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Yaddanapudi S, Wakisaka Y, Furutani KM, Yagi M, Shimizu S, Beltran CJ. Technical Note: Improving the workflow in a carbon ion therapy center with custom software for enhanced patient care. Tech Innov Patient Support Radiat Oncol 2024; 30:100251. [PMID: 38707713 PMCID: PMC11070275 DOI: 10.1016/j.tipsro.2024.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024] Open
Abstract
Carbon-ion radiation therapy (CIRT) is an up-and-coming modality for cancer treatment. Implementation of CIRT requires collaboration among specialists like radiation oncologists, medical physicists, and other healthcare professionals. Effective communication among team members is necessary for the success of CIRT. However, the current workflows involving data management, treatment planning, scheduling, and quality assurance (QA) can be susceptible to errors, leading to delays and decreased efficiency. With the aim of addressing these challenges, a team of medical physicists developed an in-house workflow management software using FileMaker Pro. This tool has streamlined the workflow and improved the efficiency and quality of patient care.
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Affiliation(s)
| | - Yushi Wakisaka
- Department of Medical Physics and Engineering, Osaka University, Osaka, Japan
- Department of Radiation Technology, Osaka Heavy Ion Therapy Center, Osaka, Japan
| | - Keith M. Furutani
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
- Department of Carbon Ion Radiotherapy, Osaka University, Osaka, Japan
| | - Masashi Yagi
- Department of Carbon Ion Radiotherapy, Osaka University, Osaka, Japan
| | - Shinichi Shimizu
- Department of Carbon Ion Radiotherapy, Osaka University, Osaka, Japan
| | - Chris J. Beltran
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
- Department of Carbon Ion Radiotherapy, Osaka University, Osaka, Japan
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Hörberger F, Andersson KM, Enmark M, Kristensen I, Flejmer A, Edvardsson A. Pencil beam scanning proton therapy for mediastinal lymphomas in deep inspiration breath-hold: a retrospective assessment of plan robustness. Acta Oncol 2024; 63:62-69. [PMID: 38415848 DOI: 10.2340/1651-226x.2024.23964] [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: 10/18/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE/BACKGROUND The aim of this study was to evaluate pencil beam scanning (PBS) proton therapy (PT) in deep inspiration breath-hold (DIBH) for mediastinal lymphoma patients, by retrospectively evaluating plan robustness to the clinical target volume (CTV) and organs at risk (OARs) on repeated CT images acquired throughout treatment. Methods: Sixteen mediastinal lymphoma patients treated with PBS-PT in DIBH were included. Treatment plans (TPs) were robustly optimized on the CTV (7 mm/4.5%). Repeated verification CTs (vCT) were acquired during the treatment course, resulting in 52 images for the entire patient cohort. The CTV and OARs were transferred from the planning CT to the vCTs with deformable image registration and the TPs were recalculated on the vCTs. Target coverage and OAR doses at the vCTs were compared to the nominal plan. Deviation in lung volume was also calculated. RESULTS The TPs demonstrated high robust target coverage throughout treatment with D98%,CTV deviations within 2% for 14 patients and above the desired requirement of 95% for 49/52 vCTs. However, two patients did not achieve a robust dose to CTV due to poor DIBH reproducibility, with D98%,CTV at 78 and 93% respectively, and replanning was performed for one patient. Adequate OAR sparing was achieved for all patients. Total lung volume variation was below 10% for 39/52 vCTs. CONCLUSION PBS PT in DIBH is generally a robust technique for treatment of mediastinal lymphomas. However, closely monitoring the DIBH-reproducibility during treatment is important to avoid underdosing CTV and achieve sufficient dose-sparing of the OARs.
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Affiliation(s)
- Filip Hörberger
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden.
| | | | - Marika Enmark
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden; Department of Medical Physics, The Skandion Clinic, Uppsala, Sweden
| | - Ingrid Kristensen
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden; Department of Clinical Sciences, Oncology, Lund University, Lund, Sweden
| | - Anna Flejmer
- Department of Medical Physics, The Skandion Clinic, Uppsala, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Anneli Edvardsson
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden; Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Fukumitsu N, Kubota H, Demizu Y, Suzuki T, Hasegawa D, Kosaka Y, Kawamura A, Soejima T. Comparison of passive-scattered and intensity-modulated proton beam therapy of craniospinal irradiation with proton beams for pediatric and young adult patients with brain tumors. Jpn J Radiol 2024; 42:182-189. [PMID: 37874526 PMCID: PMC10811119 DOI: 10.1007/s11604-023-01499-8] [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: 05/29/2023] [Accepted: 09/06/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE To investigate the dose stability of craniospinal irradiation based on irradiation method of proton beam therapy (PBT). METHODS AND MATERIALS Twenty-four pediatric and young adult brain tumor patients (age: 1-24 years) were examined. Treatment method was passive-scattered PBT (PSPT) in 8 patients and intensity-modulated PBT (IMPT) in 16 patients. The whole vertebral body (WVB) technique was used in 13 patients whose ages were younger than 10, and vertebral body sparing (VBS) technique was used for the remaining 11 patients aged 10 and above. Dose stability of planning target volume (PTV) against set-up error was investigated. RESULTS The minimum dose (Dmin) of IMPT was higher than that of PSPT (p = 0.01). Inhomogeneity index (INH) of IMPT was lower than that of PSPT (p = 0.004). When the irradiation field of the cervical spinal cord level (C level) was shifted, the maximum dose (Dmax) was lower in IMPT, and mean dose (Dmean) was higher than PSPT as movement became greater to the cranial-caudal direction (p = 0.000-0.043). Dmin was higher and INH was lower in IMPT in all directions (p = 0.000-0.034). When the irradiation field of the lumber spinal cord level (L level) was shifted, Dmax was lower in IMPT as movement became greater to the cranial direction (p = 0.000-0.028). Dmin was higher and INH was lower in IMPT in all directions (p = 0.000-0.022). CONCLUSIONS The PTV doses of IMPT and PSPT are robust and stable in both anterior-posterior and lateral directions at both C level and L level, but IMPT is more robust and stable than PSPT for cranial-caudal movements. TRIAL REGISTRY Clinical Trial Registration number: No. 04-03.
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Affiliation(s)
- Nobuyoshi Fukumitsu
- Department of Radiation Oncology, Kobe Proton Center, 1-6-8, Minatojima-Minamimachi, Kobe, 650-0047, Japan.
| | - Hikaru Kubota
- Department of Radiation Oncology, Kobe Proton Center, 1-6-8, Minatojima-Minamimachi, Kobe, 650-0047, Japan
| | - Yusuke Demizu
- Department of Radiation Oncology, Kobe Proton Center, 1-6-8, Minatojima-Minamimachi, Kobe, 650-0047, Japan
| | - Takeshi Suzuki
- Department of Anesthesiology, Kobe Proton Center, Kobe, Japan
| | - Daiichiro Hasegawa
- Department of Hematology and Oncology, Hyogo Children's Hospital, Kobe, Japan
| | - Yoshiyuki Kosaka
- Department of Hematology and Oncology, Hyogo Children's Hospital, Kobe, Japan
| | | | - Toshinori Soejima
- Department of Radiation Oncology, Kobe Proton Center, 1-6-8, Minatojima-Minamimachi, Kobe, 650-0047, Japan
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Peteani G, Paganelli C, Giovannelli AC, Bachtiary B, Safai S, Rogers S, Pusterla O, Riesterer O, Weber DC, Lomax AJ, Baroni G, Fattori G. Retrospective reconstruction of four-dimensional magnetic resonance from interleaved cine imaging - A comparative study with four-dimensional computed tomography in the lung. Phys Imaging Radiat Oncol 2024; 29:100529. [PMID: 38235286 PMCID: PMC10792758 DOI: 10.1016/j.phro.2023.100529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024] Open
Abstract
Background and purpose Imaging of respiration-induced anatomical changes is essential to ensure high accuracy in radiotherapy of lung cancer. We expanded here on methods for retrospective reconstruction of time-resolved volumetric magnetic resonance (4DMR) of the thoracic region and benchmarked the results against 4D computed tomography (4DCT). Materials and method MR data of six lung cancer patients were collected by interleaving cine-navigator images with 2D data frame images, acquired across the thorax. The data frame images have been stacked in volumes based on a similarity metric that considers the anatomical deformation of lungs, while addressing ambiguities in respiratory phase detection and interpolation of missing data. The resulting images were validated against cine-navigator images and compared to paired 4DCTs in terms of amplitude and period of motion, assessing differences in internal target volume (ITV) margin definition. Results 4DMR-based motion amplitude was on average within 1.8 mm of that measured in the corresponding 2D cine-navigator images. In our dataset, the 4DCT motion and the 4DMR median amplitude were always within 3.8 mm. The median period was generally close to CT references, although deviations up to 24 % have been observed. These changes were reflected in the ITV, which was generally larger for MRI than for 4DCT (up to 39.7 %). Conclusions The proposed algorithm for retrospective reconstruction of time-resolved volumetric MR provided quality anatomical images with high temporal resolution for motion modelling and treatment planning. The potential for imaging organ motion variability makes 4DMR a valuable complement to standard 4DCT imaging.
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Affiliation(s)
- Giulia Peteani
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Anna Chiara Giovannelli
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
- Department of Physics, ETH Zürich, Zürich, Switzerland
| | - Barbara Bachtiary
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - Sairos Safai
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - Susanne Rogers
- Department of Radiation Oncology, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Orso Pusterla
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Radiation Oncology, University Hospital of Zürich, 8091 Zürich, Switzerland
| | - Oliver Riesterer
- Department of Radiation Oncology, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
- Department of Radiation Oncology, University Hospital of Zürich, 8091 Zürich, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Antony John Lomax
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
- Department of Physics, ETH Zürich, Zürich, Switzerland
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giovanni Fattori
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
- Department of Physics, ETH Zürich, Zürich, Switzerland
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Stengl C, Panow K, Arbes E, Muñoz ID, Christensen JB, Neelsen C, Dinkel F, Weidner A, Runz A, Johnen W, Liermann J, Echner G, Vedelago J, Jäkel O. A phantom to simulate organ motion and its effect on dose distribution in carbon ion therapy for pancreatic cancer. Phys Med Biol 2023; 68:245013. [PMID: 37918022 DOI: 10.1088/1361-6560/ad0902] [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: 06/27/2023] [Accepted: 11/02/2023] [Indexed: 11/04/2023]
Abstract
Objective. Carbon ion radiotherapy is a promising radiation technique for malignancies like pancreatic cancer. However, organs' motion imposes challenges for achieving homogeneous dose delivery. In this study, an anthropomorphicPancreasPhantom forIon-beamTherapy (PPIeT) was developed to simulate breathing and gastrointestinal motion during radiotherapy.Approach. The developed phantom contains a pancreas, two kidneys, a duodenum, a spine and a spinal cord. The shell of the organs was 3D printed and filled with agarose-based mixtures. Hounsfield Units (HU) of PPIeTs' organs were measured by CT. The pancreas motion amplitude in cranial-caudal (CC) direction was evaluated from patients' 4D CT data. Motions within the obtained range were simulated and analyzed in PPIeT using MRI. Additionally, GI motion was mimicked by changing the volume of the duodenum and quantified by MRI. A patient-like treatment plan was calculated for carbon ions, and the phantom was irradiated in a static and moving condition. Dose measurements in the organs were performed using an ionization chamber and dosimetric films.Main results. PPIeT presented tissue equivalent HU and reproducible breathing-induced CC displacements of the pancreas between (3.98 ± 0.36) mm and a maximum of (18.19 ± 0.44) mm. The observed maximum change in distance of (14.28 ± 0.12) mm between pancreas and duodenum was consistent with findings in patients. Carbon ion irradiation revealed homogenous coverage of the virtual tumor at the pancreas in static condition with a 1% deviation from the treatment plan. Instead, the dose delivery during motion with the maximum amplitude yielded an underdosage of 21% at the target and an increased uncertainty by two orders of magnitude.Significance. A dedicated phantom was designed and developed for breathing motion assessment of dose deposition during carbon ion radiotherapy. PPIeT is a unique tool for dose verification in the pancreas and its organs at risk during end-to-end tests.
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Affiliation(s)
- Christina Stengl
- Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, Heidelberg D-69120, Germany
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Kathrin Panow
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Eric Arbes
- Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Department for Physics and Astronomy, Heidelberg University, Im Neuenheimer Feld 226, Heidelberg D-69120, Germany
| | - Iván D Muñoz
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Department for Physics and Astronomy, Heidelberg University, Im Neuenheimer Feld 226, Heidelberg D-69120, Germany
| | - Jeppe B Christensen
- Department of Radiation Safety and Security, Paul Scherrer Institute (PSI), Forschungsstrasse 111, Villigen PSI 5232, Switzerland
| | - Christian Neelsen
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Department of Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin D-10117, Germany
| | - Fabian Dinkel
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Artur Weidner
- Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, Heidelberg D-69120, Germany
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Armin Runz
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Wibke Johnen
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Jakob Liermann
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Im Neuenheimer Feld 400, Heidelberg D-69120, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Im Neuenheimer Feld 450, Heidelberg D-69120, Germany
- National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Gernot Echner
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - José Vedelago
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Im Neuenheimer Feld 400, Heidelberg D-69120, Germany
| | - Oliver Jäkel
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg D-69120, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Im Neuenheimer Feld 450, Heidelberg D-69120, Germany
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Becksfort J, Uh J, Saunders A, Byrd JA, Worrall HM, Marker M, Melendez-Suchi C, Li Y, Chang J, Raghavan K, Merchant TE, Hua CH. Setup Uncertainty of Pediatric Brain Tumor Patients Receiving Proton Therapy: A Prospective Study. Cancers (Basel) 2023; 15:5486. [PMID: 38001746 PMCID: PMC10670653 DOI: 10.3390/cancers15225486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
This study quantifies setup uncertainty in brain tumor patients who received image-guided proton therapy. Patients analyzed include 165 children, adolescents, and young adults (median age at radiotherapy: 9 years (range: 10 months to 24 years); 80 anesthetized and 85 awake) enrolled in a single-institution prospective study from 2020 to 2023. Cone-beam computed tomography (CBCT) was performed daily to calculate and correct manual setup errors, once per course after setup correction to measure residual errors, and weekly after treatments to assess intrafractional motion. Orthogonal radiographs were acquired consecutively with CBCT for paired comparisons of 40 patients. Translational and rotational errors were converted from 6 degrees of freedom to a scalar by a statistical approach that considers the distance from the target to the isocenter. The 95th percentile of setup uncertainty was reduced by daily CBCT from 10 mm (manual positioning) to 1-1.5 mm (after correction) and increased to 2 mm by the end of fractional treatment. A larger variation existed between the roll corrections reported by radiographs vs. CBCT than for pitch and yaw, while there was no statistically significant difference in translational variation. A quantile mixed regression model showed that the 95th percentile of intrafractional motion was 0.40 mm lower for anesthetized patients (p=0.0016). Considering additional uncertainty in radiation-imaging isocentricity, the commonly used total plan robustness of 3 mm against positional uncertainty would be appropriate for our study cohort.
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Affiliation(s)
- Jared Becksfort
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.U.); (J.A.B.); (H.M.W.); (T.E.M.); (C.-h.H.)
| | - Jinsoo Uh
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.U.); (J.A.B.); (H.M.W.); (T.E.M.); (C.-h.H.)
| | - Andrew Saunders
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.U.); (J.A.B.); (H.M.W.); (T.E.M.); (C.-h.H.)
| | - Julia A. Byrd
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.U.); (J.A.B.); (H.M.W.); (T.E.M.); (C.-h.H.)
| | - Hannah M. Worrall
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.U.); (J.A.B.); (H.M.W.); (T.E.M.); (C.-h.H.)
| | - Matt Marker
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.U.); (J.A.B.); (H.M.W.); (T.E.M.); (C.-h.H.)
| | - Christian Melendez-Suchi
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.U.); (J.A.B.); (H.M.W.); (T.E.M.); (C.-h.H.)
| | - Yimei Li
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Jenghwa Chang
- Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Kavitha Raghavan
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Thomas E. Merchant
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.U.); (J.A.B.); (H.M.W.); (T.E.M.); (C.-h.H.)
| | - Chia-ho Hua
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (J.U.); (J.A.B.); (H.M.W.); (T.E.M.); (C.-h.H.)
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Ma Y, Mao J, Liu X, Dai Z, Zhang H, Li Y, Li Q. Selection of breathing phase number in 4D scanned proton treatment planning optimization for lung tumors. Phys Med 2023; 114:103152. [PMID: 37783030 DOI: 10.1016/j.ejmp.2023.103152] [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: 05/04/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023] Open
Abstract
The standard four-dimensional (4D) treatment planning includes all breathing states in the optimization process, which is time-consuming. This work was aimed to optimize the number of intermediate phases needed for 4D proton treatment planning optimization to reduce the computational cost. Five 4D optimization strategies adopting different numbers of intermediate states and one three-dimensional (3D) optimization plan were studied for fifteen lung cancer patients treated with scanned protons, optimizing on all ten phases (4D_10), two extreme phases (4D_2), six phases during the exhalation stage (4D_6EX), six phases during the inhalation stage (4D_6IN), two extreme phases plus an intermediate state (4D_3) and average computed tomography image (3D), respectively. The 4D dose evaluation was conducted on all the ten phases, considering the interplay effect. The resulting doses accumulated on the reference phase were computed and compared. Compared to the 4D optimization plans, the 3D optimization plan performed inferiorly in target coverage, but superiorly in organ at risks (OARs) sparing. For the 4D optimization, all the five 4D plans showed similar performance in OARs protection. However, the 4D_6EX and 4D_6IN strategies out-performed the 4D_2 and 4D_3 plans in dose homogeneity. The computing times of the 4D_2, 4D_3, 4D_6EX and 4D_6IN approaches decreased to 32%, 41%, 66% and 67% of the 4D_10 method, respectively. Thus, our study suggested that the use of all phases during inhalation or exhalation stage might be a feasible approach substituting for the full phase strategy to reduce the calculation load while guaranteeing the plan quality for scanned proton therapy.
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Affiliation(s)
- Yuanyuan Ma
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China
| | - Jingfang Mao
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai 201321, China; Shanghai Key Laboratory of Radiation Oncology, Shanghai 201321, China; Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai 201321, China
| | - Xinguo Liu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China
| | - Zhongying Dai
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China
| | - Hui Zhang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China
| | - Yazhou Li
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China; University of Chinese Academy of Sciences, Beijing 100049, China; Gansu Provincial Hospital, Lanzhou 730000, China
| | - Qiang Li
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China; University of Chinese Academy of Sciences, Beijing 100049, China.
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8
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Giovannelli AC, Köthe A, Safai S, Meer D, Zhang Y, Weber DC, Lomax AJ, Fattori G. Exploring beamline momentum acceptance for tracking respiratory variability in lung cancer proton therapy: a simulation study. Phys Med Biol 2023; 68:195013. [PMID: 37652055 DOI: 10.1088/1361-6560/acf5c4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 08/31/2023] [Indexed: 09/02/2023]
Abstract
Objective. Investigating the aspects of proton beam delivery to track organ motion with pencil beam scanning therapy. Considering current systems as a reference, specify requirements for next-generation units aiming at real-time image-guided treatments.Approach. Proton treatments for six non-small cell lung cancer (NSCLC) patients were simulated using repeated 4DCTs to model respiratory motion variability. Energy corrections required for this treatment site were evaluated for different approaches to tumour tracking, focusing on the potential for energy adjustment within beamline momentum acceptance (dp/p). A respiration-synchronised tracking, taking into account realistic machine delivery limits, was compared to ideal tracking scenarios, in which unconstrained energy corrections are possible. Rescanning and the use of multiple fields to mitigate residual interplay effects and dose degradation have also been investigated.Main results. Energy correction requirements increased with motion amplitudes, for all patients and tracking scenarios. Higher dose degradation was found for larger motion amplitudes, rescanning has beneficial effects and helped to improve dosimetry metrics for the investigated limited dp/pof 1.2% (realistic) and 2.4%. The median differences between ideal and respiratory-synchronised tracking show minimal discrepancies, 1% and 5% respectively for dose coverage (CTV V95) and homogeneity (D5-D95). Multiple-field planning improves D5-D95 up to 50% in the most extreme cases while it does not show a significant effect on V95.Significance. This work shows the potential of implementing tumour tracking in current proton therapy units and outlines design requirements for future developments. Energy regulation within momentum acceptance was investigated to tracking tumour motion with respiratory-synchronisation, achieving results in line with the performance of ideal tracking scenarios. ±5% Δp/p would allow to compensate for all range offsets in our NSCLC patient cohort, including breathing variability. However, the realistic momentum of 1.2% dp/prepresentative of existing medical units limitations, has been shown to preserve plan quality.
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Affiliation(s)
- Anna Chiara Giovannelli
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Department of Physics, ETH Zürich, 8092 Zürich, Switzerland
| | - Andreas Köthe
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Department of Physics, ETH Zürich, 8092 Zürich, Switzerland
| | - Sairos Safai
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - David Meer
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Department of Radiation Oncology, University Hospital of Zürich, 8091 Zürich, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Antony John Lomax
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Department of Physics, ETH Zürich, 8092 Zürich, Switzerland
| | - Giovanni Fattori
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
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9
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Fukumitsu N, Kubota H, Mima M, Demizu Y, Suzuki T, Hasegawa D, Kosaka Y, Kawamura A, Soejima T. Comparison of Craniospinal Irradiation Using Proton Beams According to Irradiation Method and Initial Experience Treating Pediatric Patients. Adv Radiat Oncol 2023; 8:101251. [PMID: 37408669 PMCID: PMC10318217 DOI: 10.1016/j.adro.2023.101251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/11/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose This study compared craniospinal irradiation using proton beam therapy (PBT) according to irradiation method and investigated the initial effects. Methods and Materials Twenty-four pediatric patients (1-24 years old) who received proton craniospinal irradiation were examined. Passive scattered PBT (PSPT) and intensity modulated PBT (IMPT) were used in 8 and 16 patients, respectively. The whole vertebral body technique was used for 13 patients <10 years old, and the vertebral body sparing (VBS) technique was used for the remaining 11 patients aged ≥10 years. The follow-up period was 17 to 44 (median, 27) months. Organ-at-risk and planning target volume (PTV) doses and other clinical data were examined. Results The maximum lens dose using IMPT was lower than that using PSPT (P = .008). The mean thyroid, lung, esophagus, and kidney doses were lower in patients treated using the VBS technique compared with the whole vertebral body technique (all P < .001). The minimum PTV dose of IMPT was higher than that of PSPT (P = .01). The inhomogeneity index of IMPT was lower than that of PSPT (P = .004). Conclusions IMPT is better than PSPT at reducing the dose to the lens. The VBS technique can decrease the doses to neck-chest-abdomen organs. The PTV coverage of IMPT is superior to that of PSPT.
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Affiliation(s)
| | | | | | | | | | | | | | - Atsufumi Kawamura
- Neurosurgery, Hyogo Prefectual Kobe Children's Hospital, Kobe, Japan
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10
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Knäusl B, Taasti VT, Poulsen P, Muren LP. Surveying the clinical practice of treatment adaptation and motion management in particle therapy. Phys Imaging Radiat Oncol 2023; 27:100457. [PMID: 37361612 PMCID: PMC10285555 DOI: 10.1016/j.phro.2023.100457] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Affiliation(s)
- Barbara Knäusl
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Vicki T Taasti
- Department of Radiation Oncology (Maastro), GROW - School for Oncology and Reproduction, Maastricht, University Medical Centre+, Maastricht, The Netherlands
| | - Per Poulsen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University, Aarhus, Denmark
| | - Ludvig P Muren
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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11
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Graeff C, Volz L, Durante M. Emerging technologies for cancer therapy using accelerated particles. PROGRESS IN PARTICLE AND NUCLEAR PHYSICS 2023; 131:104046. [PMID: 37207092 PMCID: PMC7614547 DOI: 10.1016/j.ppnp.2023.104046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Cancer therapy with accelerated charged particles is one of the most valuable biomedical applications of nuclear physics. The technology has vastly evolved in the past 50 years, the number of clinical centers is exponentially growing, and recent clinical results support the physics and radiobiology rationale that particles should be less toxic and more effective than conventional X-rays for many cancer patients. Charged particles are also the most mature technology for clinical translation of ultra-high dose rate (FLASH) radiotherapy. However, the fraction of patients treated with accelerated particles is still very small and the therapy is only applied to a few solid cancer indications. The growth of particle therapy strongly depends on technological innovations aiming to make the therapy cheaper, more conformal and faster. The most promising solutions to reach these goals are superconductive magnets to build compact accelerators; gantryless beam delivery; online image-guidance and adaptive therapy with the support of machine learning algorithms; and high-intensity accelerators coupled to online imaging. Large international collaborations are needed to hasten the clinical translation of the research results.
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Affiliation(s)
- Christian Graeff
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Planckstraße 1, 64291 Darmstadt, Germany
- Technische Universität Darmstadt, Darmstadt, Germany
| | - Lennart Volz
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Planckstraße 1, 64291 Darmstadt, Germany
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Planckstraße 1, 64291 Darmstadt, Germany
- Technische Universität Darmstadt, Darmstadt, Germany
- Dipartimento di Fisica “Ettore Pancini”, University Federico II, Naples, Italy
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12
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Schmitz H, Thummerer A, Kawula M, Lombardo E, Parodi K, Belka C, Kamp F, Kurz C, Landry G. ScatterNet for projection-based 4D cone-beam computed tomography intensity correction of lung cancer patients. Phys Imaging Radiat Oncol 2023; 27:100482. [PMID: 37680905 PMCID: PMC10480315 DOI: 10.1016/j.phro.2023.100482] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/04/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
Background and purpose: In radiotherapy, dose calculations based on 4D cone beam CTs (4DCBCTs) require image intensity corrections. This retrospective study compared the dose calculation accuracy of a deep learning, projection-based scatter correction workflow (ScatterNet), to slower workflows: conventional 4D projection-based scatter correction (CBCTcor) and a deformable image registration (DIR)-based method (4DvCT). Materials and methods: For 26 lung cancer patients, planning CTs (pCTs), 4DCTs and CBCT projections were available. ScatterNet was trained with pairs of raw and corrected CBCT projections. Corrected projections from ScatterNet and the conventional workflow were reconstructed using MA-ROOSTER, yielding 4DCBCTSN and 4DCBCTcor. The 4DvCT was generated by 4DCT to 4DCBCT DIR, as part of the 4DCBCTcor workflow. Robust intensity modulated proton therapy treatment plans were created on free-breathing pCTs. 4DCBCTSN was compared to 4DCBCTcor and the 4DvCT in terms of image quality and dose calculation accuracy (dose-volume-histogram parameters and 3 % /3 mm gamma analysis). Results: 4DCBCTSN resulted in an average mean absolute error of 87 HU and 102 HU when compared to 4DCBCTcor and 4DvCT respectively. High agreement was observed in targets with median dose differences of 0.4 Gy (4DCBCTSN-4DCBCTcor) and 0.3 Gy (4DCBCTSN-4DvCT). The gamma analysis showed high average 3 % /3 mm pass rates of 96 % for both 4DCBCTSN vs. 4DCBCTcor and 4DCBCTSN vs. 4DvCT. Conclusions: Accurate 4D dose calculations are feasible for lung cancer patients using ScatterNet for 4DCBCT correction. Average scatter correction times could be reduced from 10 min (4DCBCTcor) to 3.9 s , showing the clinical suitability of the proposed deep learning-based method.
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Affiliation(s)
- Henning Schmitz
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Adrian Thummerer
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Maria Kawula
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Elia Lombardo
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Katia Parodi
- Department of Medical Physics, Ludwig-Maximilians-Universität München (LMU Munich), Garching (Munich), Germany
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Florian Kamp
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Radiation Oncology, University Hospital Cologne, Cologne, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
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13
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Lebbink F, Stocchiero S, Fossati P, Engwall E, Georg D, Stock M, Knäusl B. Parameter based 4D dose calculations for proton therapy. Phys Imaging Radiat Oncol 2023; 27:100473. [PMID: 37520640 PMCID: PMC10374597 DOI: 10.1016/j.phro.2023.100473] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023] Open
Abstract
Background and purpose Retrospective log file-based analysis provides the actual dose delivered based on the patient's breathing and the daily beam-delivery dynamics. To predict the motion sensitivity of the treatment plan on a patient-specific basis before treatment start a prospective tool is required. Such a parameter-based tool has been investigated with the aim to be used in clinical routine. Materials and Methods 4D dose calculations (4DDC) were performed for seven cancer patients with small breathing motion treated with scanned pulsed proton beams. Validation of the parameter-based 4DDC (p-4DDC) method was performed with an anthropomorphic phantom and patient data employing measurements and a log file-based 4DDC tool. The dose volume histogram parameters (Dx%) were investigated for the target and the organs at risk, compared to static and the file-based approach. Results The difference between the measured and the p-4DDC dose was within the deviation of the measurements. The maximum deviation was 0.4Gy. For the planning target volume D98% varied up to 15% compared to the static scenario, while the results from the log file and p-4DDC agreed within 2%. For the liver patients, D33%liver deviated up to 35% compared to static and 10% comparing the two 4DDC tools, while for the pancreas patients the D1%stomach varied up to 45% and 11%, respectively. Conclusion The results showed that p-4DDC could be used prospectively. The next step will be the clinical implementation of the p-4DDC tool, which can support a decision to either adapt the treatment plan or apply motion mitigation strategies.
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Affiliation(s)
- Franciska Lebbink
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria
| | - Silvia Stocchiero
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria
| | - Piero Fossati
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria
- Karl Landsteiner University of Health Sciences, Wiener Neustadt, Austria
| | | | - Dietmar Georg
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria
| | - Markus Stock
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria
- Karl Landsteiner University of Health Sciences, Wiener Neustadt, Austria
| | - Barbara Knäusl
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria
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14
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Knäusl B, Lebbink F, Fossati P, Engwall E, Georg D, Stock M. Patient Breathing Motion and Delivery Specifics Influencing the Robustness of a Proton Pancreas Irradiation. Cancers (Basel) 2023; 15:cancers15092550. [PMID: 37174016 PMCID: PMC10177445 DOI: 10.3390/cancers15092550] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Motion compensation strategies in particle therapy depend on the anatomy, motion amplitude and underlying beam delivery technology. This retrospective study on pancreas patients with small moving tumours analysed existing treatment concepts and serves as a basis for future treatment strategies for patients with larger motion amplitudes as well as the transition towards carbon ion treatments. The dose distributions of 17 hypofractionated proton treatment plans were analysed using 4D dose tracking (4DDT). The recalculation of clinical treatment plans employing robust optimisation for mitigating different organ fillings was performed on phased-based 4D computed tomography (4DCT) data considering the accelerator (pulsed scanned pencil beams delivered by a synchrotron) and the breathing-time structure. The analysis confirmed the robustness of the included treatment plans concerning the interplay of beam and organ motion. The median deterioration of D50% (ΔD50%) for the clinical target volume (CTV) and the planning target volume (PTV) was below 2%, while the only outlier was observed for ΔD98% with -35.1%. The average gamma pass rate over all treatment plans (2%/ 2 mm) was 88.8% ± 8.3, while treatment plans for motion amplitudes larger than 1 mm performed worse. For organs at risk (OARs), the median ΔD2% was below 3%, but for single patients, essential changes, e.g., up to 160% for the stomach were observed. The hypofractionated proton treatment for pancreas patients based on robust treatment plan optimisation and 2 to 4 horizontal and vertical beams showed to be robust against intra-fractional movements up to 3.7 mm. It could be demonstrated that the patient's orientation did not influence the motion sensitivity. The identified outliers showed the need for continuous 4DDT calculations in clinical practice to identify patient cases with more significant deviations.
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Affiliation(s)
- Barbara Knäusl
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
- MedAustron Ion Therapy Centre, Medical Physics, 2700 Wiener Neustadt, Austria
| | - Franciska Lebbink
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
- MedAustron Ion Therapy Centre, Medical Physics, 2700 Wiener Neustadt, Austria
| | - Piero Fossati
- MedAustron Ion Therapy Centre, Medical Physics, 2700 Wiener Neustadt, Austria
- Division Medical Physics, Karl Landsteiner University of Health Sciences, 2700 Wiener Neustadt, Austria
| | | | - Dietmar Georg
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria
| | - Markus Stock
- MedAustron Ion Therapy Centre, Medical Physics, 2700 Wiener Neustadt, Austria
- Division Medical Physics, Karl Landsteiner University of Health Sciences, 2700 Wiener Neustadt, Austria
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15
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Jensen SV, Muren LP, Balling P, Petersen JBB, Valdetaro LB, Poulsen PR. Dose perturbations in proton pencil beam delivery investigated by dynamically deforming silicone-based radiochromic dosimeters. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac9fa2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/02/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Objective. Proton therapy with pencil beam delivery enables dose distributions that conform tightly to the shape of a target. However, proton therapy dose delivery is sensitive to motion and deformation, which especially occur in the abdominal and thoracic regions. In this study, the dose perturbation caused by dynamic motion with and without gating during proton pencil beam deliveries were investigated using deformable three-dimensional (3D) silicone-based radiochromic dosimeters. Approach. A spread-out Bragg peak formed by four proton spots with different energies was delivered to two dosimeter batches. All dosimeters were cylindrical with a 50 mm diameter and length. The dosimeters were irradiated stationary while uncompressed and during dynamic compression by sinusoidal motion with peak-to-peak amplitudes of 20 mm in one end of the dosimeter and 10 mm in the other end. Motion experiments were made without gating and with gating near the uncompressed position. The entire experiment was video recorded and simulated in a Monte Carlo (MC) program. Main results. The 2%/2 mm gamma index analysis between the dose measurements and the MC dose simulations had pass rates of 86%–94% (first batch) and 98%–99% (second batch). Compared to the static delivery, the dose delivered during motion had gamma pass rates of 99%–100% when employing gating and 68%–87% without gating in the experiments whereas for the MC simulations it was 100% with gating and 66%–82% without gating. Significance. This study demonstrated the ability of using deformable 3D dosimeters to measure dose perturbations in proton pencil beam deliveries caused by dynamic motion and deformation.
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16
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Schneider S, Stefanowicz S, Jentsch C, Lohaus F, Thiele J, Haak D, Valentini C, Platzek I, G. C. Troost E, Hoffmann AL. Reduction of intrafraction pancreas motion using an abdominal corset compatible with proton therapy and MRI. Clin Transl Radiat Oncol 2022; 38:111-116. [DOI: 10.1016/j.ctro.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
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Vozenin MC, Bourhis J, Durante M. Towards clinical translation of FLASH radiotherapy. Nat Rev Clin Oncol 2022; 19:791-803. [DOI: 10.1038/s41571-022-00697-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/09/2022]
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18
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Sharma NK, Kappadath SC, Chuong M, Folkert M, Gibbs P, Jabbour SK, Jeyarajah DR, Kennedy A, Liu D, Meyer JE, Mikell J, Patel RS, Yang G, Mourtada F. The American Brachytherapy Society consensus statement for permanent implant brachytherapy using Yttrium-90 microsphere radioembolization for liver tumors. Brachytherapy 2022; 21:569-591. [PMID: 35599080 PMCID: PMC10868645 DOI: 10.1016/j.brachy.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/25/2022] [Accepted: 04/14/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To develop a multidisciplinary consensus for high quality multidisciplinary implementation of brachytherapy using Yttrium-90 (90Y) microspheres transarterial radioembolization (90Y TARE) for primary and metastatic cancers in the liver. METHODS AND MATERIALS Members of the American Brachytherapy Society (ABS) and colleagues with multidisciplinary expertise in liver tumor therapy formulated guidelines for 90Y TARE for unresectable primary liver malignancies and unresectable metastatic cancer to the liver. The consensus is provided on the most recent literature and clinical experience. RESULTS The ABS strongly recommends the use of 90Y microsphere brachytherapy for the definitive/palliative treatment of unresectable liver cancer when recommended by the multidisciplinary team. A quality management program must be implemented at the start of 90Y TARE program development and follow-up data should be tracked for efficacy and toxicity. Patient-specific dosimetry optimized for treatment intent is recommended when conducting 90Y TARE. Implementation in patients on systemic therapy should account for factors that may enhance treatment related toxicity without delaying treatment inappropriately. Further management and salvage therapy options including retreatment with 90Y TARE should be carefully considered. CONCLUSIONS ABS consensus for implementing a safe 90Y TARE program for liver cancer in the multidisciplinary setting is presented. It builds on previous guidelines to include recommendations for appropriate implementation based on current literature and practices in experienced centers. Practitioners and cooperative groups are encouraged to use this document as a guide to formulate their clinical practices and to adopt the most recent dose reporting policies that are critical for a unified outcome analysis of future effectiveness studies.
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Affiliation(s)
- Navesh K Sharma
- Department of Radiation Oncology, Penn State Hershey School of Medicine, Hershey, PA
| | - S Cheenu Kappadath
- Department of Imaging Physics, UT MD Anderson Cancer Center, Houston, TX
| | - Michael Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL
| | - Michael Folkert
- Northwell Health Cancer Institute, Radiation Medicine at the Center for Advanced Medicine, New Hyde Park, NY
| | - Peter Gibbs
- Personalised Oncology Division, Walter and Eliza Hall Institute, Melbourne, Victoria, Australia
| | - Salma K Jabbour
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | | | | | - David Liu
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | - Rahul S Patel
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gary Yang
- Loma Linda University, Loma Linda, CA
| | - Firas Mourtada
- Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE; Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA.
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Meschini G, Vai A, Barcellini A, Fontana G, Molinelli S, Mastella E, Pella A, Vitolo V, Imparato S, Orlandi E, Ciocca M, Baroni G, Paganelli C. Time-resolved MRI for off-line treatment robustness evaluation in carbon-ion radiotherapy of pancreatic cancer. Med Phys 2022; 49:2386-2395. [PMID: 35124811 PMCID: PMC9306947 DOI: 10.1002/mp.15510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/28/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE In this study, we investigate the use of magnetic resonance imaging (MRI) for the clinical evaluation of gating treatment robustness in carbon-ion radiotherapy (CIRT) of pancreatic cancer. Indeed, MRI allows radiation-free repeated scans and fast dynamic sequences for time-resolved (TR) imaging (cine-MRI), providing information on inter- and intra-fraction cycle-to-cycle variations of respiratory motion. MRI can therefore support treatment planning and verification, overcoming the limitations of the current clinical standard, that is, four-dimensional computed tomography (4DCT), which describes an "average" breathing cycle neglecting breathing motion variability. METHODS We integrated a technique to generate a virtual CT (vCT) from 3D MRI with a method for 3D reconstruction from 2D cine-MRI, to produce TR vCTs for dose recalculations. For eight patients, the method allowed evaluating inter-fraction variations at end-exhale and intra-fraction cycle-to-cycle variability within the gating window in terms of tumor displacement and dose to the target and organs at risk. RESULTS The median inter-fraction tumor motion was in the range 3.33-12.16 mm, but the target coverage was robust (-0.4% median D95% variation). Concerning cycle-to-cycle variations, the gating technique was effective in limiting tumor displacement (1.35 mm median gating motion) and corresponding dose variations (-3.9% median D95% variation). The larger exposure of organs at risk (duodenum and stomach) was caused by inter-fraction motion, whereas intra-fraction cycle-to-cycle dose variations were limited. CONCLUSIONS This study proposed a method for the generation of TR vCTs from MRI, which enabled an off-line evaluation of gating treatment robustness and suggested its feasibility to support treatment planning of pancreatic tumors in CIRT.
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Affiliation(s)
- Giorgia Meschini
- Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
| | - Alessandro Vai
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Amelia Barcellini
- Clinical DepartmentNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Giulia Fontana
- Clinical Bioengineering UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Silvia Molinelli
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Edoardo Mastella
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Andrea Pella
- Clinical Bioengineering UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Viviana Vitolo
- Clinical DepartmentNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Sara Imparato
- Radiology UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Ester Orlandi
- Clinical DepartmentNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Mario Ciocca
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Guido Baroni
- Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
- Clinical Bioengineering UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Chiara Paganelli
- Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
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Oonsiri S, Kitpanit S, Kannarunimit D, Chakkabat C, Lertbutsayanukul C, Prayongrat A. Comparison of intensity modulated proton therapy beam configurations for treating thoracic esophageal cancer. Phys Imaging Radiat Oncol 2022; 22:51-56. [PMID: 35514527 PMCID: PMC9065423 DOI: 10.1016/j.phro.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 04/10/2022] [Accepted: 04/20/2022] [Indexed: 01/19/2023] Open
Abstract
Dosimetric benefit of proton over x-ray treatment for thoracic esophageal cancer. Reduction of pulmonary and cardiac toxicity by proton therapy. Intensity modulated proton therapy beam configurations designed by tumor location.
Background and purpose Specific proton-beam configurations are needed to spare organs at risk (OARs), including lungs, heart, and spinal cord, when treating esophageal squamous cell carcinoma (ESCC) in the thoracic region. This study aimed to propose new intensity-modulated proton therapy (IMPT) beam configurations and to demonstrate the benefit of IMPT compared with intensity-modulated x-ray therapy (IMXT) for treating ESCC. Material and methods IMPT plans with three different beam angle configurations were generated on CT datasets of 25 ESCC patients that were treated with IMXT. The IMPT beam designs were two commonly-used beam configurations (anteroposterior and posterior oblique) and a recently proposed beam configuration (anterosuperior with posteroinferior). The target doses were 50–54 Gy(RBE) and 60–64 Gy(RBE) to the low-risk and high-risk target volumes, respectively. Robust optimization was applied for the IMPT plans. The differences in the dose-volume parameters between the IMXT and IMPT plans were compared. Results With target coverage comparable to standard IMXT, IMPT had significantly lower mean doses to the OARs. IMPT with an anteroposterior opposing beam generated the lowest lung dose (mean = 7.1 Gy(RBE), V20 = 14.1%) and the anterosuperior with posteroinferior beam resulted in the lowest heart dose (mean = 12.8 Gy(RBE), V30 = 15.7%) and liver dose (mean = 3.9 Gy(RBE), V30 = 5.9%). For the subgroup of patients with an inferior tumor location (PTVs overlapping a part of the contoured heart), the novel beam demonstrated the optimal OARs sparing. Conclusion Compared with IMXT, the IMPT plans significantly reduced the radiation dose to the surrounding organs when treating ESCC. IMPT beam configuration selection depends on the tumor location relative to the heart.
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Affiliation(s)
| | | | | | | | | | - Anussara Prayongrat
- Corresponding author at: 1873 Rama IV Road, Pathumwan District, Bangkok 10300, Thailand.
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21
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Lebbink F, Stock M, Georg D, Knäusl B. The Influence of Motion on the Delivery Accuracy When Comparing Actively Scanned Carbon Ions versus Protons at a Synchrotron-Based Radiotherapy Facility. Cancers (Basel) 2022; 14:cancers14071788. [PMID: 35406558 PMCID: PMC8997550 DOI: 10.3390/cancers14071788] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The interplay of breathing and beam motion reduces the efficacy of particle irradiation in moving tumours. The effect of motion on protons and carbon ion treatments was investigated dosimetrically and the results were benchmarked against each other by employing an anthropomorphic thorax phantom that was able to simulate tumour, rib, and lung motion. The critical question was whether target coverage and organ-at-risk sparing could be maintained when the application of simple motion mitigation was addressed. Special focus was put on unique synchrotron characteristics, such as pulsed beam delivery and beam intensity variations. It could be demonstrated that the effect of motion was greater for carbon ions than for protons. These findings demonstrated the need for applying motion mitigation techniques depending on the motion amplitude, particle type, and treatment prescription considering complex time correlations. Abstract Motion amplitudes, in need of mitigation for moving targets irradiated with pulsed carbon ions and protons, were identified to guide the decision on treatment and motion mitigation strategy. Measurements with PinPoint ionisation chambers positioned in an anthropomorphic breathing phantom were acquired to investigate different tumour motion scenarios, including rib and lung movements. The effect of beam delivery dynamics and spot characteristics was considered. The dose in the tumour centre was deteriorated up to 10% for carbon ions but only up to 5% for protons. Dose deviations in the penumbra increased by a factor of two when comparing carbon ions to protons, ranging from 2 to 30% for an increasing motion amplitude that was strongly dependent on the beam intensity. Layer rescanning was able to diminish the dose distortion caused by tumour motion, but an increase in spot size could reduce it even further to 5% within the target and 10% at the penumbra. An increased need for motion mitigation of carbon ions compared to protons was identified to assure target coverage and sparing of adjacent organs at risk in the penumbra region and outside the target. For the clinical implementation of moving target treatments at a synchrotron-based particle facility complex, time dependencies needed to be considered.
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Affiliation(s)
- Franciska Lebbink
- MedAustron Ion Therapy Centre, Medical Physics, 2700 Wiener Neustadt, Austria; (F.L.); (M.S.)
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Markus Stock
- MedAustron Ion Therapy Centre, Medical Physics, 2700 Wiener Neustadt, Austria; (F.L.); (M.S.)
| | - Dietmar Georg
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Barbara Knäusl
- MedAustron Ion Therapy Centre, Medical Physics, 2700 Wiener Neustadt, Austria; (F.L.); (M.S.)
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria;
- Correspondence:
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22
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He P, Li Q. Impact of Different Synchrotron Flattop Operation Modes on 4D Dosimetric Uncertainties for Scanned Carbon-Ion Beam Delivery. Front Oncol 2022; 12:806742. [PMID: 35223486 PMCID: PMC8873937 DOI: 10.3389/fonc.2022.806742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose The characteristic of pulsed beam delivery for synchrotron-based carbon-ion radiotherapy has led to the emergence of many scanning scenarios in order to improve the treatment efficiency and accuracy of moving target volume. Here, we aim to evaluate a novel breathing guidance motion mitigation performance under different synchrotron flattop operation modes in carbon-ion radiotherapy. Methods With the use of twelve 4DCT datasets of lung cancer patients who had been treated with respiratory-gated carbon-ion pencil beam therapy, range-adapted internal target volume (raITV) plans were optimized. Under the fixed flattop with single-energy and extended flattop with multi-energy synchrotron operation modes, the 4D treatments with breathing guidance and free breathing-based gated phase-controlled rescanning (PCR) beam delivery were simulated. Dose metrics (D95 and D5–D95 in clinical target volume (CTV)) and treatment time of the resulting 4D plans were compared. Results The two synchrotron operation modes provided different scanning dynamics. For the free breathing-based PCR method delivered in the extended flattop operation mode, the averaged CTV-D95 values were 90.4% ± 3.7%, 95.4% ± 1.7%, 96.9% ± 1.5%, 97.2% ± 1.5%, and 97.3% ± 1.5% for the 1-scanning, 2-PCR, 4-PCR, 6-PCR, and 8-PCR, respectively. For the breathing guidance-based PCR method delivered in the extended flattop mode, these values were 89.1% ± 4.0%, 97.0% ± 1.4%, 98.2% ± 0.7%, 98.6% ± 0.7%, and 98.9% ± 0.7%, respectively. However, CTV-D95 significantly increased to 98.5% ± 1.0% even with just 1-scanning breathing guidance-based fixed flattop operation mode (p < 0.01). Moreover, there was no significant difference in treatment time among the three technical combinations (p > 0.15). Conclusions The combination of the breathing guidance and PCR methods should be an alternative way for motion mitigation for the fixed flattop synchrotron operation mode. The target dose coverage and homogeneity could be further improved by the combination of the breathing guidance and PCR methods than the traditional PCR-only technology for the extended flattop synchrotron operation mode.
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Affiliation(s)
- Pengbo He
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine, Chinese Academy of Sciences, Lanzhou, China
- Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Qiang Li
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- Key Laboratory of Heavy Ion Radiation Biology and Medicine, Chinese Academy of Sciences, Lanzhou, China
- Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou, China
- University of Chinese Academy of Sciences, Beijing, China
- *Correspondence: Qiang Li,
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23
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Li H, Dong L, Bert C, Chang J, Flampouri S, Jee KW, Lin L, Moyers M, Mori S, Rottmann J, Tryggestad E, Vedam S. Report of AAPM Task Group 290: Respiratory motion management for particle therapy. Med Phys 2022; 49:e50-e81. [PMID: 35066871 PMCID: PMC9306777 DOI: 10.1002/mp.15470] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Dose uncertainty induced by respiratory motion remains a major concern for treating thoracic and abdominal lesions using particle beams. This Task Group report reviews the impact of tumor motion and dosimetric considerations in particle radiotherapy, current motion‐management techniques, and limitations for different particle‐beam delivery modes (i.e., passive scattering, uniform scanning, and pencil‐beam scanning). Furthermore, the report provides guidance and risk analysis for quality assurance of the motion‐management procedures to ensure consistency and accuracy, and discusses future development and emerging motion‐management strategies. This report supplements previously published AAPM report TG76, and considers aspects of motion management that are crucial to the accurate and safe delivery of particle‐beam therapy. To that end, this report produces general recommendations for commissioning and facility‐specific dosimetric characterization, motion assessment, treatment planning, active and passive motion‐management techniques, image guidance and related decision‐making, monitoring throughout therapy, and recommendations for vendors. Key among these recommendations are that: (1) facilities should perform thorough planning studies (using retrospective data) and develop standard operating procedures that address all aspects of therapy for any treatment site involving respiratory motion; (2) a risk‐based methodology should be adopted for quality management and ongoing process improvement.
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Affiliation(s)
- Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christoph Bert
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Joe Chang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stella Flampouri
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Kyung-Wook Jee
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Liyong Lin
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Michael Moyers
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Shinichiro Mori
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Joerg Rottmann
- Center for Proton Therapy, Proton Therapy Singapore, Proton Therapy Pte Ltd, Singapore
| | - Erik Tryggestad
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sastry Vedam
- Department of Radiation Oncology, University of Maryland, Baltimore, USA
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24
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Rana S, Rosenfeld AB. Small spot size versus large spot size: Effect on plan quality for lung cancer in pencil beam scanning proton therapy. J Appl Clin Med Phys 2022; 23:e13512. [PMID: 34989458 PMCID: PMC8833272 DOI: 10.1002/acm2.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/26/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of the current study was to evaluate the impact of spot size on the interplay effect, plan robustness, and dose to the organs at risk for lung cancer plans in pencil beam scanning (PBS) proton therapy Methods The current retrospective study included 13 lung cancer patients. For each patient, small spot (∼3 mm) plans and large spot (∼8 mm) plans were generated. The Monte Carlo algorithm was used for both robust plan optimization and final dose calculations. Each plan was normalized, such that 99% of the clinical target volume (CTV) received 99% of the prescription dose. Interplay effect was evaluated for treatment delivery starting in two different breathing phases (T0 and T50). Plan robustness was investigated for 12 perturbed scenarios, which combined the isocenter shift and range uncertainty. The nominal and worst‐case scenario (WCS) results were recorded for each treatment plan. Equivalent uniform dose (EUD) and normal tissue complication probability (NTCP) were evaluated for the total lung, heart, and esophagus. Results In comparison to large spot plans, the WCS values of small spot plans at CTV D95%, D96%, D97%, D98%, and D99% were higher with the average differences of 2.2% (range, 0.3%–3.7%), 2.3% (range, 0.5%–4.0%), 2.6% (range, 0.6%–4.4%), 2.7% (range, 0.9%–5.2%), and 2.7% (range, 0.3%–6.0%), respectively. The nominal and WCS mean dose and EUD for the esophagus, heart, and total lung were higher in large spot plans. The difference in NTCP between large spot and small spot plans was up to 1.9% for the total lung, up to 0.3% for the heart, and up to 32.8% for the esophagus. For robustness acceptance criteria of CTV D95% ≥ 98% of the prescription dose, seven small spot plans had all 12 perturbed scenarios meeting the criteria, whereas, for 13 large spot plans, there were ≥2 scenarios failing to meet the criteria. Interplay results showed that, on average, the target coverage in large spot plans was higher by 1.5% and 0.4% in non‐volumetric and volumetric repainting plans, respectively. Conclusion For robustly optimized PBS lung cancer plans in our study, a small spot machine resulted in a more robust CTV against the setup and range errors when compared to a large spot machine. In the absence of volumetric repainting, large spot PBS lung plans were more robust against the interplay effect. The use of a volumetric repainting technique in both small and large spot PBS lung plans led to comparable interplay target coverage.
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Affiliation(s)
- Suresh Rana
- Department of Medical Physics, The Oklahoma Proton Center, Oklahoma City, Oklahoma, USA.,Department of Radiation Oncology, Boca Raton Regional Hospital, Lynn Cancer Institute, Baptist Health South Florida, Boca Raton, Florida, USA.,Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Anatoly B Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
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25
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Kawashima M, Tashiro M, Varnava M, Shiba S, Matsui T, Okazaki S, Li Y, Komatsu S, Kawamura H, Okamoto M, Ohno T. An adaptive planning strategy in carbon ion therapy of pancreatic cancer involving beam angle selection. Phys Imaging Radiat Oncol 2022; 21:35-41. [PMID: 35198743 PMCID: PMC8850338 DOI: 10.1016/j.phro.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Motohiro Kawashima
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi, Gunma, Japan
- Corresponding author at: 3-39-22, Showa-Machi, Maebashi, Gunma 371-8511, Japan.
| | - Mutsumi Tashiro
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi, Gunma, Japan
| | - Maria Varnava
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi, Gunma, Japan
| | - Shintaro Shiba
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, Japan
| | - Toshiaki Matsui
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, Japan
| | - Shohei Okazaki
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, Japan
| | - Yang Li
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi, Gunma, Japan
| | - Shuichiro Komatsu
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, Japan
| | - Hidemasa Kawamura
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, Japan
| | - Masahiko Okamoto
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi, Gunma, Japan
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, Japan
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26
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Fukumitsu N, Hayakawa T, Yamashita T, Mima M, Demizu Y, Suzuki T, Soejima T. Simulation study using the spots deletion technique in spot scanning proton beam therapy for prostate cancers. Mol Clin Oncol 2021; 16:25. [PMID: 34909203 PMCID: PMC8655742 DOI: 10.3892/mco.2021.2458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of the present study was to investigate the effects on the dose distribution and beam delivery time in spot scanning proton beam therapy (PBT) incorporating the spot deletion technique. A spot scanning plan was created for 30 patients with prostate cancer. The plan was then modified via two processes: Spots with lower weighting depositions were deleted (process A) and spots that were distant from the clinical target volume (CTV) were deleted (process B). The dose distribution to the organs at risk (OAR), the expanded CTV (exCTV), which was defined by a uniform expansion of the CTV by a radius of 5 mm, and the beam delivery time were compared among initial and modified plans. The V50Gy [relative biological effectiveness (RBE)] to the rectum and bladder, and V60 Gy(RBE) to the urethral bulb, inhomogeneity index (INH) of the exCTV showed a difference (P=1.1x10-14, P=6.4x10-14, P=2.7x10-7, P=3.2x10-17), although only changes by process B were significant. Modified plan by process B showed the V50 Gy(RBE) to the rectum and bladder decreased by -2.4±1.6 and -2.3±1.4%, and the V60 Gy (RBE) to the urethral bulb decreased by -15.9±19.4%. The INH of the exCTV increased by 0.05±0.03%. On the other hand, modification of the initial plan by process A did not affect the dose of the OAR, exCTV or beam delivery time. In spot scanning PBT, modification of the initial radiotherapy plan by systemic deletion of spots distant from the CTV could result in a dose reduction to the OAR.
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Affiliation(s)
- Nobuyoshi Fukumitsu
- Department of Radiation Oncology, Kobe Proton Center, Kobe, Hyogo 650-0047, Japan
| | - Tomokatsu Hayakawa
- Division of Radiation Therapy, Radiation and Proton Therapy Center, Shizuoka Cancer Center, Shizuoka, Shizuoka 411-8777, Japan
| | - Tomohiro Yamashita
- Division of Medical Physics, Kobe Proton Center, Kobe, Hyogo 650-0047, Japan
| | - Masayuki Mima
- Department of Radiation Oncology, Kobe Proton Center, Kobe, Hyogo 650-0047, Japan
| | - Yusuke Demizu
- Department of Radiation Oncology, Kobe Proton Center, Kobe, Hyogo 650-0047, Japan
| | - Takeshi Suzuki
- Department of Anesthesiology, Kobe Proton Center, Kobe, Hyogo 650-0047, Japan
| | - Toshinori Soejima
- Department of Radiation Oncology, Kobe Proton Center, Kobe, Hyogo 650-0047, Japan
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27
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Burigo LN, Oborn BM. Integrated MRI-guided proton therapy planning: accounting for the full MRI field in a perpendicular system. Med Phys 2021; 49:1853-1873. [PMID: 34908170 DOI: 10.1002/mp.15398] [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: 03/13/2021] [Revised: 11/09/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To present a first study on the treatment planning feasibility in perpendicular field MRI-integrated proton therapy which considers the full transport of protons from the pencil beam scanning assembly to the patient inside the MRI scanner. METHODS A generic proton pencil beam scanning (PBS) gantry was modelled as being integrated with a realistic split-bore MRI system in the perpendicular orientation. MRI field strengths were modeled as 0.5 T, 1 T, and 1.5 T. The PBS beam delivery and dose calculation was modeled using the TOPAS Monte Carlo toolkit coupled with matRad as the optimizer engine. A water phantom, liver and prostate plans were evaluated and optimized in the presence of the full MRI field distribution. A simple combination of gantry angle offset and small PBS nozzle skew was used to direct the proton beams along a path that closely follows the reference planning scenario, i.e. without magnetic field. RESULTS All planning metrics could be successfully achieved with the inclusion of gantry angle offsets in the range of 8°-29° when coupled with a PBS nozzle skew of 1.6°-4.4°. These two hardware based corrections were selected to minimize the average Euclidean distance (AED) in the beam path enabling the proton beams to travel inside the patient in a path that is close to the original path (AED smaller than 3 mm at 1.5 T). Final dose optimization, performed through further changes in the pencil beam scanning delivery, was then shown to be feasible for our selection of plans studied yielding comparable plan quality metrics to reference conditions. CONCLUSIONS For the first time, we have shown a robust method to account for the full proton beam deflection in a perpendicular orientation MRI-integrated proton therapy. These results support the ongoing development of the current prototype systems. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lucas N Burigo
- German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, 69120, Germany
| | - Bradley M Oborn
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, 01309, Germany.,Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, NSW 2500, Australia.,Illawarra Cancer Care Centre (ICCC), Wollongong, NSW 2500, Australia
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28
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Yap J, De Franco A, Sheehy S. Future Developments in Charged Particle Therapy: Improving Beam Delivery for Efficiency and Efficacy. Front Oncol 2021; 11:780025. [PMID: 34956897 PMCID: PMC8697351 DOI: 10.3389/fonc.2021.780025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/16/2021] [Indexed: 01/09/2023] Open
Abstract
The physical and clinical benefits of charged particle therapy (CPT) are well recognized. However, the availability of CPT and complete exploitation of dosimetric advantages are still limited by high facility costs and technological challenges. There are extensive ongoing efforts to improve upon these, which will lead to greater accessibility, superior delivery, and therefore better treatment outcomes. Yet, the issue of cost remains a primary hurdle as utility of CPT is largely driven by the affordability, complexity and performance of current technology. Modern delivery techniques are necessary but limited by extended treatment times. Several of these aspects can be addressed by developments in the beam delivery system (BDS) which determines the overall shaping and timing capabilities enabling high quality treatments. The energy layer switching time (ELST) is a limiting constraint of the BDS and a determinant of the beam delivery time (BDT), along with the accelerator and other factors. This review evaluates the delivery process in detail, presenting the limitations and developments for the BDS and related accelerator technology, toward decreasing the BDT. As extended BDT impacts motion and has dosimetric implications for treatment, we discuss avenues to minimize the ELST and overview the clinical benefits and feasibility of a large energy acceptance BDS. These developments support the possibility of advanced modalities and faster delivery for a greater range of treatment indications which could also further reduce costs. Further work to realize methodologies such as volumetric rescanning, FLASH, arc, multi-ion and online image guided therapies are discussed. In this review we examine how increased treatment efficiency and efficacy could be achieved with improvements in beam delivery and how this could lead to faster and higher quality treatments for the future of CPT.
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Affiliation(s)
- Jacinta Yap
- School of Physics, University of Melbourne, Melbourne, VIC, Australia
| | - Andrea De Franco
- IFMIF Accelerator Development Group, Rokkasho Fusion Institute, National Institutes for Quantum Science and Technology, Aomori, Japan
| | - Suzie Sheehy
- School of Physics, University of Melbourne, Melbourne, VIC, Australia
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29
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Durante M, Debus J, Loeffler JS. Physics and biomedical challenges of cancer therapy with accelerated heavy ions. NATURE REVIEWS. PHYSICS 2021; 3:777-790. [PMID: 34870097 PMCID: PMC7612063 DOI: 10.1038/s42254-021-00368-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Radiotherapy should have low toxicity in the entrance channel (normal tissue) and be very effective in cell killing in the target region (tumour). In this regard, ions heavier than protons have both physical and radiobiological advantages over conventional X-rays. Carbon ions represent an excellent combination of physical and biological advantages. There are a dozen carbon-ion clinical centres in Europe and Asia, and more under construction or at the planning stage, including the first in the USA. Clinical results from Japan and Germany are promising, but a heated debate on the cost-effectiveness is ongoing in the clinical community, owing to the larger footprint and greater expense of heavy ion facilities compared with proton therapy centres. We review here the physical basis and the clinical data with carbon ions and the use of different ions, such as helium and oxygen. Research towards smaller and cheaper machines with more effective beam delivery is necessary to make particle therapy affordable. The potential of heavy ions has not been fully exploited in clinics and, rather than there being a single 'silver bullet', different particles and their combination can provide a breakthrough in radiotherapy treatments in specific cases.
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Affiliation(s)
- Marco Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
- Institute of Condensed Matter Physics, Technische Universität Darmstadt, Darmstadt, Germany
| | - Jürgen Debus
- Department of Radiation Oncology and Heidelberg Ion Beam Therapy Center, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jay S. Loeffler
- Departments of Radiation Oncology and Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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30
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Pastor-Serrano O, Habraken S, Lathouwers D, Hoogeman M, Schaart D, Perkó Z. How should we model and evaluate breathing interplay effects in IMPT? Phys Med Biol 2021; 66. [PMID: 34757958 DOI: 10.1088/1361-6560/ac383f] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/10/2021] [Indexed: 11/12/2022]
Abstract
Breathing interplay effects in Intensity Modulated Proton Therapy (IMPT) arise from the interaction between target motion and the scanning beam. Assessing the detrimental effect of interplay and the clinical robustness of several mitigation techniques requires statistical evaluation procedures that take into account the variability of breathing during dose delivery. In this study, we present such a statistical method to model intra-fraction respiratory motion based on breathing signals and assess clinical relevant aspects related to the practical evaluation of interplay in IMPT such as how to model irregular breathing, how small breathing changes affect the final dose distribution, and what is the statistical power (number of different scenarios) required for trustworthy quantification of interplay effects. First, two data-driven methodologies to generate artificial patient-specific breathing signals are compared: a simple sinusoidal model, and a precise probabilistic deep learning model generating very realistic samples of patient breathing. Second, we investigate the highly fluctuating relationship between interplay doses and breathing parameters, showing that small changes in breathing period result in large local variations in the dose. Our results indicate that using a limited number of samples to calculate interplay statistics introduces a bigger error than using simple sinusoidal models based on patient parameters or disregarding breathing hysteresis during the evaluation. We illustrate the power of the presented statistical method by analyzing interplay robustness of 4DCT and Internal Target Volume (ITV) treatment plans for a 8 lung cancer patients, showing that, unlike 4DCT plans, even 33 fraction ITV plans systematically fail to fulfill robustness requirements.
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Affiliation(s)
- Oscar Pastor-Serrano
- Delft University of Technology, Department of Radiation Science and Technology, Delft, The Netherlands
| | - Steven Habraken
- Erasmus MC Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands.,HollandPTC, Department of Radiation Oncology, Delft, The Netherlands
| | - Danny Lathouwers
- Delft University of Technology, Department of Radiation Science and Technology, Delft, The Netherlands
| | - Mischa Hoogeman
- Erasmus MC Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands.,HollandPTC, Department of Radiation Oncology, Delft, The Netherlands
| | - Dennis Schaart
- Delft University of Technology, Department of Radiation Science and Technology, Delft, The Netherlands.,HollandPTC, Department of Radiation Oncology, Delft, The Netherlands
| | - Zoltán Perkó
- Delft University of Technology, Department of Radiation Science and Technology, Delft, The Netherlands
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Extension of RBE-weighted 4D particle dose calculation for non-periodic motion. Phys Med 2021; 91:62-72. [PMID: 34715550 DOI: 10.1016/j.ejmp.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Highly conformal scanned Carbon Ion Radiotherapy (CIRT) might permit dose escalation and improved local control in advanced stage thoracic tumors, but is challenged by target motion. Dose calculation algorithms typically assume a periodically repeating, regular motion. To assess the effect of realistic, irregular motion, new algorithms of validated accuracy are needed. METHODS We extended an in-house treatment planning system to calculate RBE-weighted dose distributions in CIRT on non-periodic CT image sequences. Dosimetric accuracy was validated experimentally on a moving, time-resolved ionization chamber array. Log-file based dose reconstructions were compared by gamma analysis and correlation to measurements at every intermediate detector frame during delivery. The impact of irregular motion on treatment quality was simulated on a virtual 4DCT thorax phantom. Periodic motion was compared to motion with varying amplitude and period ± baseline drift. Rescanning as a mitigation strategy was assessed on all scenarios. RESULTS In experimental validation, average gamma pass rates were 99.89+-0.30% for 3%/3 mm and 88.2+-2.2% for 2%/2 mm criteria. Average correlation for integral dose distributions was 0.990±0.002. Median correlation for single 200 ms frames was 0.947±0.006. In the simulations, irregular motion deteriorated V95 target coverage to 81.2%, 76.6% and 79.0% for regular, irregular motion and irregular motion with base-line drift, respectively. Rescanning restored V95 to >98% for both scenarios without baseline drift, but not with additional baseline drift at 83.7%. CONCLUSIONS The validated algorithm permits to study the effects of irregular motion and to develop and adapt appropriate motion mitigation techniques.
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Créhange G, Goudjil F, Krhili SL, Minsat M, de Marzi L, Dendale R. [The role of proton therapy in esophageal cancer]. Cancer Radiother 2021; 26:604-610. [PMID: 34688549 DOI: 10.1016/j.canrad.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022]
Abstract
Because of the physical properties of proton beam radiation therapy (PT), which allows energy to be deposited at a specific depth with a rapid energy fall-off beyond that depth, PT has several theoretical advantages over photon radiation therapy for esophageal cancer (EC). Protons have the potential to reduce the dose to healthy tissue and to more safely allow treatment of tumors near critical organs, dose escalation, trimodal treatment, and re-irradiation. In recent years, larger multicenter retrospective studies have been published showing excellent survival rates, lower than expected toxicities and even better outcomes with PT than with photon radiotherapy even using IMRT or VMAT techniques. Although PT was associated with reduced toxicities, postoperative complications, and hospital stays compared to photon radiation therapy, these studies all had inherent biases in relation with patient selection for PT. These observations were recently confirmed by a randomized phase II study in locally advanced EC that showed significantly reduced toxicities with protons compared with IMRT. Currently, two randomized phase III trials (NRG-GI006 in the US and PROTECT in Europe) are being conducted to confirm whether protons could become the standard of care in locally advanced and resectable esophageal cancers.
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Affiliation(s)
- G Créhange
- Département d'oncologie radiothérapie, institut Curie, 25, rue d'Ulm, 75005 Paris, France; Département d'oncologie radiothérapie (Centre de Protonthérapie), institut Curie, Orsay, France; Département d'oncologie radiothérapie, institut Curie, 92, boulevard Dailly, Saint-Cloud, France.
| | - F Goudjil
- Département d'oncologie radiothérapie, institut Curie, 25, rue d'Ulm, 75005 Paris, France; Département d'oncologie radiothérapie (Centre de Protonthérapie), institut Curie, Orsay, France
| | - S L Krhili
- Département d'oncologie radiothérapie, institut Curie, 25, rue d'Ulm, 75005 Paris, France
| | - M Minsat
- Département d'oncologie radiothérapie, institut Curie, 92, boulevard Dailly, Saint-Cloud, France
| | - L de Marzi
- Département d'oncologie radiothérapie, institut Curie, 25, rue d'Ulm, 75005 Paris, France; Département d'oncologie radiothérapie (Centre de Protonthérapie), institut Curie, Orsay, France; Département d'oncologie radiothérapie, institut Curie, 92, boulevard Dailly, Saint-Cloud, France; Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, Campus universitaire, Orsay 91898, France
| | - R Dendale
- Département d'oncologie radiothérapie, institut Curie, 25, rue d'Ulm, 75005 Paris, France; Département d'oncologie radiothérapie (Centre de Protonthérapie), institut Curie, Orsay, France
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Liu P, Gao XS, Wang Z, Li X, Xi C, Jia C, Xie M, Lyu F, Ding X. Investigate the Dosimetric and Potential Clinical Benefits Utilizing Stereotactic Body Radiation Therapy With Simultaneous Integrated Boost Technique for Locally Advanced Pancreatic Cancer: A Comparison Between Photon and Proton Beam Therapy. Front Oncol 2021; 11:747532. [PMID: 34631584 PMCID: PMC8493097 DOI: 10.3389/fonc.2021.747532] [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: 07/26/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To investigate the potential clinical benefits of using stereotactic body radiation therapy (SBRT) with simultaneous integrated boost (SIB) technique for locally advanced pancreatic cancer (LAPC) among different treatment modalities and planning strategies, including photon and proton. Method A total of 19 patients were retrospectively selected in this study: 13 cases with the tumor located in the head of the pancreas and 6 cases with the tumor in the body of the pancreas. SBRT-SIB plans were generated using volumetric modulated arc therapy (VMAT), two-field Intensity Modulated Proton Therapy (IMPT), and three-field IMPT. The IMPT used the robust optimization parameters of ± 3.5% range and 5-mm setup uncertainties. Root-mean-square deviation dose (RMSD) volume histograms were used to evaluate the target coverage robustness quantitatively. Dosimetric metrics based on the dose-volume histogram (DVH), homogeneity index (HI), and normal tissue complication probability (NTCP) were analyzed to evaluate the potential clinical benefits among different planning groups. Results With a similar CTV and SIB coverage, two-field IMPT provided a lower maximum dose for the stomach (median: 18.6GyE, p<0.05) and duodenum (median: 32.62GyE, p<0.05) when the target was located in the head of the pancreas compared to VMAT and three-field IMPT. The risks of gastric bleed (3.42%) and grade ≥ 3 GI toxicity (4.55%) were also decreased. However, for the target in the body of the pancreas, VMAT showed a lower maximum dose for the stomach (median 30.93GyE, p<0.05) and toxicity of gastric bleed (median: 8.67%, p<0.05) compared to two-field IMPT and three-field IMPT, while other maximum doses and NTCPs were similar. The RMSD volume histogram (RVH) analysis shows that three-field IMPT provided better robustness for targets but not for OARs. Instead, three-field IMPT increased the Dmean of organs such as the stomach, duodenum, and intestine. Conclusion The results indicated that the tumor locations could play a critical role in determining clinical benefits among different treatment modalities. Two-field IMPT could be a better option for LAPC patients whose tumors are located in the head of the pancreas. It provides lower severe toxicity for the stomach and duodenum. Nevertheless, VMAT is preferred for the body with better protection for the possibility of gastric bleed.
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Affiliation(s)
- Peilin Liu
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Xian-Shu Gao
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Zishen Wang
- Department of Radiation Oncology, Hebei Yizhou Tumor Hospital, Zhuozhou, China
| | - Xiaomei Li
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Cao Xi
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Chenghao Jia
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Mu Xie
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Feng Lyu
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, United States
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Köthe A, Bizzocchi N, Safai S, Lomax AJ, Weber DC, Fattori G. Investigating the potential of proton therapy for hypoxia-targeted dose escalation in non-small cell lung cancer. Radiat Oncol 2021; 16:199. [PMID: 34635135 PMCID: PMC8507157 DOI: 10.1186/s13014-021-01914-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/13/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hypoxia is known to be prevalent in solid tumors such as non-small cell lung cancer (NSCLC) and reportedly correlates with poor prognostic clinical outcome. PET imaging can provide in-vivo hypoxia measurements to support targeted radiotherapy treatment planning. We explore the potential of proton therapy in performing patient-specific dose escalation and compare it with photon volumetric modulated arc therapy (VMAT). METHODS Dose escalation has been calibrated to the patient specific tumor response of ten stage IIb-IIIb NSCLC patients by combining HX4-PET imaging and radiobiological modelling of oxygen enhancement ratio (OER) to target variable tumor hypoxia. In a dose-escalation-by-contour approach, escalated dose levels were simulated to the most hypoxic region of the primary target and its effectiveness in improving loco-regional tumor control was assessed. Furthermore, the impact on normal tissue of proton treatments including dose escalation was evaluated in comparison to the normal tissue complication probability (NTCP) of conventional VMAT plans. RESULTS Ignoring regions of tumor hypoxia can cause overestimation of TCP values by up to 10%, which can effectively be recovered on average to within 0.9% of the nominal TCP, using patient-specific dose escalations of up to 22% of the prescribed dose to PET defined hypoxic regions. Despite such dose escalations, the use of protons could also simultaneously reduce mean doses to the heart (- 14.3 GyRBE), lung (- 8.3 GyRBE), esophagus (- 6.9 GyRBE) and spinal cord (- 3.8 Gy) compared to non-escalated VMAT plans. These reductions are predicted to lead to clinically relevant decreases in NTCP for radiation-induced pneumonitis (- 11.3%), high grade heart toxicity (- 7.4%) and esophagitis (- 7.5%). CONCLUSIONS This study suggests that the administration of proton therapy for dose escalation to patient specific regions of tumor hypoxia in the treatment of NSCLC can mitigate TCP reduction due to hypoxia-induced radio resistance, while simultaneously reducing NTCP levels even when compared to non-escalated treatments delivered with state-of-the-art photon techniques.
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Affiliation(s)
- Andreas Köthe
- Center for Proton Therapy, Paul Scherrer Institute, 5232, Villigen, Switzerland. .,Department of Physics, ETH-Hönggerberg, Zurich, Switzerland.
| | - Nicola Bizzocchi
- Center for Proton Therapy, Paul Scherrer Institute, 5232, Villigen, Switzerland
| | - Sairos Safai
- Center for Proton Therapy, Paul Scherrer Institute, 5232, Villigen, Switzerland
| | - Antony John Lomax
- Center for Proton Therapy, Paul Scherrer Institute, 5232, Villigen, Switzerland.,Department of Physics, ETH-Hönggerberg, Zurich, Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institute, 5232, Villigen, Switzerland.,Radiation Oncology Department, Inselspital Universitätsspital Bern, Bern, Switzerland.,Radiation Oncology Department, University Hospital of Zurich, Zurich, Switzerland
| | - Giovanni Fattori
- Center for Proton Therapy, Paul Scherrer Institute, 5232, Villigen, Switzerland
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Target motion management in breast cancer radiation therapy. Radiol Oncol 2021; 55:393-408. [PMID: 34626533 PMCID: PMC8647788 DOI: 10.2478/raon-2021-0040] [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: 06/10/2021] [Accepted: 08/04/2021] [Indexed: 12/25/2022] Open
Abstract
Background Over the last two decades, breast cancer remains the main cause of cancer deaths in women. To treat this type of cancer, radiation therapy (RT) has proved to be efficient. RT for breast cancer is, however, challenged by intrafractional motion caused by respiration. The problem is more severe for the left-sided breast cancer due to the proximity to the heart as an organ-at-risk. While particle therapy results in superior dose characteristics than conventional RT, due to the physics of particle interactions in the body, particle therapy is more sensitive to target motion. Conclusions This review highlights current and emerging strategies for the management of intrafractional target motion in breast cancer treatment with an emphasis on particle therapy, as a modern RT technique. There are major challenges associated with transferring real-time motion monitoring technologies from photon to particles beams. Surface imaging would be the dominant imaging modality for real-time intrafractional motion monitoring for breast cancer. The magnetic resonance imaging (MRI) guidance and ultra high dose rate (FLASH)-RT seem to be state-of-the-art approaches to deal with 4D RT for breast cancer.
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36
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Visser S, den Otter LA, Ribeiro CO, Korevaar EW, Both S, Langendijk JA, Muijs CT, Sijtsema NM, Knopf A. Diaphragm-Based Position Verification to Improve Daily Target Dose Coverage in Proton and Photon Radiation Therapy Treatment of Distal Esophageal Cancer. Int J Radiat Oncol Biol Phys 2021; 112:463-474. [PMID: 34530091 DOI: 10.1016/j.ijrobp.2021.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 08/21/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE In modern conformal radiation therapy of distal esophageal cancer, target coverage can be affected by variations in the diaphragm position. We investigated if daily position verification (PV) extended by a diaphragm position correction would optimize target dose coverage for esophageal cancer treatment. METHODS AND MATERIALS For 15 esophageal cancer patients, intensity modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) plans were computed. Displacements of the target volume were correlated with diaphragm displacements using repeated 4-dimensional computed tomography images to determine the correction needed to account for diaphragm variations. Afterwards, target coverage was evaluated for 3 PV approaches based on: (1) bony anatomy (PV_B), (2) bony anatomy corrected for the diaphragm position (PV_BD) and (3) target volume (PV_T). RESULTS The cranial-caudal mean target displacement was congruent with almost half of the diaphragm displacement (y = 0.459x), which was used for the diaphragm correction in PV_BD. Target dose coverage using PV_B was adequate for most patients with diaphragm displacements up till 10 mm (≥94% of the dose in 98% of the volume [D98%]). For larger displacements, the target coverage was better maintained by PV_T and PV_BD. Overall, PV_BD accounted best for target displacements, especially in combination with tissue density variations (D98%: IMPT 94% ± 5%, VMAT 96% ± 5%). Diaphragm displacements of more than 10 mm were observed in 22% of the cases. CONCLUSIONS PV_B was sufficient to achieve adequate target dose coverage in case of small deviations in diaphragm position. However, large deviations of the diaphragm were best mitigated by PV_BD. To detect the cases where target dose coverage could be compromised due to diaphragm position variations, we recommend monitoring of the diaphragm position before treatment through online imaging.
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Affiliation(s)
- Sabine Visser
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Lydia A den Otter
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cássia O Ribeiro
- 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
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Boscolo D, Kostyleva D, Safari MJ, Anagnostatou V, Äystö J, Bagchi S, Binder T, Dedes G, Dendooven P, Dickel T, Drozd V, Franczack B, Geissel H, Gianoli C, Graeff C, Grahn T, Greiner F, Haettner E, Haghani R, Harakeh MN, Horst F, Hornung C, Hucka JP, Kalantar-Nayestanaki N, Kazantseva E, Kindler B, Knöbel R, Kuzminchuk-Feuerstein N, Lommel B, Mukha I, Nociforo C, Ishikawa S, Lovatti G, Nitta M, Ozoemelam I, Pietri S, Plaß WR, Prochazka A, Purushothaman S, Reidel CA, Roesch H, Schirru F, Schuy C, Sokol O, Steinsberger T, Tanaka YK, Tanihata I, Thirolf P, Tinganelli W, Voss B, Weber U, Weick H, Winfield JS, Winkler M, Zhao J, Scheidenberger C, Parodi K, Durante M. Radioactive Beams for Image-Guided Particle Therapy: The BARB Experiment at GSI. Front Oncol 2021; 11:737050. [PMID: 34504803 PMCID: PMC8422860 DOI: 10.3389/fonc.2021.737050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/04/2021] [Indexed: 12/11/2022] Open
Abstract
Several techniques are under development for image-guidance in particle therapy. Positron (β+) emission tomography (PET) is in use since many years, because accelerated ions generate positron-emitting isotopes by nuclear fragmentation in the human body. In heavy ion therapy, a major part of the PET signals is produced by β+-emitters generated via projectile fragmentation. A much higher intensity for the PET signal can be obtained using β+-radioactive beams directly for treatment. This idea has always been hampered by the low intensity of the secondary beams, produced by fragmentation of the primary, stable beams. With the intensity upgrade of the SIS-18 synchrotron and the isotopic separation with the fragment separator FRS in the FAIR-phase-0 in Darmstadt, it is now possible to reach radioactive ion beams with sufficient intensity to treat a tumor in small animals. This was the motivation of the BARB (Biomedical Applications of Radioactive ion Beams) experiment that is ongoing at GSI in Darmstadt. This paper will present the plans and instruments developed by the BARB collaboration for testing the use of radioactive beams in cancer therapy.
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Affiliation(s)
- Daria Boscolo
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Daria Kostyleva
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | | | - Juha Äystö
- University of Jyväskylä, Jyväskylä, Finland.,Helsinki Institute of Physics, Helsinki, Finland
| | | | - Tim Binder
- Ludwig-Maximilians-Universität München, Munich, Germany
| | | | | | - Timo Dickel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Vasyl Drozd
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,University of Groningen, Groningen, Netherlands
| | | | - Hans Geissel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Justus-Liebig-Universität Gießen, Gießen, Germany
| | | | - Christian Graeff
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Tuomas Grahn
- University of Jyväskylä, Jyväskylä, Finland.,Helsinki Institute of Physics, Helsinki, Finland
| | - Florian Greiner
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Emma Haettner
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | | | - Felix Horst
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Christine Hornung
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Technische Universität Darmstadt, Darmstadt, Germany
| | - Jan-Paul Hucka
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Technische Universität Darmstadt, Darmstadt, Germany
| | | | - Erika Kazantseva
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Birgit Kindler
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Ronja Knöbel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | - Bettina Lommel
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Ivan Mukha
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Chiara Nociforo
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | | | | | | | - Stephane Pietri
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Wolfgang R Plaß
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Justus-Liebig-Universität Gießen, Gießen, Germany
| | | | | | | | - Heidi Roesch
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Technische Universität Darmstadt, Darmstadt, Germany
| | - Fabio Schirru
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Christoph Schuy
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Olga Sokol
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Timo Steinsberger
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Technische Universität Darmstadt, Darmstadt, Germany
| | | | - Isao Tanihata
- Research Center for Nuclear Physics, Osaka University, Osaka, Japan.,Peking University, Beijing, China.,Institute of Modern Physics, Lanzhou, China
| | - Peter Thirolf
- Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Bernd Voss
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Uli Weber
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Helmut Weick
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - John S Winfield
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Martin Winkler
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Jianwei Zhao
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Peking University, Beijing, China
| | - Christoph Scheidenberger
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Katia Parodi
- Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany.,Technische Universität Darmstadt, Darmstadt, Germany
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Matsumoto Y, Fukumitsu N, Ishikawa H, Nakai K, Sakurai H. A Critical Review of Radiation Therapy: From Particle Beam Therapy (Proton, Carbon, and BNCT) to Beyond. J Pers Med 2021; 11:jpm11080825. [PMID: 34442469 PMCID: PMC8399040 DOI: 10.3390/jpm11080825] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 12/24/2022] Open
Abstract
In this paper, we discuss the role of particle therapy—a novel radiation therapy (RT) that has shown rapid progress and widespread use in recent years—in multidisciplinary treatment. Three types of particle therapies are currently used for cancer treatment: proton beam therapy (PBT), carbon-ion beam therapy (CIBT), and boron neutron capture therapy (BNCT). PBT and CIBT have been reported to have excellent therapeutic results owing to the physical characteristics of their Bragg peaks. Variable drug therapies, such as chemotherapy, hormone therapy, and immunotherapy, are combined in various treatment strategies, and treatment effects have been improved. BNCT has a high dose concentration for cancer in terms of nuclear reactions with boron. BNCT is a next-generation RT that can achieve cancer cell-selective therapeutic effects, and its effectiveness strongly depends on the selective 10B accumulation in cancer cells by concomitant boron preparation. Therefore, drug delivery research, including nanoparticles, is highly desirable. In this review, we introduce both clinical and basic aspects of particle beam therapy from the perspective of multidisciplinary treatment, which is expected to expand further in the future.
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Affiliation(s)
- Yoshitaka Matsumoto
- Department of Radiation Oncology, Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (K.N.); (H.S.)
- Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
- Correspondence: ; Tel.: +81-29-853-7100
| | | | - Hitoshi Ishikawa
- National Institute of Quantum and Radiological Science and Technology Hospital, Chiba 263-8555, Japan;
| | - Kei Nakai
- Department of Radiation Oncology, Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (K.N.); (H.S.)
- Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan; (K.N.); (H.S.)
- Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
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Flatten V, Burg JM, Witt M, Derksen L, Fragoso Costa P, Wulff J, Bäumer C, Timmermann B, Weber U, Vorwerk H, Engenhart-Cabillic R, Zink K, Baumann KS. Estimating the modulating effect of lung tissue in particle therapy using a clinical CT voxel histogram analysis. Phys Med Biol 2021; 66. [PMID: 34298533 DOI: 10.1088/1361-6560/ac176e] [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: 05/27/2021] [Accepted: 07/23/2021] [Indexed: 11/12/2022]
Abstract
To treat lung tumours with particle therapy, different additional tasks and challenges in treatment planning and application have to be addressed thoroughly. One of these tasks is the quantification and consideration of the Bragg peak degradation due to lung tissue: As lung is an heterogeneous tissue, the Bragg peak is broadened when particles traverse the microscopic alveoli. These are not fully resolved in clinical CT images and thus, the effect is not considered in the dose calculation. In this work, a correlation between the CT histograms of heterogeneous material and the impact on the Bragg peak curve is presented. Different inorganic materials were scanned with a conventional CT scanner and additionally, the Bragg peak degradation was measured in a proton beam and was then quantified. A model is proposed that allows an estimation of the modulation power by performing a histogram analysis on the CT scan. To validate the model for organic samples, a second measurement series was performed with frozen porcine lunge samples. This allows to investigate the possible limits of the proposed model in a set-up closer to clinical conditions. For lung substitutes, the agreement between model and measurement is within ±0.05 mm and for the organic lung samples, within ±0.15 mm. This work presents a novel, simple and efficient method to estimate if and how much a material or a distinct region (within the lung) is degrading the Bragg peak on the basis of a common clinical CT image. Up until now, only a direct in-beam measurement of the region or material of interest could answer this question.
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Affiliation(s)
- Veronika Flatten
- Department of Radiotherapy and Radiooncology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, GERMANY
| | - Jan Michael Burg
- , University of Applied Sciences, Institute of Medical Physics and Radiation Protection, Giessen, GERMANY
| | - Matthias Witt
- Department of Radiotherapy and Radiooncology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, GERMANY
| | - Larissa Derksen
- , University of Applied Sciences, Institute of Medical Physics and Radiation Protection, Giessen, GERMANY
| | | | - Jörg Wulff
- Medical Physics, Westdeutsches Protonentherapiezentrum Essen gGmbH, Essen, GERMANY
| | | | - Beate Timmermann
- Deparment of Particle Therapy, University Hospital Essen, Essen, GERMANY
| | - Uli Weber
- , GSI Helmholtzzentrum fur Schwerionenforschung GmbH, Darmstadt, Hessen, GERMANY
| | - Hilke Vorwerk
- Department of Radiotherapy and Radiooncology, University Medical Center Giessen-Marburg, Marburg, GERMANY
| | - Rita Engenhart-Cabillic
- University Medical Center Giessen-Marburg, Department of Radiotherapy and Radiooncology, Marburg, GERMANY
| | - Klemens Zink
- University Medical Center Giessen-Marburg, Department of Radiotherapy and Radiooncology, Marburg, GERMANY
| | - Kilian-Simon Baumann
- Department of Radiotherapy and Radiooncology, University Medical Center Giessen-Marburg, Marburg, GERMANY
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Fukumitsu N, Yamashita T, Mima M, Demizu Y, Suzuki T, Soejima T. Dose distribution effects of spot-scanning proton beam therapy equipped with a multi-leaf collimator for pediatric brain tumors. Oncol Lett 2021; 22:635. [PMID: 34295382 PMCID: PMC8273856 DOI: 10.3892/ol.2021.12896] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/15/2021] [Indexed: 11/06/2022] Open
Abstract
The present study simulated the effect of spot-scanning proton beam therapy (PBT) performed using a device equipped with a multi-leaf collimator (MLC) to calculate the dose distribution. Simulation studies using 18 pediatric patients with brain tumors in the posterior fossa were performed. Treatment plans were created for the MLC at different stages: Fully open (initial plan), fully closed to allow an irradiated area extending to 15 mm from the clinical target volume (CTV) (15-mm plan), or closing only the leaves where an organ at risk (OAR) overlapped with a border at 10 or 5 mm from the CTV (10- and 5-mm plans, respectively). The mean dose values for the brainstem, cervical cord, brain and cochlea in all MLC closure plans decreased as the MLC was closed (P=9.9×10−10, P=1.3×10−17, P=2.1×10−16 and P=2.0×10−5, respectively). The maximum dose (Dmax) values of the cervical cord and cochlea in all MLC closure plans were also decreased as the MLC was closed (P=3.0×10−4 and P=1.1×10−5, respectively). The dose to the CTV was almost unchanged. In 10 patients, the Dmax of the brain in all MLC-closure plans was higher than that of the initial plan, but the maximum increase was only 0.8 gray relative biological effectiveness [Gy(RBE)]. In conclusion, the existing MLC installed in the treatment device can be used to decrease the OAR dose significantly using spot-scanning PBT without a large capital investment. The dose from the scattered particles was small.
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Affiliation(s)
- Nobuyoshi Fukumitsu
- Department of Radiation Oncology, Kobe Proton Center, Kobe, Hyōgo 650-0047, Japan
| | - Tomohiro Yamashita
- Division of Medical Physics, Kobe Proton Center, Kobe, Hyōgo 650-0047, Japan
| | - Masayuki Mima
- Department of Radiation Oncology, Kobe Proton Center, Kobe, Hyōgo 650-0047, Japan
| | - Yusuke Demizu
- Department of Radiation Oncology, Kobe Proton Center, Kobe, Hyōgo 650-0047, Japan
| | - Takeshi Suzuki
- Department of Anesthesiology, Kobe Proton Center, Kobe, Hyōgo 650-0047, Japan
| | - Toshinori Soejima
- Department of Radiation Oncology, Kobe Proton Center, Kobe, Hyōgo 650-0047, Japan
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He P, Li Q. Motion management with variable cycle-based respiratory guidance method for carbon-ion pencil beam scanning treatment. Phys Med 2021; 87:99-105. [PMID: 34134014 DOI: 10.1016/j.ejmp.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/09/2021] [Accepted: 06/04/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE A novel variable cycle-based respiratory guidance method was proposed to synchronize the patterns between patients' breathing and the magnetic excitation of synchrotron under the mode of full-energy depth scanning beam delivery, in order to improve the treatment precision and efficiency for carbon ion therapy. METHODS Audio-visual biofeedback system with variable cycle-based respiratory guidance method was developed. We enrolled 6 healthy volunteers and a simulation study of the fixed cycle-based and variable cycle-based respiratory guidance with three treatment fractions was performed. A total of 72 breathing curves were collected for 4D dose calculations with three 4DCT datasets of lung tumor cases. Target dose coverage (D95: the percent dose covering 95% of the target), dose homogeneity (D5-D95), and treatment time were analyzed. The Wilcoxon signed-rank test was used for statistical difference analysis, and p < 0.05 was considered significant. RESULTS With the variable cycle-based respiratory guidance method, the breath hold phase of breathing curve could be synchronized with the synchrotron flat-top phase over time. The dose homogeneity was improved by factors of 1.94-2.92 compared to the fixed cycle-based respiratory guidance maneuvers alone or in combination with gating technique. Moreover, the treatment efficiency increased by 11-23%, depending on the duty cycle settings of the gating window. CONCLUSIONS The proposed variable cycle-based respiratory guidance method could improve both the treatment efficiency and precision under the mode of the full-energy depth scanning beam delivery for synchrotron-based carbon ion therapy.
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Affiliation(s)
- Pengbo He
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Qiang Li
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China; Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Gansu Province, Lanzhou 730000, China; University of Chinese Academy of Sciences, Beijing 100049, China.
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Rana S, Rosenfeld AB. Impact of proton dose calculation algorithms on the interplay effect in PBS proton based SBRT lung plans. Biomed Phys Eng Express 2021; 7. [PMID: 34029212 DOI: 10.1088/2057-1976/abfea8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/06/2021] [Indexed: 01/02/2023]
Abstract
Purpose. The purpose of the current study was to investigate the impact of RayStation analytical pencil beam (APB) and Monte Carlo (MC) algorithms on the interplay effect in pencil beam scanning (PBS) proton-based stereotactic body radiation therapy (SBRT) lung plans.Methods. The currentin-silicoplanning study was designed for a total dose of 5000 cGy(RBE) with a fractional dose of 1000 cGy(RBE). First, three sets of nominal plans were generated for each patient: (a) APB optimization followed by APB dose calculation (PB-PB), (b) APB optimization followed by MC dose calculation (PB-MC), and (c) MC optimization followed by MC dose calculation (MC-MC). Second, for each patient, two sets of volumetric repainting plans (five repaintings) - PB-MCVR5and MC-MCVR5were generated based on PB-MC and MC-MC, respectively. Dosimetric differences between APB and MC algorithms were calculated on the nominal and interplay dose-volume-histograms (DVHs).Results. Interplay evaluation in non-volumetric repainting plans showed that APB algorithm overestimated the target coverage by up to 8.4% for D95%and 10.5% for D99%, whereas in volumetric repainting plans, APB algorithm overestimated by up to 5.3% for D95%and 7.0% for D99%. Interplay results for MC calculations showed a decrease in D95%and D99%by average differences of 3.5% and 4.7%, respectively, in MC-MC plans and by 1.8% and 3.0% in MC-MCVR5plans.Conclusion. In PBS proton-based SBRT lung plans, the combination of APB algorithm and interplay effect reduced the target coverage. This may result in inferior local control. The use of MC algorithm for both optimization and final dose calculations in conjunction with the volumetric repainting technique yielded superior target coverage.
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Affiliation(s)
- Suresh Rana
- Department of Medical Physics, The Oklahoma Proton Center, Oklahoma City, OK, United States of America.,Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States of America.,Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States of America.,Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, NSW, Australia
| | - Anatoly B Rosenfeld
- Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, NSW, Australia
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Emert F, Missimer J, Eichenberger PA, Walser M, Gmür C, Lomax AJ, Weber DC, Spengler CM. Enhanced Deep-Inspiration Breath Hold Superior to High-Frequency Percussive Ventilation for Respiratory Motion Mitigation: A Physiology-Driven, MRI-Guided Assessment Toward Optimized Lung Cancer Treatment With Proton Therapy. Front Oncol 2021; 11:621350. [PMID: 33996545 PMCID: PMC8116693 DOI: 10.3389/fonc.2021.621350] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/18/2021] [Indexed: 12/25/2022] Open
Abstract
Background: To safely treat lung tumors using particle radiation therapy (PRT), motion-mitigation strategies are of critical importance to ensure precise irradiation. Therefore, we compared applicability, effectiveness, reproducibility, and subjects' acceptance of enhanced deep-inspiration breath hold (eDIBH) with high-frequency percussive ventilation (HFPV) by MRI assessment within 1 month. Methods: Twenty-one healthy subjects (12 males/9 females; age: 49.5 ± 5.8 years; BMI: 24.7 ± 3.3 kg/m−2) performed two 1.5 T MRI scans in four visits at weekly intervals under eDIBH and HFPV conditions, accompanied by daily, home-based breath-hold training and spirometric assessments over a 3-week period. eDIBH consisted of 8-min 100% O2 breathing (3 min resting ventilation, 5 min controlled hyperventilation) prior to breath hold. HFPV was set at 200–250 pulses min−1 and 0.8–1.2 bar. Subjects' acceptance and preference were evaluated by questionnaire. To quantify inter- and intrafractional changes, a lung distance metric representing lung topography was computed for 10 reference points: a motion-invariant spinal cord and nine lung structure contours (LSCs: apex, carina, diaphragm, and six vessels as tumor surrogates distributed equally across the lung). To parameterize individual LSC localizability, measures of their spatial variabilities were introduced and lung volumes calculated by automated MRI analysis. Results: eDIBH increased breath-hold duration by > 100% up to 173 ± 73 s at visit 1, and to 217 ± 67 s after 3 weeks of home-based training at visit 4 (p < 0.001). Measures of vital capacity and lung volume remained constant over the 3-week period. Two vessels in the lower lung segment and the diaphragm yielded a two- to threefold improved positional stability with eDIBH, whereby absolute distance variability was significantly smaller for five LSCs; ≥70% of subjects showed significantly better intrafractional lung motion mitigation under reproducible conditions with eDIBH compared with HFPV with smaller ranges most apparent in the anterior-posterior and cranial-caudal directions. Approximately 80% of subjects preferred eDIBH over HFPV, with “less discomfort” named as most frequent reason. Conclusions: Both, eDIBH, and HFPV were well-tolerated. eDIBH duration was long enough to allow for potential PRT. Variability in lung volume was smaller and position of lung structures more precise with eDIBH. Subjects preferred eDIBH over HFPV. Thus, eDIBH is a very promising tool for lung tumor therapy with PRT, and further investigation of its applicability in patients is warranted.
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Affiliation(s)
- Frank Emert
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen, Switzerland
| | - John Missimer
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen, Switzerland
| | - Philipp A Eichenberger
- Exercise Physiology Lab, Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen, Switzerland
| | - Celina Gmür
- Exercise Physiology Lab, Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen, Switzerland.,Department of Physics, ETH Zurich, Zurich, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.,Department of Radiation Oncology, University Hospital Bern, Bern, Switzerland
| | - Christina M Spengler
- Exercise Physiology Lab, Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
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Nicholas O, Prosser S, Mortensen HR, Radhakrishna G, Hawkins MA, Gwynne SH. The Promise of Proton Beam Therapy for Oesophageal Cancer: A Systematic Review of Dosimetric and Clinical Outcomes. Clin Oncol (R Coll Radiol) 2021; 33:e339-e358. [PMID: 33931290 DOI: 10.1016/j.clon.2021.04.003] [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: 02/01/2021] [Revised: 03/08/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022]
Abstract
AIMS Due to its physical advantages over photon radiotherapy, proton beam therapy (PBT) has the potential to improve outcomes from oesophageal cancer. However, for many tumour sites, high-quality evidence supporting PBT use is limited. We carried out a systematic review of published literature of PBT in oesophageal cancer to ascertain potential benefits of this technology and to gauge the current state-of-the-art. We considered if further evaluation of this technology in oesophageal cancer is desirable. MATERIALS AND METHODS A systematic literature search of Medline, Embase, Cochrane Library and Web of Science using structured search terms was carried out. Inclusion criteria included non-metastatic cancer, full articles and English language studies only. Articles deliberating technical aspects of PBT planning or delivery were excluded to maintain a clinical focus. Studies were divided into two sections: dosimetric and clinical studies; qualitatively synthesised. RESULTS In total, 467 records were screened, with 32 included for final qualitative synthesis. This included two prospective studies with the rest based on retrospective data. There was heterogeneity in treatment protocols, including treatment intent (neoadjuvant or definitive), dose, fractionation and chemotherapy used. Compared with photon radiotherapy, PBT seemed to reduce dose to organs at risk, especially lung and heart, although not for all reported parameters. Toxicity outcomes, including postoperative complications, were reduced compared with photon radiotherapy. Survival outcomes were reported to be at least comparable with photon radiotherapy. CONCLUSION There is a paucity of high-quality evidence supporting PBT use in oesophageal cancer. Wide variation in intent and treatment protocols means that the role and 'gold-standard' treatment protocol are yet to be defined. Current literature suggests significant benefit in terms of toxicity reduction, especially in the postoperative period, with comparable survival outcomes. PBT in oesophageal cancer holds significant promise for improving patient outcomes but requires robust systematic evaluation in prospective studies.
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Affiliation(s)
- O Nicholas
- South West Wales Cancer Centre, Swansea, UK; Swansea University Medical School, Swansea, UK.
| | - S Prosser
- South West Wales Cancer Centre, Swansea, UK
| | - H R Mortensen
- The Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - M A Hawkins
- University College Hospital NHS Foundation Trust, London, UK
| | - S H Gwynne
- South West Wales Cancer Centre, Swansea, UK; Swansea University Medical School, Swansea, UK
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Gut P, Krieger M, Lomax T, Weber DC, Hrbacek J. Combining rescanning and gating for a time-efficient treatment of mobile tumors using pencil beam scanning proton therapy. Radiother Oncol 2021; 160:82-89. [PMID: 33839206 DOI: 10.1016/j.radonc.2021.03.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/04/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Respiratory motion during proton therapy can severely degrade dose distributions, particularly due to interplay effects when using pencil beam scanning. Combined rescanning and gating treatments for moving tumors mitigates dose degradation, but at the cost of increased treatment delivery time. The objective of this study was to identify the time efficiency of these dose degradation-motion mitigation strategies for different range of motions. MATERIALS AND METHODS Seventeen patients with thoracic or abdominal tumors were studied. Tumor motion amplitudes ranged from 2-30 mm. Deliveries using different combinations of rescanning and gating were simulated with a dense dose spot grid (4 × 4 × 2.5 mm3) for all patients and a sparse dose spot grid (8 × 8 × 5 mm3) for six patients with larger tumor movements (>8 mm). The resulting plans were evaluated in terms of CTV coverage and time efficiency. RESULTS Based on the studied patient cohort, it has been shown that for amplitudes up to 5 mm, no motion mitigation is required with a dense spot grid. For amplitudes between 5 and 10 mm, volumetric rescanning should be applied while maintaining a 100% duty cycle when using a dense spot grid. Although gating could be envisaged to reduce the target volume for intermediate motion, it has been shown that the dose to normal tissues would only be reduced marginally. Moreover, the treatment time would increase. Finally, for larger motion amplitudes, both volumetric rescanning and respiratory gating should be applied with both spot grids. In addition, it has been shown that a dense spot grid delivers better CTV dose coverage than a sparse dose grid. CONCLUSION Volumetric rescanning and/or respiratory gating can be used in order to effectively and efficiently mitigate dose degradation due to tumor movement.
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Affiliation(s)
- Pauline Gut
- Department of Physics, ETH Zurich, Zurich, Switzerland; Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen PSI, Switzerland
| | - Miriam Krieger
- Department of Physics, ETH Zurich, Zurich, Switzerland; Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen PSI, Switzerland
| | - Tony Lomax
- Department of Physics, ETH Zurich, Zurich, Switzerland; Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen PSI, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen PSI, Switzerland; Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jan Hrbacek
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen PSI, Switzerland.
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Keikhai Farzaneh MJ, Momennezhad M, Naseri S. Gated Radiotherapy Development and its Expansion. J Biomed Phys Eng 2021; 11:239-256. [PMID: 33937130 PMCID: PMC8064130 DOI: 10.31661/jbpe.v0i0.948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/14/2018] [Indexed: 12/25/2022]
Abstract
One of the most important challenges in treatment of patients with cancerous tumors of chest and abdominal areas is organ movement. The delivery of treatment radiation doses to tumor tissue is a challenging matter while protecting healthy and radio sensitive tissues. Since the movement of organs due to respiration causes a discrepancy in the middle of planned and delivered dose distributions. The moderation in the fatalistic effect of intra-fractional target travel on the radiation therapy correctness is necessary for cutting-edge methods of motion remote monitoring and cancerous growth irradiancy. Tracking respiratory milling and implementation of breath-hold techniques by respiratory gating systems have been used for compensation of respiratory motion negative effects. Therefore, these systems help us to deliver precise treatments and also protect healthy and critical organs. It seems aspiration should be kept under observation all over treatment period employing tracking seed markers (e.g. fiducials), skin surface scanners (e.g. camera and laser monitoring systems) and aspiration detectors (e.g. spirometers). However, these systems are not readily available for most radiotherapy centers around the word. It is believed that providing and expanding the required equipment, gated radiotherapy will be a routine technique for treatment of chest and abdominal tumors in all clinical radiotherapy centers in the world by considering benefits of respiratory gating techniques in increasing efficiency of patient treatment in the near future. This review explains the different technologies and systems as well as some strategies available for motion management in radiotherapy centers.
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Affiliation(s)
- Mohammad Javad Keikhai Farzaneh
- PhD, Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- PhD, Department of Medical Physics, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Momennezhad
- PhD, Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- PhD, Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shahrokh Naseri
- PhD, Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- PhD, Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Fratelli I, Ciavatti A, Zanazzi E, Basiricò L, Chiari M, Fabbri L, Anthony JE, Quaranta A, Fraboni B. Direct detection of 5-MeV protons by flexible organic thin-film devices. SCIENCE ADVANCES 2021; 7:7/16/eabf4462. [PMID: 33863730 PMCID: PMC8051878 DOI: 10.1126/sciadv.abf4462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/02/2021] [Indexed: 05/05/2023]
Abstract
The direct detection of 5-MeV protons by flexible organic detectors based on thin films is here demonstrated. The organic devices act as a solid-state detector, in which the energy released by the protons within the active layer of the sensor is converted into an electrical current. These sensors can quantitatively and reliably measure the dose of protons impinging on the sensor both in real time and in integration mode. This study shows how to detect and exploit the energy absorbed both by the organic semiconducting layer and by the plastic substrate, allowing to extrapolate information on the present and past irradiation of the detector. The measured sensitivity, S = (5.15 ± 0.13) pC Gy-1, and limit of detection, LOD = (30 ± 6) cGy s-1, of the here proposed detectors assess their efficacy and their potential as proton dosimeters in several fields of application, such as in medical proton therapy.
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Affiliation(s)
- Ilaria Fratelli
- Department of Physics and Astronomy, University of Bologna, Viale Berti Pichat 6/2, 40127 Bologna, Italy.
- INFN-Bologna, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - Andrea Ciavatti
- Department of Physics and Astronomy, University of Bologna, Viale Berti Pichat 6/2, 40127 Bologna, Italy
- INFN-Bologna, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - Enrico Zanazzi
- Department of Industrial Engineering, University of Trento, Via Sommarive 9, I-38123 Povo, Trento, Italy
- INFN-TIFPA, Via Sommarive 14, I-38123 Povo, Trento, Italy
| | - Laura Basiricò
- Department of Physics and Astronomy, University of Bologna, Viale Berti Pichat 6/2, 40127 Bologna, Italy
- INFN-Bologna, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - Massimo Chiari
- INFN-Florence, Via G. Sansone 1, 50019 Sesto Fiorentino, Florence, Italy
| | - Laura Fabbri
- Department of Physics and Astronomy, University of Bologna, Viale Berti Pichat 6/2, 40127 Bologna, Italy
- INFN-Bologna, Viale Berti Pichat 6/2, 40127 Bologna, Italy
| | - John E Anthony
- Department of Chemistry and Center for Applied Energy Research, University of Kentucky, Lexington, KY 40506, USA
| | - Alberto Quaranta
- Department of Industrial Engineering, University of Trento, Via Sommarive 9, I-38123 Povo, Trento, Italy
- INFN-TIFPA, Via Sommarive 14, I-38123 Povo, Trento, Italy
| | - Beatrice Fraboni
- Department of Physics and Astronomy, University of Bologna, Viale Berti Pichat 6/2, 40127 Bologna, Italy
- INFN-Bologna, Viale Berti Pichat 6/2, 40127 Bologna, Italy
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Rana S, Rosenfeld AB. Investigating volumetric repainting to mitigate interplay effect on 4D robustly optimized lung cancer plans in pencil beam scanning proton therapy. J Appl Clin Med Phys 2021; 22:107-118. [PMID: 33599391 PMCID: PMC7984493 DOI: 10.1002/acm2.13183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/19/2021] [Accepted: 01/05/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose The interplay effect between dynamic pencil proton beams and motion of the lung tumor presents a challenge in treating lung cancer patients in pencil beam scanning (PBS) proton therapy. The main purpose of the current study was to investigate the interplay effect on the volumetric repainting lung plans with beam delivery in alternating order (“down” and “up” directions), and explore the number of volumetric repaintings needed to achieve acceptable lung cancer PBS proton plan. Method The current retrospective study included ten lung cancer patients. The total dose prescription to the clinical target volume (CTV) was 70 Gy(RBE) with a fractional dose of 2 Gy(RBE). All treatment plans were robustly optimized on all ten phases in the 4DCT data set. The Monte Carlo algorithm was used for the 4D robust optimization, as well as for the final dose calculation. The interplay effect was evaluated for both the nominal (i.e., without repainting) as well as volumetric repainting plans. The interplay evaluation was carried out for each of the ten different phases as the starting phases. Several dosimetric metrics were included to evaluate the worst‐case scenario (WCS) and bandwidth based on the results obtained from treatment delivery starting in ten different breathing phases. Results The number of repaintings needed to meet the criteria 1 (CR1) of target coverage (D95% ≥ 98% and D99% ≥ 97%) ranged from 2 to 10. The number of repaintings needed to meet the CR1 of maximum dose (ΔD1% < 1.5%) ranged from 2 to 7. Similarly, the number of repaintings needed to meet CR1 of homogeneity index (ΔHI < 0.03) ranged from 3 to 10. For the target coverage region, the number of repaintings needed to meet CR1 of bandwidth (<100 cGy) ranged from 3 to 10, whereas for the high‐dose region, the number of repaintings needed to meet CR1 of bandwidth (<100 cGy) ranged from 1 to 7. Based on the overall plan evaluation criteria proposed in the current study, acceptable plans were achieved for nine patients, whereas one patient had acceptable plan with a minor deviation. Conclusion The number of repaintings required to mitigate the interplay effect in PBS lung cancer (tumor motion < 15 mm) was found to be highly patient dependent. For the volumetric repainting with an alternating order, a patient‐specific interplay evaluation strategy must be adopted. Determining the optimal number of repaintings based on the bandwidth and WCS approach could mitigate the interplay effect in PBS lung cancer treatment.
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Affiliation(s)
- Suresh Rana
- Department of Medical PhysicsThe Oklahoma Proton CenterOklahoma CityOklahomaUSA
- Department of Radiation OncologyMiami Cancer InstituteBaptist Health South FloridaMiamiFLUSA
- Department of Radiation OncologyHerbert Wertheim College of MedicineFlorida International UniversityMiamiFLUSA
- Centre for Medical Radiation Physics (CMRP)University of WollongongWollongongNSWAustralia
| | - Anatoly B. Rosenfeld
- Centre for Medical Radiation Physics (CMRP)University of WollongongWollongongNSWAustralia
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Krieger M, Giger A, Jud C, Duetschler A, Salomir R, Bieri O, Bauman G, Nguyen D, Cattin PC, Weber DC, Lomax AJ, Zhang Y. Liver-ultrasound-guided lung tumour tracking for scanned proton therapy: a feasibility study. Phys Med Biol 2021; 66:035011. [PMID: 33238246 DOI: 10.1088/1361-6560/abcde6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pencil beam scanned (PBS) proton therapy of lung tumours is hampered by respiratory motion and the motion-induced density changes along the beam path. In this simulation study, we aim to investigate the effectiveness of proton beam tracking for lung tumours both under ideal conditions and in conjunction with a respiratory motion model guided by real-time ultrasound imaging of the liver. Multiple-breathing-cycle 4DMRIs of the thorax and abdominal 2D ultrasound images were acquired simultaneously for five volunteers. Deformation vector fields extracted from the 4DMRI, referred to as ground truth motion, were used to generate 4DCT(MRI) data sets of two lung cancer patients, resulting in 10 data sets with variable motion patterns. Given the 4DCT(MRI) and the corresponding ultrasound images as surrogate data, a patient-specific motion model was built. The model consists of an autoregressive model and Gaussian process regression for the temporal and spatial prediction, respectively. Two-field PBS plans were optimised on the reference CTs, and 4D dose calculations (4DDC) were used to simulate dose delivery for (a) unmitigated motion, (b) ideal 2D and 3D tracking (both beam adaption and 4DDC based on ground truth motion), and (c) realistic 2D and 3D tracking (beam adaption based on motion predictions, 4DDC on ground truth motion). Model-guided tracking retrieved clinically acceptable target dose homogeneity, as seen in a substantial reduction of the D5%-D95% compared to the non-mitigated simulation. Tracking in 2D and 3D resulted in a similar improvement of the dose homogeneity, as did ideal and realistic tracking simulations. In some cases, however, the tracked deliveries resulted in a shift towards higher or lower dose levels, leading to unacceptable target over- or under-coverage. The presented motion modelling framework was shown to be an accurate motion prediction tool for the use in proton beam tracking. Tracking alone, however, may not always effectively mitigate motion effects, making it necessary to combine it with other techniques such as rescanning.
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Affiliation(s)
- Miriam Krieger
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Villigen PSI, Switzerland. Department of Physics, ETH Zurich, Zurich, Switzerland
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Alina G, Krieger M, Jud C, Duetschler A, Salomir R, Bieri O, Bauman G, Nguyen D, Weber DC, Lomax AJ, Zhang Y, Cattin PC. Liver-ultrasound based motion modelling to estimate 4D dose distributions for lung tumours in scanned proton therapy. ACTA ACUST UNITED AC 2020; 65:235050. [DOI: 10.1088/1361-6560/abaa26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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