumors. We tested whether proton craniospinal irradiation (pCSI) encompassing the entire CNS would result in superior CNS progression-free survival (PFS) compared with IFRT. PATIENTS AND METHODS We conducted a randomized, phase II trial of pCSI versus IFRT in patients with non-small-cell lung cancer and breast cancers with LM. We enrolled patients with other solid tumors to an exploratory pCSI group. For the randomized groups, patients were assigned (2:1), stratified by histology and systemic disease status, to pCSI or IFRT. The primary end point was CNS PFS. Secondary end points included overall survival (OS) and treatment-related adverse events (TAEs). RESULTS Between April 16, 2020, and October 11, 2021, 42 and 21 patients were randomly assigned to pCSI and IFRT, respectively. At planned interim analysis, a significant benefit in CNS PFS was observed with pCSI (median 7.5 months; 95% CI, 6.6 months to not reached) compared with IFRT (2.3 months; 95% CI, 1.2 to 5.8 months; P < .001). We also observed OS benefit with pCSI (9.9 months; 95% CI, 7.5 months to not reached) versus IFRT (6.0 months; 95% CI, 3.9 months to not reached; P = .029). There was no difference in the rate of grade 3 and 4 TAEs (P = .19). In the exploratory pCSI group, 35 patients enrolled, the median CNS PFS was 5.8 months (95% CI, 4.4 to 9.1 months) and OS was 6.6 months (95% CI, 5.4 to 11 months). CONCLUSION Compared with photon IFRT, we found pCSI improved CNS PFS and OS for patients with non-small-cell lung cancer and breast cancer with LM with no increase in serious TAEs.
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Affiliation(s)
- Jonathan T. Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - N. Ari Wijetunga
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena Pentsova
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Suzanne Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert J. Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Denise Correa
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alexa Steckler
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Weronika Bucwinska
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ashley Bernstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Allison Betof Warner
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Melanoma and Immunotherapeutics Service, New York, NY
| | - Helena Yu
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Thoracic Oncology Service, New York, NY
| | - Mark G. Kris
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Thoracic Oncology Service, New York, NY
| | - Andrew D. Seidman
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Breast Medicine Service, New York, NY
| | - Jessica A. Wilcox
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rachna Malani
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew Lin
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lisa M. DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Simon N. Powell
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Adrienne Boire
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, Brain Tumor Center, New York, NY
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Lin H, Shi C, Huang S, Shen J, Kang M, Chen Q, Zhai H, McDonough J, Tochner Z, Deville C, Simone CB, Both S. Applications of various range shifters for proton pencil beam scanning radiotherapy. Radiat Oncol 2021; 16:146. [PMID: 34362396 PMCID: PMC8344212 DOI: 10.1186/s13014-021-01873-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background A range pull-back device, such as a machine-related range shifter (MRS) or a universal patient-related range shifter (UPRS), is needed in pencil beam scanning technique to treat shallow tumors. Methods Three UPRS made by QFix (Avondale, PA, USA) allow treating targets across the body: U-shaped bolus (UB), anterior lateral bolus (ALB), and couch top bolus. Head-and-neck (HN) patients who used the UPRS were tested. The in-air spot sizes were measured and compared in this study at air gaps: 6 cm, 16 cm, and 26 cm. Measurements were performed in a solid water phantom using a single-field optimization pencil beam scanning field with the ALB placed at 0, 10, and 20 cm air gaps. The two-dimensional dose maps at the middle of the spread-out Bragg peak were measured using ion chamber array MatriXX PT (IBA-Dosimetry, Schwarzenbruck, Germany) located at isocenter and compared with the treatment planning system. Results A UPRS can be consistently placed close to the patient and maintains a relatively small spot size resulting in improved dose distributions. However, when a UPRS is non-removable (e.g. thick couch top), the quality of volumetric imaging is degraded due to their high Z material construction, hindering the value of Image-Guided Radiation Therapy (IGRT). Limitations of using UPRS with small air gaps include reduced couch weight limit, potential collision with patient or immobilization devices, and challenges using non-coplanar fields with certain UPRS. Our experience showed the combination of a U-shaped bolus exclusively for an HN target and an MRS as the complimentary device for head-and-neck targets as well as for all other treatment sites may be ideal to preserve the dosimetric advantages of pencil beam scanning proton treatments across the body. Conclusion We have described how to implement UPRS and MRS for various clinical indications using the PBS technique, and comprehensively reviewed the advantage and disadvantages of UPRS and MRS. We recommend the removable UB only to be employed for the brain and HN treatments while an automated MRS is used for all proton beams that require RS but not convenient or feasible to use UB.
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Affiliation(s)
- Haibo Lin
- New York Proton Center, New York, 10035, USA.
| | - Chengyu Shi
- New York Proton Center, New York, 10035, USA
| | - Sheng Huang
- New York Proton Center, New York, 10035, USA
| | | | | | - Qing Chen
- New York Proton Center, New York, 10035, USA
| | | | - James McDonough
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Zelig Tochner
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, 21231, USA
| | | | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, 9713 GZ, Netherlands
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Leach K, Tang S, Sturgeon J, Lee AK, Grover R, Sanghvi P, Urbanic J, Chang C. Beam-Specific Spot Guidance and Optimization for PBS Proton Treatment of Bilateral Head and Neck Cancers. Int J Part Ther 2021; 8:50-61. [PMID: 34285935 PMCID: PMC8270101 DOI: 10.14338/ijpt-20-00060.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/19/2021] [Indexed: 12/05/2022] Open
Abstract
PURPOSE A multi-field optimization (MFO) technique that uses beam-specific spot placement volumes (SPVs) and spot avoidance volumes (SAVs) is introduced for bilateral head and neck (H&N) cancers. These beam-specific volumes are used to guide the optimizer to consistently achieve optimal organ-at-risk (OAR) sparing with target coverage and plan robustness. MATERIALS AND METHODS Implementation of this technique using a 4-beam, 5-beam, and variant 5-beam arrangement is discussed. The generation of beam-specific SPVs and SAVs derived from target and OARs are shown. The SPVs for select fields are further partitioned into optimization volumes for uniform dose distributions that resemble those of single-field optimization (SFO). A conventional MFO plan that does not use beam-specific spot placement guidance (MFOcon) and an MFO plan that uses only beam-specific SPV (MFOspv) are compared with current technique (MFOspv/sav), using both simulated scenarios and forward-calculated plans on weekly verification computed tomography (VFCT) scans. RESULTS Dose distribution characteristics of the 4-beam, 5-beam, and variant 5-beam technique are demonstrated with discussion on OAR sparing. When comparing the MFOcon, MFOspv, and MFOspv/sav, the MFOspv/sav is shown to have superior OAR sparing in 9 of the 14 OARs examined. It also shows clinical plan robustness when evaluated by using both simulated uncertainty scenarios and forward-calculated weekly VFCTs throughout the 7-week treatment course. CONCLUSION The MFOspv/sav technique is a systematic approach using SPVs and SAVs to guide the optimizer to consistently reach desired OAR dose values and plan robustness.
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Affiliation(s)
- Karla Leach
- California Protons Cancer Therapy Center, San Diego, CA, USA
- Texas Center for Proton Therapy, Irving, TX, USA
| | - Shikui Tang
- Texas Center for Proton Therapy, Irving, TX, USA
| | | | | | - Ryan Grover
- California Protons Cancer Therapy Center, San Diego, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - Parag Sanghvi
- California Protons Cancer Therapy Center, San Diego, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - James Urbanic
- California Protons Cancer Therapy Center, San Diego, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - Chang Chang
- California Protons Cancer Therapy Center, San Diego, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
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Noufal MP, Sharma SD, Patro K, Arjunan M, Krishnan G, Tyagarajan R, Rana S, Chillukuri S, Jalali R. Impact of spot positional errors in robustly optimized intensity-modulated proton therapy plan of craniospinal irradiation. Radiol Phys Technol 2021; 14:271-278. [PMID: 34089492 DOI: 10.1007/s12194-021-00625-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/24/2022]
Abstract
We investigated the influence of random spot positioning errors (SPEs) on dosimetric outcomes of robustly optimized intensity-modulated proton therapy (RB-IMPT) plans in craniospinal irradiation (CSI). Six patients with CSI treated using the RB-IMPT technique were selected. An in-house MATLAB code was used to simulate a random SPE of 1 mm in positive, negative, and both directions for 25%, 50%, and 75% of the total spot positions in the nominal plan. The percentage dose variation (ΔD%) in the six nominal and 54 error-introduced plans was evaluated using standard dose-volume indices, line dose difference, and 3D gamma analysis method. The introduction of a random SPE of 1 mm resulted in a reduction in D99%, D98%, and D95% of both CTVs and PTVs by < 2% compared with the corresponding nominal plans. However, this leads to an increase in D1% of the lens by up to 16.9%. The line dose in the junction region showed ΔD% < 2% for the brain and upper spine and < 4% for the upper and lower spine. The 3D gamma values for 3% at 3 mm and 2% at 2 mm were above 99% and 95%, respectively, in all 54 error-introduced plans. The worst decrease in gamma values was observed for 1% at 1 mm, with values ranging from 64 to 78% for all types of SPE. The RB-IMPT plan for CSI investigated in this study is robust enough for target coverage, even if there are random SPEs of 1 mm. However, this leads to an increase in the dose to the critical organ located close to the target.
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Affiliation(s)
- Manthala Padannayil Noufal
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, Tamil Nadu, 400053, India.
| | | | - Katikeshwar Patro
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, Tamil Nadu, 400053, India
| | - Manikandan Arjunan
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, Tamil Nadu, 400053, India
| | - Ganapathy Krishnan
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, Tamil Nadu, 400053, India
| | - Rajesh Tyagarajan
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, Tamil Nadu, 400053, India
| | - Suresh Rana
- Department of Medical Physics, Oklahoma Proton Center, Oklahoma City, OK, 73142, USA
| | - Srinivas Chillukuri
- Department of Radiation Oncology, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, Tamil Nadu, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, Tamil Nadu, India
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9
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Hua CH, Mascia AE, Servalli E, Lomax AJ, Seiersen K, Ulin K. Advances in radiotherapy technology for pediatric cancer patients and roles of medical physicists: COG and SIOP Europe perspectives. Pediatr Blood Cancer 2021; 68 Suppl 2:e28344. [PMID: 33818892 PMCID: PMC8030241 DOI: 10.1002/pbc.28344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/27/2020] [Accepted: 04/02/2020] [Indexed: 11/11/2022]
Abstract
Over the last two decades, rapid technological advances have dramatically changed radiation delivery to children with cancer, enabling improved normal-tissue sparing. This article describes recent advances in photon and proton therapy technologies, image-guided patient positioning, motion management, and adaptive therapy that are relevant to pediatric cancer patients. For medical physicists who are at the forefront of realizing the promise of technology, challenges remain with respect to ensuring patient safety as new technologies are implemented with increasing treatment complexity. The contributions of medical physicists to meeting these challenges in daily practice, in the conduct of clinical trials, and in pediatric oncology cooperative groups are highlighted. Representing the perspective of the physics committees of the Children's Oncology Group (COG) and the European Society for Paediatric Oncology (SIOP Europe), this paper provides recommendations regarding the safe delivery of pediatric radiotherapy. Emerging innovations are highlighted to encourage pediatric applications with a view to maximizing the therapeutic ratio.
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Affiliation(s)
- Chia-ho Hua
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Anthony E. Mascia
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Enrica Servalli
- Department of Radiotherapy, University Medical Center Utrecht, The Netherlands
| | - Antony J. Lomax
- Center for Proton Therapy, Paul Scherrer Institute, PSI Villigen, Switzerland
| | | | - Kenneth Ulin
- Department of Radiation Oncology, University of Massachusetts, Worcester, Massachusetts, USA
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10
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Yang TJ, Wijetunga NA, Yamada J, Wolden S, Mehallow M, Goldman DA, Zhang Z, Young RJ, Kris MG, Yu HA, Seidman AD, Gavrilovic IT, Lin A, Santomasso B, Grommes C, Piotrowski AF, Schaff L, Stone JB, DeAngelis LM, Boire A, Pentsova E. Clinical trial of proton craniospinal irradiation for leptomeningeal metastases. Neuro Oncol 2021; 23:134-143. [PMID: 32592583 PMCID: PMC7850116 DOI: 10.1093/neuonc/noaa152] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Leptomeningeal metastases (LM) are associated with limited survival and treatment options. While involved-field radiotherapy is effective for local palliation, it lacks durability. We evaluated the toxicities of proton craniospinal irradiation (CSI), a treatment encompassing the entire central nervous system (CNS) compartment, for patients with LM from solid tumors. METHODS We enrolled patients with LM to receive hypofractionated proton CSI in this phase I prospective trial. The primary endpoint was to describe treatment-related toxicity, with dose-limiting toxicity (DLT) defined as any radiation-related grade 3 non-hematologic toxicity or grade 4 hematologic toxicity according to the Common Terminology Criteria for Adverse Events that occurred during or within 4 weeks of completion of proton CSI. Secondary endpoints included CNS progression-free survival (PFS) and overall survival (OS). RESULTS We enrolled 24 patients between June 2018 and April 2019. Their median follow-up was 11 months. Twenty patients were evaluable for protocol treatment-related toxicities and 21 for CNS PFS and OS. Two patients in the dose expansion cohort experienced DLTs consisted of grade 4 lymphopenia, grade 4 thrombocytopenia, and/or grade 3 fatigue. All DLTs resolved without medical intervention. The median CNS PFS was 7 months (95% CI: 5-13) and the median OS was 8 months (95% CI: 6 to not reached). Four patients (19%) were progression-free in the CNS for more than 12 months. CONCLUSION Hypofractionated proton CSI using proton therapy is a safe treatment for patients with LM from solid tumors. We saw durable disease control in some patients.
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Affiliation(s)
- T Jonathan Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- PROMISE (Precision Radiation for OligoMetastatIc and MetaStatic DiseasE) Program, Memorial Sloan Kettering Cancer Center, New York, New York
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neil A Wijetunga
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Josh Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- PROMISE (Precision Radiation for OligoMetastatIc and MetaStatic DiseasE) Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Suzanne Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michelle Mehallow
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert J Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark G Kris
- Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helena A Yu
- Division of Solid Tumor Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew D Seidman
- Division of Solid Tumor Oncology, Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Igor T Gavrilovic
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew Lin
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bianca Santomasso
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christian Grommes
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anna F Piotrowski
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lauren Schaff
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jacqueline B Stone
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adrienne Boire
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena Pentsova
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York
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11
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Sharma S, Noufal M, Krishnan G, Sawant M, Gaikwad U, Jalali R. Robustly optimized hybrid intensity-modulated proton therapy for craniospinal irradiation. J Cancer Res Ther 2021; 18:1597-1603. [DOI: 10.4103/jcrt.jcrt_740_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Zhou Y, Ai Y, Han C, Zheng X, Yi J, Xie C, Jin X. Impact of setup errors on multi-isocenter volumetric modulated arc therapy for craniospinal irradiation. J Appl Clin Med Phys 2020; 21:115-123. [PMID: 33070426 PMCID: PMC7700930 DOI: 10.1002/acm2.13044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/27/2020] [Accepted: 09/15/2020] [Indexed: 01/30/2023] Open
Abstract
Multi‐isocenter volumetric modulated arc therapy (VMAT) is recommended for craniospinal irradiation (CSI) to smooth the dose distribution in the junction regions relying solely on inverse optimization. However, few studies have measured the dosimetric impact of setup errors on this multi‐isocenter VMAT in the junction areas. The purpose of this study is to evaluate the impact of positional errors during VMAT CSI with two‐dimension (2D) and three‐dimension (3D) dosimetric measurements. A total of 20 patients treated by three‐isocenter VMAT CSI were retrospectively reviewed and analyzed. A 3D diode array ArcCHECK and radiochromic film EBT3 were applied to measure the percentage gamma passing rates (%GPs) and dose distributions in the junction areas between the cranial/upper‐spinal and the upper/lower‐spinal fields with intentionally introduced setup errors of ± 1 mm, ±2 mm, ±3 mm, ±5 mm, and ± 8 mm, respectively. The length and volume of planning target volume (PTV) for these CSI patients ranged from 50.14 to 80.8 cm, and 1572.3 to 2114.5 cm3, respectively. The %GPs for ±3 mm, ±5 mm, and ±8 mm positional errors were around 95%, 90%, and 85%, respectively, in the junction areas. The dosimetric verification results with EBT3 films indicated that cold and hot areas were observed with the increase of introduced setup errors. In conclusion, the dosimetric verification with intentionally introduced setup errors demonstrated that positional errors within 3 mm have a little impact for VMAT CSI, although setup errors should be minimized. Relying on the inverse optimization of VMAT to smooth the dose distribution in the junction areas is feasible for CSI.
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Affiliation(s)
- Yongqiang Zhou
- Department of radiation and medical oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yao Ai
- Department of radiation and medical oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ce Han
- Department of radiation and medical oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaomin Zheng
- Department of radiation and medical oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinling Yi
- Department of radiation and medical oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Congying Xie
- Department of radiation and medical oncology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiance Jin
- Department of radiation and medical oncology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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13
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Automatic feathering algorithm for VMAT craniospinal irradiation: A comprehensive comparison with other VMAT planning strategies. Med Dosim 2020; 46:103-110. [PMID: 32967789 DOI: 10.1016/j.meddos.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/22/2020] [Accepted: 09/11/2020] [Indexed: 01/06/2023]
Abstract
In craniospinal irradiation, field matching is very sensitive to intrafraction positional uncertainties in cranio-caudal direction, which could lead to severe overdoses/underdoses inside the planning target volume. During the last decade, significant efforts were made to develop volumetric-modulated arc therapy strategies, which were less sensitive to setup uncertainties. In this study, a treatment planning system-integrated method, named automatic feathering (AF) algorithm, was compared against other volumetric-modulated arc therapy strategies. Three patients were retrospectively included. Five different planning techniques were compared, including overlap (O), staggered overlap (SO), gradient optimization (GO), overlap with AF algorithm turned on (O-AF), and staggered overlap with AF algorithm turned on (SO-AF). Three overlapping lengths were considered (5 cm, 7.5 cm, and 10 cm). The middle isocenter was shifted of ±1 mm, ±3 mm, and ±5 mm to simulate setup uncertainties. Plan robustness against simulated uncertainties was evaluated by calculating near maximum and near minimum dose differences between shifted and nonshifted plans (ΔD2%, ΔD98%). Dose differences among combinations of techniques and junction lengths were tested using Wilcoxon signed-rank test. Higher ΔD2% and ΔD98% were obtained using the overlap technique (ΔD2% = 15.4%, ΔD98% = 15.0%). O-AF and SO-AF provided comparable plan robustness to GO technique. Their performance improved significantly for grater overlapping length. For 10-cm overlap and 5-mm shift, GO, O-AF, and SO-AF yielded to the better plan robustness (5.7% < ΔD2% < 6.0%, 6.1% < ΔD98% < 7.6%). SO provided an intermediate plan robustness (9.8% < ΔD2% < 10.8%, 8.9% < ΔD98% < 10.3%). The addition of AF to the overlap technique significantly improves plan robustness especially if larger overlapping lengths are used. Using the AF algorithm, plans become as robust as plans optimized with more sophisticated and time-consuming approaches (like GO).
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14
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Kato M, Dobashi S, Kato T, Kato R, Masaki K, Arai K, Komori S, Oyama S, Endo H, Wada H, Murakami M, Takeda K. [Influence and Countermeasure of Respiratory Motion on Matchline Profile of Field Matching Technique in Passive Scattering Proton Therapy for Esophageal Cancer]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:1383-1393. [PMID: 31866636 DOI: 10.6009/jjrt.2019_jsrt_75.12.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study aimed to evaluate the influence of change in respiratory motion on matchline (ML) and reduction of the effect by increasing ML levels of field matching technique in passive scattering proton therapy for esophageal cancer. To evaluate the influence of respiratory motion in terms of stability, we measured relative dose around ML using a respiratory motion phantom. The relative error was -0.5% when the respiratory motion phantom worked stable, whereas there was obvious change that the relative error was -25.5% when the difference of amplitude between upper field and lower field was one side 3 mm on each cranially and caudally direction. In clinical case of the seven esophageal cancer patients simulated by the treatment planning system, assuming the difference of amplitude was 3 mm, the relative error of maximum (minimum) dose in clinical target volume around ML against the original treatment plan were 5.8±1.2% (-6.0±2.7%), 3.3±0.9% (-3.8±1.0%), and 2.4±0.5% (2.6±0.8%) on average (±SD) when ML levels were 2, 4, and 6, respectively. Increasing ML levels can reduce the influence of respiratory motion.
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Affiliation(s)
- Masato Kato
- Department of Radiology, Southern TOHOKU Proton Therapy Center, Southern TOHOKU Research Institute for Neuroscience
| | - Suguru Dobashi
- Course of Radiological Technology, Health Sciences, Tohoku University School of Medicine
| | - Takahiro Kato
- Department of Radiology, Southern TOHOKU Proton Therapy Center, Southern TOHOKU Research Institute for Neuroscience.,Department of Radiotherapy Quality Management, Southern TOHOKU Proton Therapy Center, Southern TOHOKU Research Institute for Neurosciences.,Preparing Section for New Faculty of Medical Science, Fukushima Medical University
| | - Ryohei Kato
- Department of Radiotherapy Quality Management, Southern TOHOKU Proton Therapy Center, Southern TOHOKU Research Institute for Neurosciences
| | - Keita Masaki
- Department of Radiotherapy Quality Management, Southern TOHOKU Proton Therapy Center, Southern TOHOKU Research Institute for Neurosciences
| | - Kazuhiro Arai
- Department of Radiotherapy Quality Management, Southern TOHOKU Proton Therapy Center, Southern TOHOKU Research Institute for Neurosciences
| | - Shinya Komori
- Department of Radiotherapy Quality Management, Southern TOHOKU Proton Therapy Center, Southern TOHOKU Research Institute for Neurosciences
| | - Sho Oyama
- Department of Radiotherapy Quality Management, Southern TOHOKU Proton Therapy Center, Southern TOHOKU Research Institute for Neurosciences
| | - Hiromitsu Endo
- Department of Radiology, Southern TOHOKU Proton Therapy Center, Southern TOHOKU Research Institute for Neuroscience
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Southern TOHOKU Research Institute for Neuroscience
| | - Masao Murakami
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Southern TOHOKU Research Institute for Neuroscience
| | - Ken Takeda
- Course of Radiological Technology, Health Sciences, Tohoku University School of Medicine
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15
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Hong CS, Kim MJ, Kim J, Chang KH, Park K, Kim DW, Han MC, Yoon HI, Kim JS, Lee H. Feasibility of hybrid TomoHelical- and TomoDirect-based volumetric gradient matching technique for total body irradiation. Radiat Oncol 2019; 14:233. [PMID: 31856870 PMCID: PMC6924057 DOI: 10.1186/s13014-019-1435-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tomotherapy-based total body irradiation (TBI) is performed using the head-first position (HFP) and feet-first position (FFP) due to treatment length exceeding the 135 cm limit. To reduce the dosimetric variation at the match lines, we propose and verify a volumetric gradient matching technique (VGMT) by combining TomoHelical (TH) and TomoDirect (TD) modes. METHODS Two planning CT image sets were acquired with HFP and FFP using 15 × 55 × 18 cm3 of solid water phantom. Planning target volume (PTV) was divided into upper, lower, and gradient volumes. The junction comprised 2-cm thick five and seven gradient volumes (5-GVs and 7-GVs) to create a dose distribution with a gentle slope. TH-IMRT and TD-IMRT plans were generated with 5-GVs and 7-GVs. The setup error in the calculated dose was assessed by shifting dose distribution of the FFP plan by 5, 10, 15, and 20 mm in the longitudinal direction and comparing it with the original. Doses for 95% (D95) and 5% of the PTV (D5) were calculated for all simulated setup error plans. Absolute dose measurements were performed using an ionization chamber in the junction. RESULTS The TH&TD plan produced a linear gradient in junction volume, comparable to that of the TH&TH plan. D5 of the PTV was 110% of the prescribed dose when the FFP plan was shifted 0.7 cm and 1.2 cm in the superior direction for 5-GVs and 7-GVs. D95 of the PTV decreased to < 90% of the prescribed dose when the FF plan was shifted 1.1 cm and 1.3 cm in the inferior direction for 5-GVs and 7-GVs. The absolute measured dose showed a good correlation with the calculated dose in the gradient junction volume. The average percent difference (±SD) in all measured points was - 0.7 ± 1.6%, and the average dose variations between depths was - 0.18 ± 1.07%. CONCLUSION VGMT can create a linear dose gradient across the junction area in both TH&TH and TH&TD and can minimize the dose sensitivity to longitudinal setup errors in tomotherapy-based TBI.
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Affiliation(s)
- Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Min-Joo Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Jihun Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Kyung Hwan Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Kwangwoo Park
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Dong Wook Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Min Cheol Han
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea.
| | - Ho Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea.
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16
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Vogel J, Grewal A, O’Reilly S, Lustig R, Kurtz G, Minturn JE, Shah AC, Waanders AJ, Belasco JB, Cole KA, Fisher MJ, Phillips PC, Balamuth NJ, Storm PB, Hill-Kayser CE. Risk of brainstem necrosis in pediatric patients with central nervous system malignancies after pencil beam scanning proton therapy. Acta Oncol 2019; 58:1752-1756. [PMID: 31512931 DOI: 10.1080/0284186x.2019.1659996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: Radiation therapy (RT) plays an important role in management of pediatric central nervous system (CNS) malignancies. Centers are increasingly utilizing pencil beam scanning proton therapy (PBS-PT). However, the risk of brainstem necrosis has not yet been reported. In this study, we evaluate the rate of brainstem necrosis in pediatric patients with CNS malignancies treated with PBS-PT.Material and methods: Pediatric patients with non-hematologic CNS malignancies treated with PBS-PT who received dose to the brainstem were included. All procedures were approved by the institutional review board. Brainstem necrosis was defined as symptomatic toxicity. The actuarial rate was analyzed by the Kaplan Meier method.Results: One hundred and sixty-six consecutive patients were reviewed. Median age was 10 years (range 0.5-21 years). Four patients (2.4%) had prior radiation. Median maximum brainstem dose in the treated course was 55.4 Gy[RBE] (range 0.15-61.4 Gy[RBE]). In patients with prior RT, cumulative median maximum brainstem dose was 98.0 Gy [RBE] (range 17.0-111.0 Gy [RBE]). Median follow up was 19.6 months (range, 2.0-63.0). One patient who had previously been treated with twice-daily radiation therapy and intrathecal (IT) methotrexate experienced brainstem necrosis. The actuarial incidence of brainstem necrosis was 0.7% at 24 months (95% CI 0.1-5.1%).Conclusion: The rate of symptomatic brainstem necrosis was extremely low after treatment with PBS-PT in this study. Further work to clarify clinical and dosimetric parameters associated with risk of brainstem necrosis after PBS-PT is needed.
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Affiliation(s)
- J. Vogel
- Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A. Grewal
- Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - S. O’Reilly
- Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - R. Lustig
- Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - G. Kurtz
- Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - J. E. Minturn
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - A. C. Shah
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - A. J. Waanders
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - J. B. Belasco
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - K. A. Cole
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - M. J. Fisher
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - P. C. Phillips
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - N. J. Balamuth
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - P. B. Storm
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - C. E. Hill-Kayser
- Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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17
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Fellin F, Fracchiolla F, Rombi B, Lipparini M, Vennarini S, Farace P. An advanced junction concept in pediatric craniospinal irradiation by proton pencil beam scanning. Phys Med 2019; 60:168-173. [DOI: 10.1016/j.ejmp.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/03/2019] [Accepted: 04/06/2019] [Indexed: 11/24/2022] Open
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18
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Farr JB, Flanz JB, Gerbershagen A, Moyers MF. New horizons in particle therapy systems. Med Phys 2018; 45:e953-e983. [DOI: 10.1002/mp.13193] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 05/28/2018] [Accepted: 07/14/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jonathan B. Farr
- Department of Medical Physics Applications of Detectors and Accelerators to Medicine SA 1217 Geneva Switzerland
| | - Jacob B. Flanz
- Department of Radiation Oncology Massachusetts General Hospital and Harvard Medical School Boston MAUSA
| | - Alexander Gerbershagen
- Department of Engineering European Organization for Nuclear Research (CERN) 1211 Geneva 23 Switzerland
| | - Michael F. Moyers
- Department of Medical Physics Shanghai Proton and Heavy Ion Center Shanghai 201315 China
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19
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De B, Cahlon O, Sine K, Mah D, Hug EB, Wolden SL. Early Axial Growth Outcomes of Pediatric Patients Receiving Proton Craniospinal Irradiation. J Pediatr Hematol Oncol 2018; 40:574-579. [PMID: 29889805 PMCID: PMC6197896 DOI: 10.1097/mph.0000000000001242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Guidelines on proton craniospinal irradiation (p-CSI) target volume selection in children are lacking. We examined the impact of target volume selection on growth of children receiving p-CSI at a institution. Records of 58 patients who received p-CSI were reviewed. Median age at treatment initiation was 8 years (range, 2 to 18 y). Spinal target volumes included whole vertebral body (WVB) in 67% and partial vertebral body (PVB) in 33%. Height z-scores before and after p-CSI were assessed using Centers for Disease Control and Prevention stature-for-age charts. Maximal Cobb angle and height z-score change were compared for WVB versus PVB p-CSI using a t test. Among 93% of patients with detailed data, median follow-up was 19 months (range, 2 to 58 mo) after radiation therapy initiation. Quantitative growth evaluations were available for 64% of patients. Median change in height z-score was -0.5 (range, -2.1 to +0.7) after treatment, representing a decrease (P<0.001) in age-adjusted height. WVB patients had significantly greater reduction in height z-score versus PVB patients (P=0.004) but no difference in Cobb angle change (P>0.05). Despite reluctance surrounding its use in younger patients, PVB p-CSI was associated with similar spinal curvature and less growth suppression as compared with WVB p-CSI; a trial comparing WVB versus PVB in children may be warranted.
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Affiliation(s)
- Brian De
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- ProCure Proton Therapy Center, 103 Cedar Grove Lane, Somerset, NJ 08873, USA
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- ProCure Proton Therapy Center, 103 Cedar Grove Lane, Somerset, NJ 08873, USA
| | - Kevin Sine
- ProCure Proton Therapy Center, 103 Cedar Grove Lane, Somerset, NJ 08873, USA
| | - Dennis Mah
- ProCure Proton Therapy Center, 103 Cedar Grove Lane, Somerset, NJ 08873, USA
| | - Eugen B. Hug
- ProCure Proton Therapy Center, 103 Cedar Grove Lane, Somerset, NJ 08873, USA
| | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- ProCure Proton Therapy Center, 103 Cedar Grove Lane, Somerset, NJ 08873, USA
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20
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Dabaja BS, Hoppe BS, Plastaras JP, Newhauser W, Rosolova K, Flampouri S, Mohan R, Mikhaeel NG, Kirova Y, Specht L, Yahalom J. Proton therapy for adults with mediastinal lymphomas: the International Lymphoma Radiation Oncology Group guidelines. Blood 2018; 132:1635-1646. [PMID: 30108066 PMCID: PMC6212652 DOI: 10.1182/blood-2018-03-837633] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/19/2018] [Indexed: 12/25/2022] Open
Abstract
Among adult lymphoma survivors, radiation treatment techniques that increase the excess radiation dose to organs at risk (OARs) put patients at risk for increased side effects, especially late toxicities. Minimizing radiation to OARs in adults patients with Hodgkin and non-Hodgkin lymphomas involving the mediastinum is the deciding factor for the choice of treatment modality. Proton therapy may help to reduce the radiation dose to the OARs and reduce toxicities, especially the risks for cardiac morbidity and second cancers. Because proton therapy may have some disadvantages, identifying the patients and the circumstances that may benefit the most from proton therapy is important. We present modern guidelines to identify adult lymphoma patients who may derive the greatest benefit from proton therapy, along with an analysis of the advantages and disadvantages of proton treatment.
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Affiliation(s)
- Bouthaina Shbib Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bradford S Hoppe
- Department of Radiation Oncology, University of Florida, Jacksonville, FL
| | - John P Plastaras
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Wayne Newhauser
- Department of Radiation Physics, University of Louisiana, Baton Rouge, LA
| | - Katerina Rosolova
- Proton Therapy Department, Proton Therapy Center Czech, Prague, Czech Republic
- Department of Oncology, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Stella Flampouri
- Department of Radiation Oncology, University of Florida, Jacksonville, FL
| | - Radhe Mohan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - N George Mikhaeel
- Department of Radiation Oncology, Guy's and St. Thomas' Hospital, London, United Kingdom
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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21
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Seravalli E, Bosman M, Lassen-Ramshad Y, Vestergaard A, Oldenburger F, Visser J, Koutsouveli E, Paraskevopoulou C, Horan G, Ajithkumar T, Timmermann B, Fuentes CS, Whitfield G, Marchant T, Padovani L, Garnier E, Gandola L, Meroni S, Hoeben BAW, Kusters M, Alapetite C, Losa S, Goudjil F, Magelssen H, Evensen ME, Saran F, Smyth G, Rombi B, Righetto R, Kortmann RD, Janssens GO. Dosimetric comparison of five different techniques for craniospinal irradiation across 15 European centers: analysis on behalf of the SIOP-E-BTG (radiotherapy working group) . Acta Oncol 2018; 57:1240-1249. [PMID: 29698060 DOI: 10.1080/0284186x.2018.1465588] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Conventional techniques (3D-CRT) for craniospinal irradiation (CSI) are still widely used. Modern techniques (IMRT, VMAT, TomoTherapy®, proton pencil beam scanning [PBS]) are applied in a limited number of centers. For a 14-year-old patient, we aimed to compare dose distributions of five CSI techniques applied across Europe and generated according to the participating institute protocols, therefore representing daily practice. MATERIAL AND METHODS A multicenter (n = 15) dosimetric analysis of five different techniques for CSI (3D-CRT, IMRT, VMAT, TomoTherapy®, PBS; 3 centers per technique) was performed using the same patient data, set of delineations and dose prescription (36.0/1.8 Gy). Different treatment plans were optimized based on the same planning target volume margin. All participating institutes returned their best treatment plan applicable in clinic. RESULTS The modern radiotherapy techniques investigated resulted in superior conformity/homogeneity-indices (CI/HI), particularly in the spinal part of the target (CI: 3D-CRT:0.3 vs. modern:0.6; HI: 3D-CRT:0.2 vs. modern:0.1), and demonstrated a decreased dose to the thyroid, heart, esophagus and pancreas. Dose reductions of >10.0 Gy were observed with PBS compared to modern photon techniques for parotid glands, thyroid and pancreas. Following this technique, a wide range in dosimetry among centers using the same technique was observed (e.g., thyroid mean dose: VMAT: 5.6-24.6 Gy; PBS: 0.3-10.1 Gy). CONCLUSIONS The investigated modern radiotherapy techniques demonstrate superior dosimetric results compared to 3D-CRT. The lowest mean dose for organs at risk is obtained with proton therapy. However, for a large number of organs ranges in mean doses were wide and overlapping between techniques making it difficult to recommend one radiotherapy technique over another.
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Affiliation(s)
- Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht and Princess Maxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Mirjam Bosman
- Department of Radiation Oncology, University Medical Center Utrecht and Princess Maxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Yasmin Lassen-Ramshad
- Department of Oncology and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Vestergaard
- Department of Oncology and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Foppe Oldenburger
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jorrit Visser
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Efi Koutsouveli
- Department of Radiation Oncology, Hygeia Hospital, Athens, Greece
| | | | - Gail Horan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Thankamma Ajithkumar
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Beate Timmermann
- Clinic for Particle Therapy, West German Protontherapy Center Essen, University Hospital Essen, Essen, Germany
| | - Carolina-Sofia Fuentes
- Clinic for Particle Therapy, West German Protontherapy Center Essen, University Hospital Essen, Essen, Germany
| | - Gillian Whitfield
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK and The Children's Brain Tumour Research Network, University of Manchester, Royal Mancheste Children's Hospital, Manchester, UK
| | | | - Laetitia Padovani
- Department of Radiotherapy, Centre Hospitalier Universitaire de La Timone, Marseille, France
| | - Eloise Garnier
- Department of Radiotherapy, Centre Hospitalier Universitaire de La Timone, Marseille, France
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Silvia Meroni
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Bianca A. W. Hoeben
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martijn Kusters
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Claire Alapetite
- Department of Radiation Oncology, Institut Curie and Centre de protontherapie, Paris and Orsay, France
| | - Sandra Losa
- Department of Radiation Oncology, Institut Curie and Centre de protontherapie, Paris and Orsay, France
| | - Farid Goudjil
- Department of Radiation Oncology, Institut Curie and Centre de protontherapie, Paris and Orsay, France
| | - Henriette Magelssen
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Morten Egeberg Evensen
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Frank Saran
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Gregory Smyth
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Barbara Rombi
- Protontherapy Center, Azienda Provinciale per i Servizi Sanitari APSS, Trento, Italy
| | - Roberto Righetto
- Protontherapy Center, Azienda Provinciale per i Servizi Sanitari APSS, Trento, Italy
| | | | - Geert O. Janssens
- Department of Radiation Oncology, University Medical Center Utrecht and Princess Maxima Centre for Pediatric Oncology, Utrecht, The Netherlands
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22
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Wang K, Meng H, Chen J, Zhang W, Feng Y. Plan quality and robustness in field junction region for craniospinal irradiation with VMAT. Phys Med 2018; 48:21-26. [DOI: 10.1016/j.ejmp.2018.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/02/2018] [Accepted: 03/11/2018] [Indexed: 02/05/2023] Open
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23
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Ding X, Li X, Qin A, Zhou J, Yan D, Stevens C, Krauss D, Kabolizadeh P. Have we reached proton beam therapy dosimetric limitations? - A novel robust, delivery-efficient and continuous spot-scanning proton arc (SPArc) therapy is to improve the dosimetric outcome in treating prostate cancer. Acta Oncol 2018; 57:435-437. [PMID: 28774218 DOI: 10.1080/0284186x.2017.1358463] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
| | - Xiaoqiang Li
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
| | - An Qin
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
| | - Jun Zhou
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
| | - Di Yan
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
| | - Daniel Krauss
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
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24
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Tasson A, Laack NN, Beltran C. Clinical Implementation of Robust Optimization for Craniospinal Irradiation. Cancers (Basel) 2018; 10:cancers10010007. [PMID: 29301336 PMCID: PMC5789357 DOI: 10.3390/cancers10010007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/15/2017] [Accepted: 12/26/2017] [Indexed: 12/02/2022] Open
Abstract
With robust optimization for spot scanning proton therapy now commercially available, the ability exists to account for setup, range, and interfield uncertainties during optimization. Robust optimization is particularly beneficial for craniospinal irradiation (CSI) where the large target volume lends itself to larger setup uncertainties and the need for robust match lines can all be handled with the uncertainty parameters found inside the optimizer. Suggested robust optimization settings, parameters, and image guidance for CSI patients using proton therapy spot scanning are provided. Useful structures are defined and described. Suggestions are given for perturbations to be entered into the optimizer in order to achieve a plan that provides robust target volume coverage and critical structure sparing as well as a robust match line. Interfield offset effects, a concern when using multifield optimization, can also be addressed within the robust optimizer. A robust optimizer can successfully be employed to produce robust match lines, target volume coverage, and critical structure sparing under specified uncertainties. The robust optimizer can also be used to reduce effects arising from interfield uncertainties. Using robust optimization, a plan robust against setup, range, and interfield uncertainties for craniospinal treatments can be created. Utilizing robust optimization allows one to ensure critical structures are spared and target volumes are covered under the desired uncertainty parameters.
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Affiliation(s)
- Alexandria Tasson
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Chris Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
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25
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Traneus E, Bizzocchi N, Fellin F, Rombi B, Farace P. Universal field matching in craniospinal irradiation by a background-dose gradient-optimized method. J Appl Clin Med Phys 2017; 19:46-49. [PMID: 29115059 PMCID: PMC5768013 DOI: 10.1002/acm2.12204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 09/13/2017] [Accepted: 09/27/2017] [Indexed: 12/28/2022] Open
Abstract
Purpose The gradient‐optimized methods are overcoming the traditional feathering methods to plan field junctions in craniospinal irradiation. In this note, a new gradient‐optimized technique, based on the use of a background dose, is described. Methods Treatment planning was performed by RayStation (RaySearch Laboratories, Stockholm, Sweden) on the CT scans of a pediatric patient. Both proton (by pencil beam scanning) and photon (by volumetric modulated arc therapy) treatments were planned with three isocenters. An ‘in silico’ ideal background dose was created first to cover the upper‐spinal target and to produce a perfect dose gradient along the upper and lower junction regions. Using it as background, the cranial and the lower‐spinal beams were planned by inverse optimization to obtain dose coverage of their relevant targets and of the junction volumes. Finally, the upper‐spinal beam was inversely planned after removal of the background dose and with the previously optimized beams switched on. Results In both proton and photon plans, the optimized cranial and the lower‐spinal beams produced a perfect linear gradient in the junction regions, complementary to that produced by the optimized upper‐spinal beam. The final dose distributions showed a homogeneous coverage of the targets. Discussion Our simple technique allowed to obtain high‐quality gradients in the junction region. Such technique universally works for photons as well as protons and could be applicable to the TPSs that allow to manage a background dose.
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Affiliation(s)
| | | | | | | | - Paolo Farace
- Proton therapy UnitHospital of TrentoTrentoItaly
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26
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Stützer K, Lin A, Kirk M, Lin L. Superiority in Robustness of Multifield Optimization Over Single-Field Optimization for Pencil-Beam Proton Therapy for Oropharynx Carcinoma: An Enhanced Robustness Analysis. Int J Radiat Oncol Biol Phys 2017; 99:738-749. [PMID: 29280468 DOI: 10.1016/j.ijrobp.2017.06.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 06/01/2017] [Accepted: 06/13/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE To compare the difference in robustness of single-field optimized (SFO) and robust multifield optimized (rMFO) proton plans for oropharynx carcinoma patients by an improved robustness analysis. METHODS AND MATERIALS We generated rMFO proton plans for 11 patients with oropharynx carcinoma treated with SFO intensity modulated proton therapy with simultaneous integrated boost prescription. Doses from both planning approaches were compared for the initial plans and the worst cases from 20 optimization scenarios of setup errors and range uncertainties. Expected average dose distributions per range uncertainty were obtained by weighting the contributions from the respective scenarios with their expected setup error probability, and the spread of dose parameters for different range uncertainties were quantified. Using boundary dose distributions created from 56 combined setup error and range uncertainty scenarios and considering the vanishing influence of setup errors after 30 fractions, we approximated realistic worst-case values for the total treatment course. Error bar metrics derived from these boundary doses are reported for the clinical target volumes (CTVs) and organs at risk (OARs). RESULTS The rMFO plans showed improved CTV coverage and homogeneity while simultaneously reducing the average mean dose to the constrictor muscles, larynx, and ipsilateral middle ear by 5.6 Gy, 2.0 Gy, and 3.9 Gy, respectively. We observed slightly larger differences during robustness evaluation, as well as a significantly higher average brainstem maximum and ipsilateral parotid mean dose for SFO plans. For rMFO plans, the range uncertainty-related spread in OAR dose parameters and many error bar metrics were found to be superior. The SFO plans showed a lower global maximum dose for single-scenario worst cases and a slightly lower mean oral cavity dose throughout. CONCLUSIONS An enhanced robustness analysis has been proposed and implemented into clinical systems. The benefit of better CTV coverage and OAR dose sparing in oropharynx carcinoma patients by rMFO compared with SFO proton plans is preserved in a robustness analysis with consideration of setup error and range uncertainty.
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Affiliation(s)
- Kristin Stützer
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania; OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maura Kirk
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Liyong Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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27
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Farace P, Bizzocchi N, Righetto R, Fellin F, Fracchiolla F, Lorentini S, Widesott L, Algranati C, Rombi B, Vennarini S, Amichetti M, Schwarz M. Supine craniospinal irradiation in pediatric patients by proton pencil beam scanning. Radiother Oncol 2017; 123:112-118. [DOI: 10.1016/j.radonc.2017.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/19/2017] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
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28
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Pencil beam scanning proton therapy vs rotational arc radiation therapy: A treatment planning comparison for postoperative oropharyngeal cancer. Med Dosim 2017; 42:7-11. [DOI: 10.1016/j.meddos.2016.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 07/26/2016] [Accepted: 09/13/2016] [Indexed: 12/13/2022]
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29
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Liao L, Lim GJ, Li Y, Yu J, Sahoo N, Li H, Gillin M, Zhu XR, Mahajan A, Frank SJ, Grosshans DR, Nguyen QN, Gomez D, Zhang X. Robust Optimization for Intensity Modulated Proton Therapy Plans with Multi-Isocenter Large Fields. Int J Part Ther 2016; 3:305-311. [PMID: 31772982 DOI: 10.14338/ijpt-16-00012.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/10/2016] [Indexed: 12/27/2022] Open
Abstract
We have developed a robust optimization approach for intensity modulated proton therapy treatment plans with multi-isocenter large fields. The method creates a low-gradient field dose in the junction regions to mitigate the impact caused by misalignment errors and is more efficient than the conventional junction shifting technique.
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Affiliation(s)
- Li Liao
- Department of Industrial Engineering, The University of Houston, Houston, TX, USA
| | - Gino J Lim
- Department of Industrial Engineering, The University of Houston, Houston, TX, USA
| | - Yupeng Li
- Applied Research, Varian Medical Systems, Palo Alto, CA, USA
| | - Juan Yu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Maryland Proton Treatment Center, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Narayan Sahoo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Heng Li
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Gillin
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - X Ronald Zhu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Mahajan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David R Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiaodong Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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30
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Yamashita H, Kase Y, Murayama S. Simplified estimation method for dose distributions around field junctions in proton craniospinal irradiation. Radiol Phys Technol 2016; 10:95-105. [PMID: 27586848 DOI: 10.1007/s12194-016-0373-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022]
Abstract
In radiotherapy involving craniospinal irradiation (CSI), field junctions of therapeutic beams are necessary, because a CSI target is generally several times larger than the maximum field size of the beams. The purpose of this study was to develop a simplified method for estimating dose uniformity around the field junctions in proton CSI. We estimated the dose profiles around the field junctions of proton beams using a simplified field-junction model, in which partial lateral dose distributions around the field edge were assumed to be approximated using the error function. We measured the lateral dose distributions of the proton beams planned for the CSI treatment using a two-dimensional (2D) ionization chamber array. Although dose hot spots and cold spots tend to be underestimated by a chamber array because of the partial volume effect of the sensitive volume and discrete chamber positions, the model estimation results were fairly consistent with the measurements obtained using a 2D chamber array subjected to CSI-simulated serial irradiation. The simplified junction model enabled us to estimate the dose distributions and dependence of the setup position gap on the dose uniformity around the field junctions on the basis of the field-by-field dose profiles measured using the 2D chamber array.
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Affiliation(s)
- Haruo Yamashita
- Proton Therapy Division, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan. .,Proton Therapy Division, Shizuoka Cancer Center Research Institute, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan.
| | - Yuki Kase
- Proton Therapy Division, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan.,Proton Therapy Division, Shizuoka Cancer Center Research Institute, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Shigeyuki Murayama
- Proton Therapy Division, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan.,Proton Therapy Division, Shizuoka Cancer Center Research Institute, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan
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Shen J, Liu W, Anand A, Stoker JB, Ding X, Fatyga M, Herman MG, Bues M. Impact of range shifter material on proton pencil beam spot characteristics. Med Phys 2016; 42:1335-40. [PMID: 25735288 DOI: 10.1118/1.4908208] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To quantitatively investigate the effect of range shifter materials on single-spot characteristics of a proton pencil beam. METHODS An analytic approximation for multiple Coulomb scattering ("differential Moliere" formula) was adopted to calculate spot sizes of proton spot scanning beams impinging on a range shifter. The calculations cover a range of delivery parameters: six range shifter materials (acrylonitrile butadiene styrene, Lexan, Lucite, polyethylene, polystyrene, and wax) and water as reference material, proton beam energies ranging from 75 to 200 MeV, range shifter thicknesses of 4.5 and 7.0 g/cm(2), and range shifter positions from 5 to 50 cm. The analytic method was validated by comparing calculation results with the measurements reported in the literature. RESULTS Relative to a water-equivalent reference, the spot size distal to a wax or polyethylene range shifter is 15% smaller, while the spot size distal to a range shifter made of Lexan or Lucite is about 6% smaller. The relative spot size variations are nearly independent of beam energy and range shifter thickness and decrease with smaller air gaps. CONCLUSIONS Among the six material investigated, wax and polyethylene are desirable range shifter materials when the spot size is kept small. Lexan and Lucite are the desirable range shifter materials when the scattering power is kept similar to water.
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Affiliation(s)
- Jiajian Shen
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona 85054
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona 85054
| | - Aman Anand
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona 85054
| | - Joshua B Stoker
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona 85054
| | - Xiaoning Ding
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona 85054
| | - Mirek Fatyga
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona 85054
| | - Michael G Herman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota 55905
| | - Martin Bues
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona 85054
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Initial Report of Pencil Beam Scanning Proton Therapy for Posthysterectomy Patients With Gynecologic Cancer. Int J Radiat Oncol Biol Phys 2016; 95:181-189. [DOI: 10.1016/j.ijrobp.2015.07.2205] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 11/16/2022]
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Farace P, Vinante L, Ravanelli D, Bizzocchi N, Vennarini S. Planning field-junction in proton cranio-spinal irradiation - the ancillary-beam technique. Acta Oncol 2015; 54:1075-8. [PMID: 25350525 DOI: 10.3109/0284186x.2014.970667] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Paolo Farace
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Lorenzo Vinante
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Daniele Ravanelli
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Nicola Bizzocchi
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Sabina Vennarini
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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Hill-Kayser C, Kirk M. Brainstem-sparing craniospinal irradiation delivered with pencil beam scanning proton therapy. Pediatr Blood Cancer 2015; 62:718-20. [PMID: 25557901 DOI: 10.1002/pbc.25378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/06/2014] [Indexed: 11/05/2022]
Abstract
Delivery of craniospinal irradiation (CSI) is a curative approach to recurrent ependymoma, but is associated with risks from re-irradiation, particularly of the brainstem. Pencil beam scanning proton therapy allows delivery of CSI with sparing of normal tissues. Here, we describe a case of brainstem-sparing CSI that resulted in excellent coverage of the craniospinal axis with minimal radiation to brainstem. This is a novel concept that compares favorably to previously described methods using x-rays that may result in underdosing of surrounding tissues in effort to spare brainstem.
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Affiliation(s)
- Christine Hill-Kayser
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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