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Vogin G, Wambersie A, Koto M, Ohno T, Uhl M, Fossati P, Balosso J. A step towards international prospective trials in carbon ion radiotherapy: investigation of factors influencing dose distribution in the facilities in operation based on a case of skull base chordoma. Radiat Oncol 2019; 14:24. [PMID: 30709366 PMCID: PMC6359776 DOI: 10.1186/s13014-019-1224-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/20/2019] [Indexed: 12/23/2022] Open
Abstract
Background Carbon ion radiotherapy (CIRT) has been delivered to more than 20,000 patients worldwide. International trials have been recommended in order to emphasize the actual benefits. The ULICE program (Union of Light Ion Centers in Europe) addressed the need for harmonization of CIRT practices. A comparative knowledge of the sources and magnitudes of uncertainties altering dose distribution and clinical effects during the whole CIRT procedure is required in that aim. Methods As part of ULICE WP2 task group, we sent a centrally reviewed questionnaire exploring candidate sources of uncertainties in dose deposition to the ten CIRT facilities in operation by February 2017. We aimed to explore native beam characterization, immobilization, anatomic data acquisition, target volumes and organs at risks delineation, treatment planning, dose delivery, quality assurance prior and during treatment. The responders had to consider the clinical case of a clival chordoma eligible for postoperative CIRT according to their clinical practice. With the results, our task group discussed ways to harmonize CIRT practices. Results We received 5 surveys from facilities that have treated 77% of the patients worldwide per November 2017. We pointed out the singularity of the facilities and beam delivery systems, a divergent definition of target volumes, the multiplicity of TPS and equieffective dose calculation approximations. Conclusion Multiple uncertainties affect equieffective dose definition, deposition and calculation in CIRT. Although it is not possible to harmonize all the steps of the CIRT planning between the centers, our working group proposed counter-measures addressing the improvable limitations.
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Affiliation(s)
- G Vogin
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, 6 avenue de bourgogne - CS 30519, 54519, Nancy, Vandoeuvre-les-Nancy Cedex, France. .,UMR 7365 CNRS-UL, IMoPA, Nancy, Vandoeuvre-les-Nancy Cedex, France.
| | - A Wambersie
- Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), University Clinics St Luc, Brussels, Belgium.,Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium
| | - M Koto
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - T Ohno
- Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Gunma, Japan
| | - M Uhl
- Universitätsklinik Heidelberg, Abteilung für Radioonkologie und Strahlentherapie, Heidelberg, Germany
| | - P Fossati
- EBG GmbH MedAustron, Wiener Neustadt, Austria.,Fondazione CNAO (Centro Nazionale di Adroterapia Oncologica), Pavia, Italy
| | - J Balosso
- Service de Cancérologie-Radiothérapie, Hôpital A.Michallon, CHU de Grenoble, Grenoble, France.,Université Grenoble Alpes, Grenoble, France.,Département de radiothérapie, Centre François Baclesse, Caen, France
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Vogin G, Wambersie A, Pötter R, Beuve M, Combs SE, Magrin G, Mayer R, Mock U, Sarrut D, Schreiner T, Fossati P, Balosso J. Concepts and terms for dose/volume parameters in carbon-ion radiotherapy: Conclusions of the ULICE taskforce. Cancer Radiother 2018; 22:802-809. [PMID: 30327228 DOI: 10.1016/j.canrad.2017.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE The Union of Light Ion Centers in Europe (ULICE) program addressed the need for uniting scientific results for carbon-ion radiation therapy obtained by several institutions worldwide in different fields of excellence, and translating them into a real benefit to the community. Particularly, the concepts for dose/volume parameters developed in photon radiotherapy cannot be extrapolated to high linear energy transfer particles. METHODS AND MATERIALS The ULICE-WP2 taskforce included radiation oncologists involved in carbon-ion radiation therapy and International Commission on Radiation Units and Measurements, radiation biologists, expert physicists in the fields of carbon-ion radiation therapy, microdosimetry, biological modeling and image-guided radiotherapy. Consensual reports emerged from multiple discussions within both the restricted group and the wider ULICE community. Public deliverables were produced and disseminated to the European Commission. RESULTS Here we highlight the disparity in practices between treating centers, then address the main topics to finally elaborate specific recommendations. Although it appears relatively simple to add geometrical margins around the clinical target volume to obtain the planning target volume as performed in photon radiotherapy, this procedure is not appropriate for carbon-ion radiation therapy. Due to the variation of the radiation quality in depth, there is no generic relative biological effectiveness value for carbon-ions outside of an isolated point, for a given fractionation and specific experimental conditions. Absorbed dose and "equieffective dose" for specified conditions must always be reported. CONCLUSIONS This work contributed to the development of standard operating procedures for carbon-ion radiation therapy clinical trials. These procedures are now being applied, particularly in the first phase III international, multicenter trial (PHRC Étoile).
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Affiliation(s)
- G Vogin
- Département de radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, 54519 Vandœuvre-lès-Nancy cedex, France; CNRS, UMR 7365, ingénierie moléculaire et physiopathologie articulaire (Imopa), 54505 Vandœuvre-lès-Nancy cedex, France; Université de Lorraine, 54505 Vandoeuvre-lès-Nancy, France.
| | - A Wambersie
- Institut de recherche expérimentale et clinique (Irec), Molecular Imaging, Radiotherapy and Oncology (MIRO), cliniques universitaires Saint-Luc, 1200 Brussels, Belgium; Université catholique de Louvain (UCL), 1348 Louvain-la-Neuve, Belgium
| | - R Pötter
- Department of Radiotherapy, Comprehensive Cancer Center, Vienna, Austria; Medical University of Vienna, Vienna, Austria
| | - M Beuve
- Université Lyon 1, 69100 Villeurbanne, France; Institut de physique nucléaire de Lyon, 69622 Villeurbanne cedex, France
| | - S E Combs
- Klinik und Poliklinik für RadioOnkologie und Strahlentherapie, Technische Universität München (TUM), 81675 München, Germany; Instituts für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, 85764 Oberschleißheim, Germany
| | - G Magrin
- EBG MedAustron GmbH, 2700 Wiener-Neustadt, Austria
| | - R Mayer
- EBG MedAustron GmbH, 2700 Wiener-Neustadt, Austria
| | - U Mock
- EBG MedAustron GmbH, 2700 Wiener-Neustadt, Austria
| | - D Sarrut
- Université Lyon 1, 69100 Villeurbanne, France; CNRS, UMR 5220 Laboratoire Creatis, 69100 Villeurbanne, France; Inserm, U1044 Laboratoire Creatis, 69100 Villeurbanne, France
| | - T Schreiner
- EBG MedAustron GmbH, 2700 Wiener-Neustadt, Austria
| | - P Fossati
- Università di Milano-Medicina e Chirurgia, Milano, Italy; Fondazione CNAO (Centro Nazionale di Adroterapia Oncologica), Pavia, Italy
| | - J Balosso
- Service de cancérologie-radiothérapie, hôpital Albert-Michallon, CHU Grenoble Alpes, 38043 Grenoble cedex 09, France; IPNL, France Hadron national research infrastructure, 69000 Lyon, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France
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Giovannini G, Böhlen T, Cabal G, Bauer J, Tessonnier T, Frey K, Debus J, Mairani A, Parodi K. Variable RBE in proton therapy: comparison of different model predictions and their influence on clinical-like scenarios. Radiat Oncol 2016; 11:68. [PMID: 27185038 PMCID: PMC4869317 DOI: 10.1186/s13014-016-0642-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 04/27/2016] [Indexed: 01/02/2023] Open
Abstract
Background In proton radiation therapy a constant relative biological effectiveness (RBE) of 1.1 is usually assumed. However, biological experiments have evidenced RBE dependencies on dose level, proton linear energy transfer (LET) and tissue type. This work compares the predictions of three of the main radio-biological models proposed in the literature by Carabe-Fernandez, Wedenberg, Scholz and coworkers. Methods Using the chosen models, a spread-out Bragg peak (SOBP) as well as two exemplary clinical cases (single field and two fields) for cranial proton irradiation, all delivered with state-of-the-art pencil-beam scanning, have been analyzed in terms of absorbed dose, dose-averaged LET (LETD), RBE-weighted dose (DRBE) and biological range shift distributions. Results In the systematic comparison of RBE predictions by the three models we could show different levels of agreement depending on (α/β)x and LET values. The SOBP study emphasizes the variation of LETD and RBE not only as a function of depth but also of lateral distance from the central beam axis. Application to clinical-like scenario shows consistent discrepancies from the values obtained for a constant RBE of 1.1, when using a variable RBE scheme for proton irradiation in tissues with low (α/β)x, regardless of the model. Biological range shifts of 0.6– 2.4 mm (for high (α/β)x) and 3.0 – 5.4 mm (for low (α/β)x) were found from the fall-off analysis of individual profiles of RBE-weighted fraction dose along the beam penetration depth. Conclusions Although more experimental evidence is needed to validate the accuracy of the investigated models and their input parameters, their consistent trend suggests that their main RBE dependencies (dose, LET and (α/β)x) should be included in treatment planning systems. In particular, our results suggest that simpler models based on the linear-quadratic formalism and LETD might already be sufficient to reproduce important RBE dependencies for re-evaluation of plans optimized with the current RBE = 1.1 approximation. This approach would be a first step forward to consider RBE variations in proton therapy, thus enabling a more robust choice of biological dose delivery. The latter could in turn impact clinical outcome, especially in terms of reduced toxicities for tumors adjacent to organs at risk.
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Affiliation(s)
- Giulia Giovannini
- Ludwig-Maximilians-Universität München, Am Coulombwall 1, D-85748, Garching b. München, Germany.,University of Pavia, Department of Physics, Via Bassi 6, I-27100, Pavia, Italy.,Department of Radiation Oncology, Heidelberg University Clinic, Im Neuenheimer, Feld 400, D-69120, Heidelberg, Germany
| | - Till Böhlen
- Ludwig-Maximilians-Universität München, Am Coulombwall 1, D-85748, Garching b. München, Germany.,European Organization for Nuclear Research CERN, CH-1211, Geneva, 23, Switzerland.,Now with Medical Physics Division, EBG MedAustron GmbH, Marie Curie-Straβe 5, Wiener Neustadt, A-2700, Austria
| | - Gonzalo Cabal
- Ludwig-Maximilians-Universität München, Am Coulombwall 1, D-85748, Garching b. München, Germany
| | - Julia Bauer
- Department of Radiation Oncology, Heidelberg University Clinic, Im Neuenheimer, Feld 400, D-69120, Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center, Im Neuenheimer Feld 450, D-69120, Heidelberg, Germany
| | - Thomas Tessonnier
- Department of Radiation Oncology, Heidelberg University Clinic, Im Neuenheimer, Feld 400, D-69120, Heidelberg, Germany
| | - Kathrin Frey
- Ludwig-Maximilians-Universität München, Am Coulombwall 1, D-85748, Garching b. München, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Clinic, Im Neuenheimer, Feld 400, D-69120, Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center, Im Neuenheimer Feld 450, D-69120, Heidelberg, Germany
| | - Andrea Mairani
- Heidelberg Ion Beam Therapy Center, Im Neuenheimer Feld 450, D-69120, Heidelberg, Germany. .,Medical Physics Unit, CNAO Foundation, Via Strada Campeggi 53, I-27100, Pavia, Italy.
| | - Katia Parodi
- Ludwig-Maximilians-Universität München, Am Coulombwall 1, D-85748, Garching b. München, Germany.,Department of Radiation Oncology, Heidelberg University Clinic, Im Neuenheimer, Feld 400, D-69120, Heidelberg, Germany.,Heidelberg Ion Beam Therapy Center, Im Neuenheimer Feld 450, D-69120, Heidelberg, Germany
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Ammazzalorso F, Jelen U, Engenhart-Cabillic R, Schlegel W. Dosimetric robustness against setup errors in charged particle radiotherapy of skull base tumors. Radiat Oncol 2014; 9:279. [PMID: 25477197 PMCID: PMC4263024 DOI: 10.1186/s13014-014-0279-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 09/23/2014] [Indexed: 02/08/2023] Open
Abstract
Background It is expected that physical dose deposition properties render charged particle dose distributions sensitive to targeting uncertainties. Purpose of this work was to investigate the robustness of scanned-beam particle therapy plans against setup errors for different optimization modalities, beam setups and ion species. Material and methods For 15 patients with skull base tumors, localized in regions of severe tissue density heterogeneity, scanned lateral-opposed-beam treatment plans were prepared with the treatment planning system TRiP98, employing different optimization settings (single- and multiple-field modulation) and ion species (carbon ions and protons). For 10 of the patients, additional plans were prepared with individually selected beam setups, aiming at avoiding severe tissue heterogeneities. Subsequently, multiple rigid positioning errors of magnitude 1–2 mm (i.e. within planning target expansion) were simulated by introducing a shift of the irradiation fields with respect to the computed tomography (CT) data and recomputing the plans. Results In presence of shifts, in carbon ion plans using a lateral-opposed beam setup and fulfilling clinical healthy tissue dose constraints, the median reduction in CTV V95% was up to 0.7 percentage points (pp) and 3.5 pp, for shifts of magnitude 1 mm and 2 mm respectively, however, in individual cases, the reduction reached 5.1 pp and 9.7 pp. In the corresponding proton plans similar median CTV V95% reductions of up to 0.9 pp (1 mm error) and 3.4 pp (2 mm error) were observed, with respective individual-case reductions of at most 3.2 pp and 11.7 pp. Unconstrained plans offered slightly higher coverage values, while no relevant differences were observed between different field modulation methods. Individually selected beam setups had a visible dosimetric advantage over lateral-opposed beams, for both particle species. While carbons provided more conformal plans and generally more advantageous absolute dose values, in presence of setup errors, protons showed greater dosimetric stability, in most of the investigated scenarios. Conclusion Residual patient setup errors may lead to substantial dose perturbation in scanned-beam particle therapy of skull base tumors, which cannot be dealt with by planning target expansion alone. Choice of irradiation directions avoiding extreme density heterogeneities can improve plan stability against such delivery-time uncertainties.
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Affiliation(s)
- Filippo Ammazzalorso
- Department of Radiotherapy and Radiation Oncology, University of Marburg, Baldingerstraße, Marburg, 35043, Germany. .,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
| | - Urszula Jelen
- Department of Radiotherapy and Radiation Oncology, University of Marburg, Baldingerstraße, Marburg, 35043, Germany.
| | - Rita Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University of Marburg, Baldingerstraße, Marburg, 35043, Germany.
| | - Wolfgang Schlegel
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany.
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Fattori G, Riboldi M, Scifoni E, Krämer M, Pella A, Durante M, Ronchi S, Bonora M, Orecchia R, Baroni G. Dosimetric effects of residual uncertainties in carbon ion treatment of head chordoma. Radiother Oncol 2014; 113:66-71. [DOI: 10.1016/j.radonc.2014.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 07/19/2014] [Accepted: 08/02/2014] [Indexed: 01/03/2023]
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Flampouri S, Hoppe BS, Slopsema RL, Li Z. Beam-specific planning volumes for scattered-proton lung radiotherapy. Phys Med Biol 2014; 59:4549-66. [PMID: 25069103 DOI: 10.1088/0031-9155/59/16/4549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This work describes the clinical implementation of a beam-specific planning treatment volume (bsPTV) calculation for lung cancer proton therapy and its integration into the treatment planning process. Uncertainties incorporated in the calculation of the bsPTV included setup errors, machine delivery variability, breathing effects, inherent proton range uncertainties and combinations of the above. Margins were added for translational and rotational setup errors and breathing motion variability during the course of treatment as well as for their effect on proton range of each treatment field. The effect of breathing motion and deformation on the proton range was calculated from 4D computed tomography data. Range uncertainties were considered taking into account the individual voxel HU uncertainty along each proton beamlet. Beam-specific treatment volumes generated for 12 patients were used: a) as planning targets, b) for routine plan evaluation, c) to aid beam angle selection and d) to create beam-specific margins for organs at risk to insure sparing. The alternative planning technique based on the bsPTVs produced similar target coverage as the conventional proton plans while better sparing the surrounding tissues. Conventional proton plans were evaluated by comparing the dose distributions per beam with the corresponding bsPTV. The bsPTV volume as a function of beam angle revealed some unexpected sources of uncertainty and could help the planner choose more robust beams. Beam-specific planning volume for the spinal cord was used for dose distribution shaping to ensure organ sparing laterally and distally to the beam.
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Affiliation(s)
- S Flampouri
- University of Florida Proton Therapy Institute, Jacksonville 32206, FL, USA
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