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Xu Y, Jin W, Butkus M, De Ornelas M, Cyriac J, Studenski MT, Padgett K, Simpson G, Samuels S, Samuels M, Dogan N. Cone beam CT-based adaptive intensity modulated proton therapy assessment using automated planning for head-and-neck cancer. Radiat Oncol 2024; 19:13. [PMID: 38263237 PMCID: PMC10804468 DOI: 10.1186/s13014-024-02406-9] [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: 11/28/2022] [Accepted: 01/15/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND To assess the feasibility of CBCT-based adaptive intensity modulated proton therapy (IMPT) using automated planning for treatment of head and neck (HN) cancers. METHODS Twenty HN cancer patients who received radiotherapy and had pretreatment CBCTs were included in this study. Initial IMPT plans were created using automated planning software for all patients. Synthetic CTs (sCT) were then created by deforming the planning CT (pCT) to the pretreatment CBCTs. To assess dose calculation accuracy on sCTs, repeat CTs (rCTs) were deformed to the pretreatment CBCT obtained on the same day to create deformed rCT (rCTdef), serving as gold standard. The dose recalculated on sCT and on rCTdef were compared by using Gamma analysis. The accuracy of DIR generated contours was also assessed. To explore the potential benefits of adaptive IMPT, two sets of plans were created for each patient, a non-adapted IMPT plan and an adapted IMPT plan calculated on weekly sCT images. The weekly doses for non-adaptive and adaptive IMPT plans were accumulated on the pCT, and the accumulated dosimetric parameters of two sets were compared. RESULTS Gamma analysis of the dose recalculated on sCT and rCTdef resulted in a passing rate of 97.9% ± 1.7% using 3 mm/3% criteria. With the physician-corrected contours on the sCT, the dose deviation range of using sCT to estimate mean dose for the most organ at risk (OARs) can be reduced to (- 2.37%, 2.19%) as compared to rCTdef, while for V95 of primary or secondary CTVs, the deviation can be controlled within (- 1.09%, 0.29%). Comparison of the accumulated doses from the adaptive planning against the non-adaptive plans reduced mean dose to constrictors (- 1.42 Gy ± 2.79 Gy) and larynx (- 2.58 Gy ± 3.09 Gy). The reductions result in statistically significant reductions in the normal tissue complication probability (NTCP) of larynx edema by 7.52% ± 13.59%. 4.5% of primary CTVs, 4.1% of secondary CTVs, and 26.8% tertiary CTVs didn't meet the V95 > 95% constraint on non-adapted IMPT plans. All adaptive plans were able to meet the coverage constraint. CONCLUSION sCTs can be a useful tool for accurate proton dose calculation. Adaptive IMPT resulted in better CTV coverage, OAR sparing and lower NTCP for some OARs as compared with non-adaptive IMPT.
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Affiliation(s)
- Yihang Xu
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, College of Engineering, University of Miami, Coral Gables, FL, USA
| | - William Jin
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael Butkus
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mariluz De Ornelas
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jonathan Cyriac
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Matthew T Studenski
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kyle Padgett
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Garrett Simpson
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stuart Samuels
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael Samuels
- Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Nesrin Dogan
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.
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Huiskes M, Astreinidou E, Kong W, Breedveld S, Heijmen B, Rasch C. Dosimetric impact of adaptive proton therapy in head and neck cancer - A review. Clin Transl Radiat Oncol 2023; 39:100598. [PMID: 36860581 PMCID: PMC9969246 DOI: 10.1016/j.ctro.2023.100598] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023] Open
Abstract
Background Intensity Modulated Proton Therapy (IMPT) in head and neck cancer (HNC) is susceptible to anatomical changes and patient set-up inaccuracies during the radiotherapy course, which can cause discrepancies between planned and delivered dose. The discrepancies can be counteracted by adaptive replanning strategies. This article reviews the observed dosimetric impact of adaptive proton therapy (APT) and the timing to perform a plan adaptation in IMPT in HNC. Methods A literature search of articles published in PubMed/MEDLINE, EMBASE and Web of Science from January 2010 to March 2022 was performed. Among a total of 59 records assessed for possible eligibility, ten articles were included in this review. Results Included studies reported on target coverage deterioration in IMPT plans during the RT course, which was recovered with the application of an APT approach. All APT plans showed an average improved target coverage for the high- and low-dose targets as compared to the accumulated dose on the planned plans. Dose improvements up to 2.5 Gy (3.5 %) and up to 4.0 Gy (7.1 %) in the D98 of the high- and low dose targets were observed with APT. Doses to the organs at risk (OARs) remained equal or decreased slightly after APT was applied. In the included studies, APT was largely performed once, which resulted in the largest target coverage improvement, but eventual additional APT improved the target coverage further. There is no data showing what is the most appropriate timing for APT. Conclusion APT during IMPT for HNC patients improves target coverage. The largest improvement in target coverage was found with a single adaptive intervention, and an eventual second or more frequent APT application improved the target coverage further. Doses to the OARs remained equal or decreased slightly after applying APT. The most optimal timing for APT is yet to be determined.
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Affiliation(s)
- Merle Huiskes
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands,Corresponding author at: Department of Radiation Oncology, Leiden University Medical Centre, Albinusdreef 2, P.O. Box 9600, Postal zone K1-P, 2300 RC Leiden, the Netherlands.
| | - Eleftheria Astreinidou
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wens Kong
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Sebastiaan Breedveld
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Ben Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Coen Rasch
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands,HollandPTC, Delft, the Netherlands
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Zhao R, Wang X, Wei H. Accuracy and Feasibility of Synthetic CT for Lung Adaptive Radiotherapy: A Phantom Study. Technol Cancer Res Treat 2023; 22:15330338231218161. [PMID: 38037343 PMCID: PMC10693223 DOI: 10.1177/15330338231218161] [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: 06/02/2023] [Revised: 10/22/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES The respiratory variations will lead to inconsistency between the actual delivery dose and the planning dose. How the minor interfractional amplitude changes affect the geometry and dose delivery accuracy remains to be investigated in the context of lung adaptive radiotherapy. METHODS Planning 4-dimensional-computed tomography and kV-cone beam computed tomography were scanned based on the Computerized Imaging Reference Systems phantom, which was employed to simulate the minor interfractional amplitude variations. The corresponding synthetic computed tomography for a particular motion pattern can be generated from Velocity program. Then a clinically meaningful synthetic computed tomography was analyzed through the geometrical and dosimetric assessment. RESULTS The image quality of synthetic computed tomography was improved obviously compared with cone beam computed tomography. Mean absolute error was minimized when no significant interfractional motion occurs and Velocity can be qualified for dealing with the regular breathing motion patterns. The mean percent hounsfield unit difference of the synthetic hounsfield unit values per organ relative to the planning 4-dimensional-computed tomography image was 22.3%. Under the same conditions, the mean percent hounsfield unit difference of the cone beam computed tomography hounsfield unit values per organ, relative to the planning 4-dimensional-computed tomography image was 83.9%. Overall, the accuracy of hounsfield unit in synthetic computed tomography was improved obviously and the variability of the synthetic image correlates with the planning 4-dimensional-computed tomography image variability. Meanwhile, the dose-volume histograms between planning 4-dimensional-computed tomography and synthetic computed tomography almost coincided each other, which indicates that Velocity program can qualify lung adaptive radiotherapy well when there were no interfractional respiratory variations. However, for cases with obvious interfractional amplitude change, the volume covered at least by 100% of the prescription dose was only 59.6% for that synthetic image. CONCLUSION The synthetic computed tomography images generated from Velocity were close to the real images in anatomy and dosimetry, which can make clinical lung adaptive radiotherapy possible based on the actual patient anatomy during treatment.
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Affiliation(s)
- Ruifeng Zhao
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xingliu Wang
- Application, Varian Medical System, Beijing, China
| | - Huanhai Wei
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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MRI-based adaptive radiotherapy has the potential to reduce dysphagia in patients with head and neck cancer. Phys Med 2023; 105:102511. [PMID: 36563523 DOI: 10.1016/j.ejmp.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/24/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
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Yao W, Zhang B, Han D, Polf J, Vedam S, Lasio G, Yi B. Use of CBCT plus plan robustness for reducing QACT frequency in intensity-modulated proton therapy: Head-and-neck cases. Med Phys 2022; 49:6794-6801. [PMID: 35933322 DOI: 10.1002/mp.15915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/20/2022] [Accepted: 08/01/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Anatomic variation has a significant dosimetric impact in intensity-modulated proton therapy. Weekly or biweekly computed tomography (CT) scans, called quality assurance CTs (QACTs), are used to monitor anatomic and resultant dose changes to determine whether adaptive plans are needed. Frequent CT scans result in unwanted QACT dose and increased clinical workloads. This study proposed utilizing patient setup cone-beam CTs (CBCTs) and treatment plan robustness to reduce the frequency of QACTs. METHODS We retrospectively analyzed data from 27 patients with head-and-neck cancer, including 594 CBCTs, 136 QACTs, and 19 adaptive plans. For each CBCT, water-equivalent thickness (WET) along the pencil-beam path was calculated. For each treatment plan, the WET of the first-day CBCT was used as the reference, and the mean WET changes (ΔWET) in each following CBCT was used as the surrogate of proton range change. Using CBCTs acquired prior to a QACT, we predicted the ΔWET on the QACT day by a linear regression model. The impact of range change on target dose was calculated as the predicted ΔWET weighted by the monitor units of each field. In addition, plan robustness was estimated from the robust dose-volume histograms (DVHs) and combined with ΔWET to reduce QACT frequency. Robustness was estimated from the distance between the DVH curves of the nominal and worst scenarios. RESULTS When the estimated mean ΔWET was <6.5 mm (or <7.5 mm if the robustness was >95%), the QACT could be skipped without missing any adaptive planning; otherwise a QACT was required. Overall, 41% of QACTs could be eliminated when ΔWET was <6.5 mm and 56% when ΔWET was <7.5 mm, and robustness was >95%. At least one QACT could have been omitted in 25 of the 27 cases under skipping thresholds at ΔWETs <7.5 mm and R > 95%. CONCLUSION This study suggests that the number of QACTs can be greatly reduced by calculating range change in patient setup CBCTs and can be further reduced by combining this information with analyses of plan robustness.
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Affiliation(s)
- Weiguang Yao
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Baoshe Zhang
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dong Han
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jerimy Polf
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sastry Vedam
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Giovanni Lasio
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Byongyong Yi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Li H, Hrinivich WT, Chen H, Sheikh K, Ho MW, Ger R, Liu D, Hales RK, Voong KR, Halthore A, Deville C. Evaluating Proton Dose and Associated Range Uncertainty Using Daily Cone-Beam CT. Front Oncol 2022; 12:830981. [PMID: 35449577 PMCID: PMC9016186 DOI: 10.3389/fonc.2022.830981] [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: 12/07/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aimed to quantitatively evaluate the range uncertainties that arise from daily cone-beam CT (CBCT) images for proton dose calculation compared to CT using a measurement-based technique. Methods For head and thorax phantoms, wedge-shaped intensity-modulated proton therapy (IMPT) treatment plans were created such that the gradient of the wedge intersected and was measured with a 2D ion chamber array. The measured 2D dose distributions were compared with 2D dose planes extracted from the dose distributions using the IMPT plan calculated on CT and CBCT. Treatment plans of a thymoma cancer patient treated with breath-hold (BH) IMPT were recalculated on 28 CBCTs and 9 CTs, and the resulting dose distributions were compared. Results The range uncertainties for the head phantom were determined to be 1.2% with CBCT, compared to 0.5% for CT, whereas the range uncertainties for the thorax phantom were 2.1% with CBCT, compared to 0.8% for CT. The doses calculated on CBCT and CT were similar with similar anatomy changes. For the thymoma patient, the primary source of anatomy change was the BH uncertainty, which could be up to 8 mm in the superior-inferior (SI) direction. Conclusion We developed a measurement-based range uncertainty evaluation method with high sensitivity and used it to validate the accuracy of CBCT-based range and dose calculation. Our study demonstrated that the CBCT-based dose calculation could be used for daily dose validation in selected proton patients.
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Affiliation(s)
- Heng Li
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - William T Hrinivich
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hao Chen
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Khadija Sheikh
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Meng Wei Ho
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rachel Ger
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dezhi Liu
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Russell Kenneth Hales
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Khinh Ranh Voong
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aditya Halthore
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Curtiland Deville
- Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Mohamed N, Lee A, Lee NY. Proton beam radiation therapy treatment for head and neck cancer. PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Nader Mohamed
- Department of Radiation Oncology Memorial Sloan Kettering Cancer Center New York NY USA
| | - Anna Lee
- Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Nancy Y. Lee
- Department of Radiation Oncology Memorial Sloan Kettering Cancer Center New York NY USA
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Vidal M, Moignier C, Patriarca A, Sotiropoulos M, Schneider T, De Marzi L. Future technological developments in proton therapy - A predicted technological breakthrough. Cancer Radiother 2021; 25:554-564. [PMID: 34272182 DOI: 10.1016/j.canrad.2021.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022]
Abstract
In the current spectrum of cancer treatments, despite high costs, a lack of robust evidence based on clinical outcomes or technical and radiobiological uncertainties, particle therapy and in particular proton therapy (PT) is rapidly growing. Despite proton therapy being more than fifty years old (first proposed by Wilson in 1946) and more than 220,000 patients having been treated with in 2020, many technological challenges remain and numerous new technical developments that must be integrated into existing systems. This article presents an overview of on-going technical developments and innovations that we felt were most important today, as well as those that have the potential to significantly shape the future of proton therapy. Indeed, efforts have been done continuously to improve the efficiency of a PT system, in terms of cost, technology and delivery technics, and a number of different developments pursued in the accelerator field will first be presented. Significant developments are also underway in terms of transport and spatial resolution achievable with pencil beam scanning, or conformation of the dose to the target: we will therefore discuss beam focusing and collimation issues which are important parameters for the development of these techniques, as well as proton arc therapy. State of the art and alternative approaches to adaptive PT and the future of adaptive PT will finally be reviewed. Through these overviews, we will finally see how advances in these different areas will allow the potential for robust dose shaping in proton therapy to be maximised, probably foreshadowing a future era of maturity for the PT technique.
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Affiliation(s)
- M Vidal
- Centre Antoine-Lacassagne, Fédération Claude Lalanne, 227, avenue de la Lanterne, 06200 Nice, France
| | - C Moignier
- Centre François Baclesse, Department of Medical Physics, Centre de protonthérapie de Normandie, 14000 Caen, France
| | - A Patriarca
- Institut Curie, PSL Research University, Radiation oncology department, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, 91898 Orsay, France
| | - M Sotiropoulos
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation radiobiologie et cancer, 91400 Orsay, France
| | - T Schneider
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation radiobiologie et cancer, 91400 Orsay, France
| | - L De Marzi
- Institut Curie, PSL Research University, Radiation oncology department, Centre de protonthérapie d'Orsay, Campus universitaire, bâtiment 101, 91898 Orsay, France; Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, Campus universitaire, 91898 Orsay, France.
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