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Johnson PB, Mamalui M, Brodin P, Janssens G. Secondary cancer risk in six anatomical sites when using PAT, IMPT, and VMAT/IMRT radiotherapy. Radiother Oncol 2024; 199:110421. [PMID: 38997093 DOI: 10.1016/j.radonc.2024.110421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND AND PURPOSE Compared to intensity modulated proton therapy (IMPT), proton arc therapy (PAT) is expected to improve dose conformality, delivery efficiency, and provide a more favorable LET distribution. Alternatively, the low-dose bath is potentially spread over larger volumes, which could impact the likelihood of developing a radiation-induced, secondary cancer (SC). The goal of this study was to evaluate this risk in several anatomical sites using newly developed commercial tools. MATERIALS AND METHODS Treatment plans encompassing six anatomical sites, five patients per site, and three techniques per patient were created using RayStation. Techniques included PAT and IMPT for protons, and either volumetrically modulated radiotherapy (VMAT) or intensity modulated radiotherapy (IMRT) for photons. Risk estimates were based on the organ-equivalent dose (OED) concept using both Schneider's mechanistic dose-response model for carcinoma induction and a linear dose-response model. RESULTS With few exceptions, mean and integral dose were lowest with PAT. For protons, the factor OEDIMPT/OEDPAT ranged from 0.7 to 1.8 with both the mechanistic and linear model, while for photons OEDphoton/OEDPAT ranged from 1.5 to 10 using the mechanistic model and 1.3 to using the linear model. A strong correlation was found between mean dose and OED for organs with significant repopulation/repair (high R value) and less cell death from single hit interactions (low α value). CONCLUSION Based on results from both mechanistic and linear risk models, the transition from IMPT to PAT should not substantially affect SC risk in patients treated with proton therapy. Additionally, when using Schneider's model, the shapes of the dose-response curves can be used as a good predictor of how SC risk will respond to shifts from intermediate dose to low dose as anticipated when moving from IMPT to PAT.
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Affiliation(s)
- Perry B Johnson
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, United States; University of Florida College of Medicine, Gainesville, FL, United States.
| | - Maria Mamalui
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, United States; University of Florida College of Medicine, Gainesville, FL, United States
| | - Patrik Brodin
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
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Liu P, Cao X, Dalfsen R, Soukup M, Dolan J, Zhao L, Wang Z, Mulhem A, Gao XS, Liu G, Cong X, Stevens C, Deroniyagala R, Li X, Ding X. Investigate potential clinical benefits and linear energy transfer sparing utilizing proton arc therapy for hepatocellular carcinoma. Phys Med 2024; 126:104816. [PMID: 39326286 DOI: 10.1016/j.ejmp.2024.104816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/19/2024] [Accepted: 09/21/2024] [Indexed: 09/28/2024] Open
Abstract
PURPOSE To investigate the potential clinical benefits and dose-averaged Linear Energy Transfer (LETd) sparing, utilizing proton arc plan for hepatocellular carcinoma (HCC) patients in comparison with Intensity Modulated Proton Therapy (IMPT). METHODS Ten HCC patients have been retrospectively selected. Two planning groups were created: Proton Arc plans using Monaco ver. 6 and the clinical IMPT plan. Both planning groups used the same robustness parameters. The prescription dose is 67.5 Gy (RBE) in 15 fractions of the Clinical Target Volume (CTV). Robustness evaluations were performed to ensure dose coverage. Normal Tissue Complicated Probability (NTCP) model was utilized to predict the possibility of Radiation-Induced Liver Disease (RILD) and evaluate the potential benefit of proton arc therapy. LETd calculation and evaluation were performed as well. RESULTS Proton arc plan has shown better dosimetric improvements of most Organ-At-Risks (OARs). More specifically, the liver mean dose has been significantly reduced from 14.7 GyE to 10.62 GyE compared to the IMPT plan. The predicted possibility of RILD has also been significantly reduced for cases with a large and deep liver target where healthy liver tissue sparing is a challenge. Additionally, proton arc therapy could increase the average LETd in the target and reduce LETd in adjacent OARs. CONCLUSIONS The potential clinical benefit of utilizing proton arc therapy HCC varies depending on the patient-specific geometry. With more freedom, proton arc therapy can offer a better dosimetric plan quality in the challenge cases, which might not be feasible using the current IMPT technique.
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Affiliation(s)
- Peilin Liu
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, MI, United States
| | - Xi Cao
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, MI, United States
| | | | | | | | - Lewei Zhao
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, United States
| | - Zishen Wang
- Department of Radiation Oncology, Hebei Yizhou Tumor Hospital, Zhuozhou, China
| | - Anthony Mulhem
- Lyman Briggs College, Michigan State University, MI, United States
| | - Xian-Shu Gao
- Department of Radiation Oncology, Beijing University First Hospital, Beijing, China
| | - Gang Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Key Laboratory of Precision Radiation Oncology, Wuhan, China; Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
| | - Xiaoda Cong
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, MI, United States
| | - Craig Stevens
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, MI, United States
| | - Rohan Deroniyagala
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, MI, United States
| | - Xiaoqiang Li
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, MI, United States
| | - Xuanfeng Ding
- Department of Radiation Oncology, William Beaumont University Hospital, Royal Oak, MI, United States.
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Chhabra AM, Snider JW, Kole AJ, Stock M, Holtzman AL, Press R, Wang CJ, Li H, Lin H, Shi C, McDonald M, Soike M, Zhou J, Sabouri P, Mossahebi S, Colaco R, Albertini F, Simone CB. Proton Therapy for Spinal Tumors: A Consensus Statement From the Particle Therapy Cooperative Group. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00507-8. [PMID: 39181272 DOI: 10.1016/j.ijrobp.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/29/2024] [Accepted: 04/03/2024] [Indexed: 08/27/2024]
Abstract
PURPOSE Proton beam therapy (PBT) plays an important role in the management of primary spine tumors. The purpose of this consensus statement was to summarize safe and optimal delivery of PBT for spinal tumors. METHODS AND MATERIALS The Particle Therapy Cooperative Group Skull Base/Central nervous system/Sarcoma Subcommittee consisting of radiation oncologists and medical physicists with specific expertise in spinal irradiation developed expert recommendations discussing treatment planning considerations and current approaches in the treatment of primary spinal tumors. RESULTS Computed tomography simulation: factors that require significant consideration include (1) patient comfort, (2) setup reproducibility and stability, and (3) accessibility of appropriate beam angles. SPINE STABILIZATION HARDWARE If present, hardware should be placed with cross-links well above/below the level of the primary tumor to reduce the metal burden at the level of the tumor bed. New materials that can reduce uncertainties include polyether-ether-ketone and composite polyether-ether-ketone-carbon fiber implants. FIELD ARRANGEMENT Appropriate beam selection is required to ensure robust target coverage and organ at risk sparing. Commonly, 2 to 4 treatment fields, typically from posterior and/or posterior-oblique directions, are used. TREATMENT PLANNING METHODOLOGY Robust optimization is recommended for all pencil beam scanning plans (the preferred treatment modality) and should consider setup uncertainty (between 3 and 7 mm) and range uncertainty (3%-3.5%). In the presence of metal hardware, use of an increased range uncertainty up to 5% is recommended. CONCLUSIONS The Particle Therapy Cooperative Group Skull Base/Central nervous system/Sarcoma Subcommittee has developed recommendations to enable centers to deliver PBT safely and effectively for the management of primary spinal tumors.
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Affiliation(s)
- Arpit M Chhabra
- Department of Radiation Oncology, New York Proton Center, New York, New York.
| | - James W Snider
- Department of Radiation Oncology, South Florida Proton Therapy Institute, Delray Beach, Florida
| | - Adam J Kole
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama
| | - Markus Stock
- Department of Medical Physics, EBG MedAustron, Wiener Neustadt, Austria
| | - Adam L Holtzman
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Robert Press
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - C Jake Wang
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - Heng Li
- Department of Medical Physics, Johns Hopkins, Baltimore, Maryland
| | - Haibo Lin
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - Chengyu Shi
- Department of Medical Physics, City of Hope, Irvine, California
| | - Mark McDonald
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Michael Soike
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama
| | - Jun Zhou
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Pouya Sabouri
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sina Mossahebi
- Department of Medical Physics, Maryland Proton Treatment Center, Baltimore, Maryland
| | - Rovel Colaco
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Francesca Albertini
- Department of Medical Physics, Paul Scherrer Institut, Würenlingen, Switzerland
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
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Liu G, Zhao L, Liu P, Yan D, Deraniyagala R, Stevens C, Li X, Ding X. Development of a standalone delivery sequence model for proton arc therapy. Med Phys 2024; 51:3067-3075. [PMID: 38064634 DOI: 10.1002/mp.16879] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Spot-scanning proton arc (SPArc) has been drawing significant interests in recent years because of its capability of continuous proton irradiation during the gantry rotation. Previous studies demonstrated SPArc plans were delivered on a prototype of the DynamicARC solution, IBA ProteusONE. PURPOSE We built a novel delivery sequence model through an independent experimental approach: the first SPArc delivery sequence model (DSMSPArc). Based on the model, we investigated SPArc treatment efficiency improvement in the routine proton clinical operation. METHODS SPArc test plans were generated and delivered on a prototype of the DynamicARC solution, IBA ProteusONE. An independent gantry inclinometer and the machine logfiles were used to derive the DSMSPArc. Seventeen SPArc plans were used to validate the model's accuracy independently. Two random clinical operation dates (6th January and 22nd March, 2021) from a single-room proton therapy center (PTC) were selected to quantitatively assess the improvement of treatment efficiency compared to the IMPT. RESULTS The difference between the logfile and DSMSPArc is about 3.2 ± 4.8%. SPArc reduced 58.1% of the average treatment delivery time per patient compared to IMPT (p < 0.01). Daily treatment throughput could be increased by 30% using SPArc using a single-room proton therapy system. CONCLUSIONS The first model of dynamic arc therapy is established in this study through an independent experimental approach using logfiles and measurements which allows clinical users and investigators to simulate the dynamic treatment delivery and assess the daily treatment throughput improvement.
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Affiliation(s)
- Gang Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Precision Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lewei Zhao
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Peilin Liu
- Department of Radiation Oncology, Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Di Yan
- Department of Radiation Oncology, Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Rohan Deraniyagala
- Department of Radiation Oncology, Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Craig Stevens
- Department of Radiation Oncology, Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Xiaoqiang Li
- Department of Radiation Oncology, Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Xuanfeng Ding
- Department of Radiation Oncology, Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan, USA
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Liu G, Zhao L, Li X, Zhang S, Dai S, Lu X, Ding X. A Novel Ultrahigh-Dose-Rate Proton Therapy Technology: Spot-Scanning Proton Arc Therapy + FLASH (SPLASH). Int J Radiat Oncol Biol Phys 2023; 117:730-737. [PMID: 37196836 DOI: 10.1016/j.ijrobp.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/10/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE To take full advantage of FLASH dose rate (40 Gy/s) and high-dose conformity, we introduce a novel optimization and delivery technique, the spot-scanning proton arc therapy (SPArc) + FLASH (SPLASH). METHODS AND MATERIALS SPLASH framework was implemented in an open-source proton planning platform (MatRad, Department of Medical Physics in Radiation Oncology, German Cancer Research Center). It optimizes with the clinical dose-volume constraint based on dose distribution and the dose-average dose rate by minimizing the monitor unit constraint on spot weight and accelerator beam current sequentially, enabling the first dynamic arc therapy with voxel-based FLASH dose rate. This new optimization framework minimizes the overall cost function value combined with plan quality and voxel-based dose-rate constraints. Three representative cases (brain, liver, and prostate cancer) were used for testing purposes. Dose-volume histogram, dose-rate-volume histogram, and dose-rate map were compared among intensity modulated proton radiation therapy (IMPT), SPArc, and SPLASH. RESULTS SPLASH/SPArc could offer superior plan quality over IMPT in terms of dose conformity. The dose-rate-volume histogram results indicated SPLASH could significantly improve V40 Gy/s in the target and region of interest for all tested cases compared with SPArc and IMPT. The optimal beam current per spot is simultaneously generated, which is within the existing proton machine specifications in the research version (<200 nA). CONCLUSIONS SPLASH offers the first voxel-based ultradose-rate and high-dose conformity treatment using proton beam therapy. Such a technique has the potential to fit the needs of a broad range of disease sites and simplify clinical workflow without applying a patient-specific ridge filter, which has never before been demonstrated.
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Affiliation(s)
- Gang Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430023 China.
| | - Lewei Zhao
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Xiaoqiang Li
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan
| | - Sheng Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430023 China.
| | - Shuyang Dai
- School of Mathematics and Statistics, Wuhan University, Wuhan 430072 China
| | - Xiliang Lu
- School of Mathematics and Statistics, Wuhan University, Wuhan 430072 China
| | - Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan.
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Liu G, Zhao L, Liu P, Dao R, Qian Y, Cong X, Janssens G, Li X, Ding X. The first investigation of spot-scanning proton arc (SPArc) delivery time and accuracy with different delivery tolerance window settings. Phys Med Biol 2023; 68:215003. [PMID: 37774715 DOI: 10.1088/1361-6560/acfec5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/29/2023] [Indexed: 10/01/2023]
Abstract
Objective. To investigate the impact of various delivery tolerance window settings on the treatment delivery time and dosimetric accuracy of spot-scanning proton arc (SPArc) therapy.Approach. SPArc plans were generated for three representative disease sites (brain, lung, and liver cancer) with an angle sampling frequency of 2.5°. An in-house dynamic arc controller was used to simulate the arc treatment delivery with various tolerance windows (±0.25, ±0.5, ±1, and ±1.25°). The controller generates virtual logfiles during the arc delivery simulation, such as gantry speed, acceleration and deceleration, spot position, and delivery sequence, similar to machine logfiles. The virtual logfile was then imported to the treatment planning system to reconstruct the delivered dose distribution and compare it to the initial SPArc nominal plan. A three-dimensional gamma index was used to quantitatively assess delivery accuracy. Total treatment delivery time and relative lost time (dynamic arc delivery time-fix beam delivery time)/fix beam delivery time) were reported.Main Results. The 3D gamma passing rate (GPR) was greater than 99% for all cases when using 3%/3 mm and 2%/2 mm criteria and the GPR (1%/1 mm criteria) degraded as the tolerance window opens. The total delivery time for dynamic arc delivery increased with the decreasing delivery tolerance window length. The average delivery time and the relative lost time (%) were 630 ± 212 s (253% ± 68%), 322 ± 101 s (81% ± 31%), 225 ± 60 s (27% ± 16%), 196 ± 41 s (11% ± 6%), 187 ± 29 s (6% ± 1%) for tolerance windows ±0.25, ±0.5, ±1, and ±1.25° respectively.Significance. The study quantitatively analyzed the dynamic SPArc delivery time and accuracy with different delivery tolerance window settings, which offer a critical reference in the future SPArc plan optimization and delivery controller design.
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Affiliation(s)
- Gang Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
- Hubei Key Laboratory of Precision Radiation Oncology, Wuhan, People's Republic of China
- Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, People's Republic of China
| | - Lewei Zhao
- Department of Radiation Oncology, Corewell Health Beaumont University, Royal Oak, MI,48073, United States of America
- Department of Radiation Oncology, Stanford University, CA, United States of America
| | - Peilin Liu
- Department of Radiation Oncology, Corewell Health Beaumont University, Royal Oak, MI,48073, United States of America
| | - Riao Dao
- School of Physics and Technology, Wuhan University, Wuhan,430072, People's Republic of China
| | - Yujia Qian
- School of Physics and Technology, Wuhan University, Wuhan,430072, People's Republic of China
| | - Xiaoda Cong
- Department of Radiation Oncology, Corewell Health Beaumont University, Royal Oak, MI,48073, United States of America
| | | | - Xiaoqiang Li
- Department of Radiation Oncology, Corewell Health Beaumont University, Royal Oak, MI,48073, United States of America
| | - Xuanfeng Ding
- Department of Radiation Oncology, Corewell Health Beaumont University, Royal Oak, MI,48073, United States of America
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Engwall E, Marthin O, Wase V, Sundström J, Mikhalev V, de Jong BA, Langendijk JA, Melbéus H, Andersson B, Korevaar EW, Both S, Bokrantz R, Glimelius L, Fredriksson A. Partitioning of discrete proton arcs into interlaced subplans can bring proton arc advances to existing proton facilities. Med Phys 2023; 50:5723-5733. [PMID: 37482909 DOI: 10.1002/mp.16617] [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: 04/27/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Proton arcs have shown potential to reduce the dose to organs at risks (OARs) by delivering the protons from many different directions. While most previous studies have been focused on dynamic arcs (delivery during rotation), an alternative approach is discrete arcs, where step-and-shoot delivery is used over a large number of beam directions. The major advantage of discrete arcs is that they can be delivered at existing proton facilities. However, this advantage comes at the expense of longer treatment times. PURPOSE To exploit the dosimetric advantages of proton arcs, while achieving reasonable delivery times, we propose a partitioning approach where discrete arc plans are split into subplans to be delivered over different fractions in the treatment course. METHODS For three oropharyngeal cancer patients, four different arc plans have been created and compared to the corresponding clinical IMPT plan. The treatment plans are all planned to be delivered in 35 fractions, but with different delivery approaches over the fractions. The first arc plan (1×30) has 30 directions to be delivered every fraction, while the others are partitioned into subplans with 10 and 6 beam directions, each to be delivered every third (3×10), fifth fraction (5×6), or seventh fraction (7×10). All plans are assessed with respect to delivery time, target robustness over the treatment course, doses to OARs and NTCP for dysphagia and xerostomia. RESULTS The delivery time (including an additional delay of 30 s between the discrete directions to simulate manual interaction with the treatment control system) is reduced from on average 25.2 min for the 1×30 plan to 9.2 min for the 3×10 and 7×10 plans and 5.7 min for the 5×6 plans. The delivery time for the IMPT plan is 7.9 min. When accounting for the combination of delivery time, target robustness, OAR sparing, and NTCP reduction, the plans with 10 directions in each fraction are the preferred choice. Both the 3×10 and 7×10 plans show improved target robustness compared to the 1×30 plans, while keeping OAR doses and NTCP values at almost as low levels as for the 1×30 plans. For all patients the NTCP values for dysphagia are lower for the partitioned plans with 10 directions compared to the IMPT plans. NTCP reduction for xerostomia compared to IMPT is seen in two of the three patients. The best results are seen for the first patient, where the NTCP reductions for the 7×10 plan are 1.6 p.p. (grade 2 xerostomia) and 1.5 p.p. (grade 2 dysphagia). The corresponding NTCP reductions for the 1×30 plan are 2.7 p.p. (xerostomia, grade 2) and 2.0 p.p. (dysphagia, grade 2). CONCLUSIONS Discrete proton arcs can be implemented at any proton facility with reasonable treatment times using a partitioning approach. The technique also makes the proton arc treatments more robust to changes in the patient anatomy.
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Affiliation(s)
| | | | | | | | | | - Bas A de Jong
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | - Erik W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Toussaint L, Indelicato DJ, Muren LP, Stokkevåg CH. Risk of second primary cancer from proton arc therapy of pediatric brain tumors. Phys Imaging Radiat Oncol 2023; 27:100480. [PMID: 37655121 PMCID: PMC10465935 DOI: 10.1016/j.phro.2023.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023] Open
Abstract
Proton arc therapy (PAT) is currently explored for clinical implementation, despite its associated low-dose bath. This study therefore aimed at evaluating the risk of radiation-induced second primary cancer (SPC) for PAT in pediatric brain tumor patients. Two brain-specific models for SPC induction were applied in five cases to compare volumetric modulated arc therapy (VMAT), intensity modulated proton therapy (IMPT) and PAT surrogate plans. The PAT integral dose was reduced by a median of 29% compared to VMAT, and 17% compared to IMPT. For both models, the estimated SPC risks were consistently the lowest for PAT.
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Affiliation(s)
- Laura Toussaint
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - Ludvig P Muren
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Camilla H Stokkevåg
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
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Rong Y, Ding X, Daly ME. Hypofractionation and SABR: 25 years of evolution in medical physics and a glimpse of the future. Med Phys 2023. [PMID: 36756953 DOI: 10.1002/mp.16270] [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: 12/13/2022] [Revised: 12/13/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
As we were invited to write an article for celebrating the 50th Anniversary of Medical Physics journal, on something historically significant, commemorative, and exciting happening in the past decades, the first idea came to our mind is the fascinating radiotherapy paradigm shift from conventional fractionation to hypofractionation and stereotactic ablative radiotherapy (SABR). It is historically and clinically significant since as we all know this RT treatment revolution not only reduces treatment duration for patients, but also improves tumor control and cancer treatment outcomes. It is also commemorative and exciting for us medical physicists since the technology development in medical physics has been the main driver for the success of this treatment regimen which requires high precision and accuracy throughout the entire treatment planning and delivery. This article provides an overview of the technological development and clinical trials evolvement in the past 25 years for hypofractionation and SABR, with an outlook to the future improvement.
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Affiliation(s)
- Yi Rong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Xuanfeng Ding
- Department of Radiation Oncology, Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
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10
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Zhao L, You J, Liu G, Wuyckens S, Lu X, Ding X. The first direct method of spot sparsity optimization for proton arc therapy. Acta Oncol 2023; 62:48-52. [PMID: 36729848 DOI: 10.1080/0284186x.2023.2172689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Lewei Zhao
- Proton Therapy Center, Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Juntao You
- Department of Mathematics, The Hong Kong University of Science and Technology, Hong Kong SAR, PR China
| | - Gang Liu
- Proton Therapy Center, Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA.,Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Sophie Wuyckens
- Molecular Imaging, Radiotherapy and Oncology (MIRO), UCLouvain, Belgium
| | - Xiliang Lu
- School of Mathematics and Statistics, and Hubei Key Laboratory of Computational Science, Wuhan University, Wuhan, PR China
| | - Xuanfeng Ding
- Proton Therapy Center, Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
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Chang S, Liu G, Zhao L, Zheng W, Yan D, Chen P, Li X, Deraniyagala R, Stevens C, Grills I, Chinnaiyan P, Li X, Ding X. Introduce a rotational robust optimization framework for spot-scanning proton arc (SPArc) therapy. Phys Med Biol 2022; 68. [PMID: 36546347 DOI: 10.1088/1361-6560/aca874] [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: 08/01/2022] [Accepted: 12/02/2022] [Indexed: 12/03/2022]
Abstract
Objective. Proton dosimetric uncertainties resulting from the patient's daily setup errors in rotational directions exist even with advanced image-guided radiotherapy techniques. Thus, we developed a new rotational robust optimization SPArc algorithm (SPArcrot) to mitigate the dosimetric impact of the rotational setup error in Raystation ver. 6.02 (RaySearch Laboratory AB, Stockholm, Sweden).Approach.The initial planning CT was rotated ±5° simulating the worst-case setup error in the roll direction. The SPArcrotuses a multi-CT robust optimization framework by taking into account of such rotational setup errors. Five cases representing different disease sites were evaluated. Both SPArcoriginaland SPArcrotplans were generated using the same translational robust optimized parameters. To quantitatively investigate the mitigation effect from the rotational setup errors, all plans were recalculated using a series of pseudo-CT with rotational setup error (±1°/±2°/±3°/±5°). Dosimetric metrics such as D98% of CTV, and 3D gamma analysis were used to assess the dose distribution changes in the target and OARs.Main results.The magnitudes of dosimetric changes in the targets due to rotational setup error were significantly reduced by the SPArcrotcompared to SPArc in all cases. The uncertainties of the max dose to the OARs, such as brainstem, spinal cord and esophagus were significantly reduced using SPArcrot. The uncertainties of the mean dose to the OARs such as liver and oral cavity, parotid were comparable between the two planning techniques. The gamma passing rate (3%/3 mm) was significantly improved for CTV of all tumor sites through SPArcrot.Significance.Rotational setup error is one of the major issues which could lead to significant dose perturbations. SPArcrotplanning approach can consider such rotational error from patient setup or gantry rotation error by effectively mitigating the dose uncertainties to the target and in the adjunct series OARs.
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Affiliation(s)
- Sheng Chang
- Department of Radiation Oncology, Wuhan University, Renmin Hospital, Wuhan, 430060 Hubei Province, People's Republic of China.,Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48074, United States of America
| | - Gang Liu
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48074, United States of America.,Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430023, People's Republic of China
| | - Lewei Zhao
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48074, United States of America
| | - Weili Zheng
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48074, United States of America
| | - Di Yan
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48074, United States of America
| | - Peter Chen
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48074, United States of America
| | - Xiangpan Li
- Department of Radiation Oncology, Wuhan University, Renmin Hospital, Wuhan, 430060 Hubei Province, People's Republic of China
| | - Rohan Deraniyagala
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48074, United States of America
| | - Craig Stevens
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48074, United States of America
| | - Inga Grills
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48074, United States of America
| | - Prakash Chinnaiyan
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48074, United States of America
| | - Xiaoqiang Li
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48074, United States of America
| | - Xuanfeng Ding
- Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48074, United States of America
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12
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Deraniyagala R, Ding X, Alonso-Basanta M, Li T, Rong Y. It is beneficial to invest resources to implement proton intracranial SRS. J Appl Clin Med Phys 2022; 23:e13701. [PMID: 35713887 PMCID: PMC9278676 DOI: 10.1002/acm2.13701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rohan Deraniyagala
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Xuanfeng Ding
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Taoran Li
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yi Rong
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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13
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Chang S, Liu G, Zhao L, Zheng W, Yan D, Chen P, Li X, Yang K, Deraniyagala R, Stevens C, Grills I, Chinnaiyan P, Li X, Ding X. Redefine the Role of Spot-Scanning Proton Beam Therapy for the Single Brain Metastasis Stereotactic Radiosurgery. Front Oncol 2022; 12:804036. [PMID: 35664795 PMCID: PMC9160604 DOI: 10.3389/fonc.2022.804036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/14/2022] [Indexed: 12/30/2022] Open
Abstract
Purpose To explore the role of using Pencil Beam Scanning (PBS) proton beam therapy in single lesion brain stereotactic radiosurgery (SRS), we developed and validated a dosimetric in silico model to assist in the selection of an optimal treatment approach among the conventional Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Proton Therapy (IMPT) and Spot-scanning Proton Arc (SPArc). Material and Methods A patient’s head CT data set was used as an in silico model. A series of targets (volume range from 0.3 cc to 33.03 cc) were inserted in the deep central and peripheral region, simulating targets with different sizes and locations. Three planning groups: IMPT, VMAT, and SPArc were created for dosimetric comparison purposes and a decision tree was built based on this in silico model. Nine patients with single brain metastases were retrospectively selected for validation. Multiple dosimetric metrics were analyzed to assess the plan quality, such as dose Conformity Index (CI) (ratio of the target volume to 100% prescription isodose volume); R50 (ratio of 50% prescription isodose volume to the target volume); V12Gy (volume of brain tissue minus GTV receiving 12 Gy), and mean dose of the normal brain. Normal tissue complication probability (NTCP) of brain radionecrosis (RN) was calculated using the Lyman-Kutcher-Burman (LKB) model and total treatment delivery time was calculated. Six physicians from different institutions participated in the blind survey to evaluate the plan quality and rank their choices. Results The study showed that SPArc has a dosimetric advantage in the V12Gy and R50 with target volumes > 9.00 cc compared to VMAT and IMPT. A significant clinical benefit can be found in deep centrally located lesions larger than 20.00 cc using SPArc because of the superior dose conformity and mean dose reduction in healthy brain tissue. Nine retrospective clinical cases and the blind survey showed good agreement with the in silico dosimetric model and decision tree. Additionally, SPArc significantly reduced the treatment delivery time compared to VMAT (SPArc 184.46 ± 59.51s vs. VMAT: 1574.78 ± 213.65s). Conclusion The study demonstrated the feasibility of using Proton beam therapy for single brain metastasis patients utilizing the SPArc technique. At the current stage of technological development, VMAT remains the current standard modality of choice for single lesion brain SRS. The in silico dosimetric model and decision tree presented here could be used as a practical clinical decision tool to assist the selection of the optimal treatment modality among VMAT, IMPT, and SPArc in centers that have both photon and proton capabilities.
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Affiliation(s)
- Sheng Chang
- Department of Radiation Oncology, Renmin Hospital, Wuhan University, Wuhan, China
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Gang Liu
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lewei Zhao
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Weili Zheng
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Di Yan
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Peter Chen
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Xiangpan Li
- Department of Radiation Oncology, Renmin Hospital, Wuhan University, Wuhan, China
| | - Kunyu Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rohan Deraniyagala
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Inga Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Prakash Chinnaiyan
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Xiaoqiang Li
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
- *Correspondence: Xuanfeng Ding,
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14
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Wuyckens S, Saint-Guillain M, Janssens G, Zhao L, Li X, Ding X, Sterpin E, Lee JA, Souris K. Treatment planning in arc proton therapy: Comparison of several optimization problem statements and their corresponding solvers. Comput Biol Med 2022; 148:105609. [DOI: 10.1016/j.compbiomed.2022.105609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
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Engwall E, Battinelli C, Wase V, Marthin O, Glimelius L, Bokrantz R, Andersson B, Fredriksson A. Fast robust optimization of proton PBS arc therapy plans using early energy layer selection and spot assignment. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac55a6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/16/2022] [Indexed: 12/31/2022]
Abstract
Abstract
Objective. Proton pencil-beam scanning arcs (PBS arcs) have gained much attention during the past years, due to its potential for increased clinical benefit compared to conventional proton therapy. Previous studies on PBS arcs have primarily been focused on plan quality, and lately efforts have been made to reduce the delivery time. However, the methods presented so far suffer from slow optimization processes. Approach. We present a new method for fast robust optimization of PBS arc plans. The new method assigns a single energy layer per discretized direction prior to spot weight optimization and reduces the number of initial spots considerably compared to conventional methods. We used the new method for three prostate cancer patients with a prescribed dose to the CTV of 77 GyRBE in 35 fractions. For each of the patients, four plans were created: 2-beam IMPT (2IMPT), 1-beam PBS arc (1Arc), 1-beam PBS arc without focus on reducing upward energy jumps (1Arc_unseq) and two-beam PBS arc (2Arc). Main results. All PBS arc plans show a reduced integral dose compared to their respective 2IMPT plans. In the nominal case, the average CTV D98 and D2 metrics over the three patients were best for the 2Arc, followed by 2IMPT (
D
98
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D
2
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7523/7986 cGyRBE (2IMPT), 7478/7984 cGy (1Arc), 7486/7951 cGy (1Arc_unseq), 7531/7951 cGyRBE (2Arc)). The average robust target coverage in terms of V95 of the voxelwise minimum dose distribution (evaluated over 42 scenarios) was: 98.0% (2IMPT), 88.6% (1Arc), 92.5% (1Arc_unseq), 97.3% (2Arc). The optimization time, including spot selection and spot dose computation, is longest for the 2Arc plan, but is below 6 min for all patients. The maximum estimated delivery time for all types of arc plans is just above 5 min Significance. The ability for efficient treatment planning constitutes an important step towards clinical introduction of proton PBS arcs.
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Vidal M, Moignier C, Patriarca A, Sotiropoulos M, Schneider T, De Marzi L. Future technological developments in proton therapy - A predicted technological breakthrough. Cancer Radiother 2021; 25:554-564. [PMID: 34272182 DOI: 10.1016/j.canrad.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022]
Abstract
In the current spectrum of cancer treatments, despite high costs, a lack of robust evidence based on clinical outcomes or technical and radiobiological uncertainties, particle therapy and in particular proton therapy (PT) is rapidly growing. Despite proton therapy being more than fifty years old (first proposed by Wilson in 1946) and more than 220,000 patients having been treated with in 2020, many technological challenges remain and numerous new technical developments that must be integrated into existing systems. This article presents an overview of on-going technical developments and innovations that we felt were most important today, as well as those that have the potential to significantly shape the future of proton therapy. Indeed, efforts have been done continuously to improve the efficiency of a PT system, in terms of cost, technology and delivery technics, and a number of different developments pursued in the accelerator field will first be presented. Significant developments are also underway in terms of transport and spatial resolution achievable with pencil beam scanning, or conformation of the dose to the target: we will therefore discuss beam focusing and collimation issues which are important parameters for the development of these techniques, as well as proton arc therapy. State of the art and alternative approaches to adaptive PT and the future of adaptive PT will finally be reviewed. Through these overviews, we will finally see how advances in these different areas will allow the potential for robust dose shaping in proton therapy to be maximised, probably foreshadowing a future era of maturity for the PT technique.
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Affiliation(s)
- M Vidal
- Centre Antoine-Lacassagne, Fédération Claude Lalanne, 227, avenue de la Lanterne, 06200 Nice, France
| | - C Moignier
- Centre François Baclesse, Department of Medical Physics, Centre de protonthérapie de Normandie, 14000 Caen, France
| | - A Patriarca
- Institut Curie, PSL Research University, Radiation oncology department, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, 91898 Orsay, France
| | - M Sotiropoulos
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation radiobiologie et cancer, 91400 Orsay, France
| | - T Schneider
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation radiobiologie et cancer, 91400 Orsay, France
| | - L De Marzi
- Institut Curie, PSL Research University, Radiation oncology department, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, 91898 Orsay, France; Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, Campus universitaire, 91898 Orsay, France.
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