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Clausen M, Ruangchan S, Sotoudegan A, Resch AF, Knäusl B, Palmans H, Georg D. Small field proton irradiation for in vivo studies: Potential and limitations when adapting clinical infrastructure. Z Med Phys 2023; 33:542-551. [PMID: 36357294 PMCID: PMC10751703 DOI: 10.1016/j.zemedi.2022.10.002] [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: 05/12/2022] [Revised: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To evaluate the dosimetric accuracy for small field proton irradiation relevant for pre-clinical in vivo studies using clinical infrastructure and technology. In this context additional beam collimation and range reduction was implemented. METHODS AND MATERIALS The clinical proton beam line employing pencil beam scanning (PBS) was adapted for the irradiation of small fields at shallow depths. Cylindrical collimators with apertures of 15, 12, 7 and 5mm as well as two different range shifter types, placed at different distances relative to the target, were tested: a bolus range shifter (BRS) attached to the collimator and a clinical nozzle mounted range shifter (CRS) placed at a distance of 72cm from the collimator. The Monte Carlo (MC) based dose calculation engine implemented in the clinical treatment planning system (TPS) was commissioned for these two additional hardware components. The study was conducted with a phantom and cylindrical target sizes between 2 and 25mm in diameter following a dosimetric end-to-end test concept. RESULTS The setup with the CRS provided a uniform dose distribution across the target. An agreement of better than5% between the planned dose and the measurements was obtained for a target with 3mm diameter (collimator 5mm). A 2mm difference between the collimator and the target diameter (target being 2 mm smaller than the collimator) sufficed to cover the whole target with the planned dose in the setup with CRS. Using the BRS setup (target 8mm, collimator 12mm) resulted in non-homogeneous dose distributions, with a dose discrepancy of up to 10% between the planned and measured doses. CONCLUSION The clinical proton infrastructure with adequate beam line adaptations and a state-of-the-art TPS based on MC dose calculations enables small animal irradiations with a high dosimetric precision and accuracy for target sizes down to 3mm.
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Affiliation(s)
- Monika Clausen
- Division of Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna, Austria.
| | - Sirinya Ruangchan
- Division of Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna, Austria; Division of Therapeutic Radiation and Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Arame Sotoudegan
- Division of Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna, Austria
| | - Andreas F Resch
- Division of Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna, Austria
| | - Barbara Knäusl
- Division of Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna, Austria
| | - Hugo Palmans
- Division of Medical Physics, MedAustron Ion Therapy Center, Wiener Neustadt, Austria; National Physical Laboratory, Teddington, United Kingdom
| | - Dietmar Georg
- Division of Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna, Austria; Division of Medical Physics, MedAustron Ion Therapy Center, Wiener Neustadt, Austria
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2
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Carrasquilla M, Paudel N, Collins BT, Anderson E, Krochmal R, Margolis M, Balawi A, DeBlois D, Giaccone G, Kim C, Liu S, Lischalk JW. High-Risk Non-Small Cell Lung Cancer Treated With Active Scanning Proton Beam Radiation Therapy and Immunotherapy. Adv Radiat Oncol 2022; 8:101125. [PMID: 36578277 PMCID: PMC9791120 DOI: 10.1016/j.adro.2022.101125] [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: 04/12/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose Non-small cell lung cancer (NSCLC) is a deadly malignancy that is frequently diagnosed in patients with significant medical comorbidities. When delivering local and regional therapy, an exceedingly narrow therapeutic window is encountered, which often precludes patients from receiving aggressive curative therapy. Radiation therapy advances including particle therapy have been employed in an effort to expand this therapeutic window. Here we report outcomes with the use of proton therapy with curative intent and immunotherapy to treat patients diagnosed with high-risk NSCLC. Methods and Materials Patients were determined to be high risk if they had severe underlying cardiopulmonary dysfunction, history of prior thoracic radiation therapy, and/or large volume or unfavorable location of disease (eg, bilateral hilar involvement, supraclavicular involvement). As such, patients were determined to be ineligible for conventional x-ray-based radiation therapy and were treated with pencil beam scanning proton beam therapy (PBS-PBT). Patients who demonstrated excess respiratory motion (ie, greater than 1 cm in any dimension noted on the 4-dimensional computed tomography simulation scan) were deemed to be ineligible for PBT. Toxicity was reported using the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Overall survival and progression-free survival were calculated using the Kaplan-Meier method. Results A total of 29 patients with high-risk NSCLC diagnoses were treated with PBS-PBT. The majority (55%) of patients were defined as high risk due to severe cardiopulmonary dysfunction. Most commonly, patients were treated definitively to a total dose of 6000 cGy (relative biological effectiveness) in 30 fractions with concurrent chemotherapy. Overall, there were a total of 6 acute grade 3 toxicities observed in our cohort. Acute high-grade toxicities included esophagitis (n = 4, 14%), dyspnea (n = 1, 3.5%), and cough (n = 1, 3.5%). No patients developed grade 4 or higher toxicity. The majority of patients went on to receive immunotherapy, and high-grade pneumonitis was rare. Two-year progression-free and overall survival was estimated to be 51% and 67%, respectively. COVID-19 was confirmed or suspected to be responsible for 2 patient deaths during the follow-up period. Conclusions Radical PBS-PBT treatment delivered in a cohort of patients with high-risk lung cancer with immunotherapy is feasible with careful multidisciplinary evaluation and rigorous follow-up.
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Affiliation(s)
- Michael Carrasquilla
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Nitika Paudel
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Brian T. Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Eric Anderson
- Division of Pulmonary and Critical Care Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Rebecca Krochmal
- Division of Pulmonary and Critical Care Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Marc Margolis
- Division of Thoracic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Ahssan Balawi
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - David DeBlois
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Giuseppe Giaccone
- Department of Hematology and Oncology, Weill Cornell Medical Center, New York, New York
| | - Chul Kim
- Lombardi Cancer Center, MedStar Georgetown University Hospital, Washington, DC
| | - Stephen Liu
- Lombardi Cancer Center, MedStar Georgetown University Hospital, Washington, DC
| | - Jonathan W. Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital – Long Island, New York, New York,Corresponding author: Jonathan W. Lischalk, MD
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Thomas HMT, Hippe DS, Forouzannezhad P, Sasidharan BK, Kinahan PE, Miyaoka RS, Vesselle HJ, Rengan R, Zeng J, Bowen SR. Radiation and immune checkpoint inhibitor-mediated pneumonitis risk stratification in patients with locally advanced non-small cell lung cancer: role of functional lung radiomics? Discov Oncol 2022; 13:85. [PMID: 36048266 PMCID: PMC9437196 DOI: 10.1007/s12672-022-00548-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients undergoing chemoradiation and immune checkpoint inhibitor (ICI) therapy for locally advanced non-small cell lung cancer (NSCLC) experience pulmonary toxicity at higher rates than historical reports. Identifying biomarkers beyond conventional clinical factors and radiation dosimetry is especially relevant in the modern cancer immunotherapy era. We investigated the role of novel functional lung radiomics, relative to functional lung dosimetry and clinical characteristics, for pneumonitis risk stratification in locally advanced NSCLC. METHODS Patients with locally advanced NSCLC were prospectively enrolled on the FLARE-RT trial (NCT02773238). All received concurrent chemoradiation using functional lung avoidance planning, while approximately half received consolidation durvalumab ICI. Within tumour-subtracted lung regions, 110 radiomics features (size, shape, intensity, texture) were extracted on pre-treatment [99mTc]MAA SPECT/CT perfusion images using fixed-bin-width discretization. The performance of functional lung radiomics for pneumonitis (CTCAE v4 grade 2 or higher) risk stratification was benchmarked against previously reported lung dosimetric parameters and clinical risk factors. Multivariate least absolute shrinkage and selection operator Cox models of time-varying pneumonitis risk were constructed, and prediction performance was evaluated using optimism-adjusted concordance index (c-index) with 95% confidence interval reporting throughout. RESULTS Thirty-nine patients were included in the study and pneumonitis occurred in 16/39 (41%) patients. Among clinical characteristics and anatomic/functional lung dosimetry variables, only the presence of baseline chronic obstructive pulmonary disease (COPD) was significantly associated with the development of pneumonitis (HR 4.59 [1.69-12.49]) and served as the primary prediction benchmark model (c-index 0.69 [0.59-0.80]). Discrimination of time-varying pneumonitis risk was numerically higher when combining COPD with perfused lung radiomics size (c-index 0.77 [0.65-0.88]) or shape feature classes (c-index 0.79 [0.66-0.91]) but did not reach statistical significance compared to benchmark models (p > 0.26). COPD was associated with perfused lung radiomics size features, including patients with larger lung volumes (AUC 0.75 [0.59-0.91]). Perfused lung radiomic texture features were correlated with lung volume (adj R2 = 0.84-1.00), representing surrogates rather than independent predictors of pneumonitis risk. CONCLUSIONS In patients undergoing chemoradiation with functional lung avoidance therapy and optional consolidative immune checkpoint inhibitor therapy for locally advanced NSCLC, the strongest predictor of pneumonitis was the presence of baseline chronic obstructive pulmonary disease. Results from this novel functional lung radiomics exploratory study can inform future validation studies to refine pneumonitis risk models following combinations of radiation and immunotherapy. Our results support functional lung radiomics as surrogates of COPD for non-invasive monitoring during and after treatment. Further study of clinical, dosimetric, and radiomic feature combinations for radiation and immune-mediated pneumonitis risk stratification in a larger patient population is warranted.
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Affiliation(s)
- Hannah M T Thomas
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356043, Seattle, WA, 98195, USA
- Department of Radiation Oncology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Daniel S Hippe
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Parisa Forouzannezhad
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356043, Seattle, WA, 98195, USA
| | - Balu Krishna Sasidharan
- Department of Radiation Oncology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Paul E Kinahan
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Robert S Miyaoka
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Hubert J Vesselle
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356043, Seattle, WA, 98195, USA
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356043, Seattle, WA, 98195, USA
| | - Stephen R Bowen
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356043, Seattle, WA, 98195, USA.
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
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4
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Mairani A, Mein S, Blakely E, Debus J, Durante M, Ferrari A, Fuchs H, Georg D, Grosshans DR, Guan F, Haberer T, Harrabi S, Horst F, Inaniwa T, Karger CP, Mohan R, Paganetti H, Parodi K, Sala P, Schuy C, Tessonnier T, Titt U, Weber U. Roadmap: helium ion therapy. Phys Med Biol 2022; 67. [PMID: 35395649 DOI: 10.1088/1361-6560/ac65d3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/08/2022] [Indexed: 12/16/2022]
Abstract
Helium ion beam therapy for the treatment of cancer was one of several developed and studied particle treatments in the 1950s, leading to clinical trials beginning in 1975 at the Lawrence Berkeley National Laboratory. The trial shutdown was followed by decades of research and clinical silence on the topic while proton and carbon ion therapy made debuts at research facilities and academic hospitals worldwide. The lack of progression in understanding the principle facets of helium ion beam therapy in terms of physics, biological and clinical findings persists today, mainly attributable to its highly limited availability. Despite this major setback, there is an increasing focus on evaluating and establishing clinical and research programs using helium ion beams, with both therapy and imaging initiatives to supplement the clinical palette of radiotherapy in the treatment of aggressive disease and sensitive clinical cases. Moreover, due its intermediate physical and radio-biological properties between proton and carbon ion beams, helium ions may provide a streamlined economic steppingstone towards an era of widespread use of different particle species in light and heavy ion therapy. With respect to the clinical proton beams, helium ions exhibit superior physical properties such as reduced lateral scattering and range straggling with higher relative biological effectiveness (RBE) and dose-weighted linear energy transfer (LETd) ranging from ∼4 keVμm-1to ∼40 keVμm-1. In the frame of heavy ion therapy using carbon, oxygen or neon ions, where LETdincreases beyond 100 keVμm-1, helium ions exhibit similar physical attributes such as a sharp lateral penumbra, however, with reduced radio-biological uncertainties and without potentially spoiling dose distributions due to excess fragmentation of heavier ion beams, particularly for higher penetration depths. This roadmap presents an overview of the current state-of-the-art and future directions of helium ion therapy: understanding physics and improving modeling, understanding biology and improving modeling, imaging techniques using helium ions and refining and establishing clinical approaches and aims from learned experience with protons. These topics are organized and presented into three main sections, outlining current and future tasks in establishing clinical and research programs using helium ion beams-A. Physics B. Biological and C. Clinical Perspectives.
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Affiliation(s)
- Andrea Mairani
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Centre of Oncological Hadrontherapy (CNAO), Medical Physics, Pavia, Italy.,Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Stewart Mein
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eleanor Blakely
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, CA, United States of America
| | - Jürgen Debus
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany.,Technische Universität Darmstadt, Institut für Physik Kondensierter Materie, Darmstadt, Germany
| | - Alfredo Ferrari
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hermann Fuchs
- Division of Medical Physics, Department of Radiation Oncology, Medical University of Vienna, Austria.,MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Dietmar Georg
- Division of Medical Physics, Department of Radiation Oncology, Medical University of Vienna, Austria.,MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - David R Grosshans
- The University of Texas MD Anderson cancer Center, Houston, Texas, United States of America
| | - Fada Guan
- The University of Texas MD Anderson cancer Center, Houston, Texas, United States of America.,Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, 06510, United States of America
| | - Thomas Haberer
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Semi Harrabi
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Felix Horst
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - Taku Inaniwa
- Department of Accelerator and Medical Physics, Institute for Quantum Medical Science, QST, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan.,Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Christian P Karger
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Radhe Mohan
- The University of Texas MD Anderson cancer Center, Houston, Texas, United States of America
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, United States of America.,Harvard Medical School, Boston, United States of America
| | - Katia Parodi
- Ludwig-Maximilians-Universität München, Department of Experimental Physics-Medical Physics, Munich, Germany
| | - Paola Sala
- Ludwig-Maximilians-Universität München, Department of Experimental Physics-Medical Physics, Munich, Germany
| | - Christoph Schuy
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Uwe Titt
- The University of Texas MD Anderson cancer Center, Houston, Texas, United States of America
| | - Ulrich Weber
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
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5
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Wang W, Chang Y, Liu Y, Liang Z, Liao Y, Qin B, Liu X, Yang Z. Feasibility study of fast intensity-modulated proton therapy dose prediction method using deep neural networks for prostate cancer. Med Phys 2022; 49:5451-5463. [PMID: 35543109 DOI: 10.1002/mp.15702] [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: 02/07/2022] [Revised: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Compared to the pencil-beam algorithm, the Monte-Carlo (MC) algorithm is more accurate for dose calculation but time-consuming in proton therapy. To solve this problem, this study uses deep learning to provide fast 3D dose prediction for prostate cancer patients treated with intensity-modulated proton therapy (IMPT). METHODS A novel recurrent U-net (RU-net) architecture was trained to predict the 3D dose distribution. Doses, CT images, and beam spot information from IMPT plans were used to train the RU-net with a 5-fold cross-validation. However, predicting the complicated dose properties of the IMPT plan is difficult for neural networks. Instead of the Peak-MU model, this work develops the Multi-MU model that adopted more comprehensive inputs and was trained with a combinational loss function. The dose difference between the prediction dose and MC dose was evaluated with gamma analysis, dice similarity coefficient (DSC), and dose-volume histogram (DVH) metrics. The Monte-Carlo dropout was also added to the network to quantify the uncertainty of the model. RESULTS Compared to the Peak-MU model, the Multi-MU model led to smaller mean absolute errors (3.03% vs. 2.05%, p = 0.005), higher gamma-passing rate (2mm, 3%: 97.42% vs. 93.69%, p = 0.005), higher dice similarity coefficient, and smaller relative DVH metrics error (CTV D98% : 3.03% vs. 6.08%, p = 0.017; in Bladder V30: 3.08% vs. 5.28%, p = 0.028; and in Bladder V20: 3.02% vs. 4.42%, p = 0.017). Considering more prior knowledge, the Multi-MU model had better-predicted accuracy with a prediction time of less than half a second for each fold. The mean uncertainty value of the Multi-MU model is 0.46%, with a dropout rate of 10%. CONCLUSION This method was a nearly real-time IMPT dose prediction algorithm with accuracy comparable to the PB analytical algorithms used in prostate cancer. This RU-net might be used in plan robustness optimization and robustness evaluation in the future. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Wei Wang
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yu Chang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yilin Liu
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, 77030-3722, USA.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Zhikai Liang
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yicheng Liao
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Bin Qin
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Xu Liu
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Zhiyong Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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6
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Nenoff L, Matter M, Charmillot M, Krier S, Uher K, Weber DC, Lomax AJ, Albertini F. Experimental validation of daily adaptive proton therapy. Phys Med Biol 2021; 66. [PMID: 34587589 DOI: 10.1088/1361-6560/ac2b84] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/29/2021] [Indexed: 11/12/2022]
Abstract
Anatomical changes during proton therapy require rapid treatment plan adaption to mitigate the associated dosimetric impact. This in turn requires a highly efficient workflow that minimizes the time between imaging and delivery. At the Paul Scherrer Institute, we have developed an online adaptive workflow, which is specifically designed for treatments in the skull-base/cranium, with the focus set on simplicity and minimizing changes to the conventional workflow. The dosimetric and timing performance of this daily adaptive proton therapy (DAPT) workflow has been experimentally investigated using an in-house developed DAPT software and specifically developed anthropomorphic phantom. After a standard treatment preparation, which includes the generation of a template plan, the treatment can then be adapted each day, based on daily imaging acquired on an in-room CT. The template structures are then rigidly propagated to this CT and the daily plan is fully re-optimized using the same field arrangement, DVH constraints and optimization settings of the template plan. After a dedicated plan QA, the daily plan is delivered. To minimize the time between imaging and delivery, clinically integrated software for efficient execution of all online adaption steps, as well as tools for comprehensive and automated QA checks, have been developed. Film measurements of an end-to-end validation of a multi-fraction DAPT treatment showed high agreement to the calculated doses. Gamma pass rates with a 3%/3 mm criteria were >92% when comparing the measured dose to the template plan. Additionally, a gamma pass rate >99% was found comparing measurements to the Monte Carlo dose of the daily plans reconstructed from the logfile, accumulated over the delivered fractions. With this, we experimentally demonstrate that the described adaptive workflow can be delivered accurately in a timescale similar to a standard delivery.
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Affiliation(s)
- Lena Nenoff
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland.,Department of Physics, ETH Zurich, Switzerland
| | - Michael Matter
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland.,Department of Physics, ETH Zurich, Switzerland
| | | | - Serge Krier
- Department of Physics, ETH Zurich, Switzerland
| | - Klara Uher
- Department of Physics, ETH Zurich, Switzerland
| | - Damien Charles Weber
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Switzerland.,Department of Radiation Oncology, University Hospital Bern, Switzerland
| | - Antony John Lomax
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland.,Department of Physics, ETH Zurich, Switzerland
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7
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Ruangchan S, Palmans H, Knäusl B, Georg D, Clausen M. Dose calculation accuracy in particle therapy: Comparing carbon ions with protons. Med Phys 2021; 48:7333-7345. [PMID: 34482555 PMCID: PMC9291072 DOI: 10.1002/mp.15209] [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: 03/29/2021] [Revised: 06/02/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose This work presents the validation of an analytical pencil beam dose calculation algorithm in a commercial treatment planning system (TPS) for carbon ions by measurements of dose distributions in heterogeneous phantom geometries. Additionally, a comparison study of carbon ions versus protons is performed considering current best solutions in commercial TPS. Methods All treatment plans were optimized and calculated using the RayStation TPS (RaySearch, Sweden). The dose distributions calculated with the TPS were compared with measurements using a 24‐pinpoint ionization chamber array (T31015, PTW, Germany). Tissue‐like inhomogeneities (bone, lung, and soft tissue) were embedded in water, while a target volume of 4 x 4 x 4 cm3 was defined at two different depths behind the heterogeneities. In total, 10 different test cases, with and without range shifter as well as different air gaps, were investigated. Dose distributions inside as well as behind the target volume were evaluated. Results Inside the target volume, the mean dose difference between calculations and measurements, averaged over all test cases, was 1.6% for carbon ions. This compares well to the final agreement of 1.5% obtained in water at the commissioning stage of the TPS for carbon ions and is also within the clinically acceptable interval of 3%. The mean dose difference and maximal dose difference obtained outside the target area were 1.8% and 13.4%, respectively. The agreement of dose distributions for carbon ions in the target volumes was comparable or better to that between Monte Carlo (MC) dose calculations and measurements for protons. Percentage dose differences of more than 10% were present outside the target area behind bone–lung structures, where the carbon ion calculations systematically over predicted the dose. MC dose calculations for protons were superior to carbon ion beams outside the target volumes. Conclusion The pencil beam dose calculations for carbon ions in RayStation were found to be in good agreement with dosimetric measurements in heterogeneous geometries for points of interest located within the target. Large local discrepancies behind the target may contribute to incorrect dose predictions for organs at risk.
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Affiliation(s)
- Sirinya Ruangchan
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria.,Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Hugo Palmans
- Division of Medical Physics, MedAustron Ion Therapy Center, Wiener Neustadt, Austria.,Medical Radiation Science, National Physical Laboratory, Teddington, UK
| | - Barbara Knäusl
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria.,Division of Medical Physics, MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Dietmar Georg
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria.,Division of Medical Physics, MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Monika Clausen
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
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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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Magro G, Mein S, Kopp B, Mastella E, Pella A, Ciocca M, Mairani A. FRoG dose computation meets Monte Carlo accuracy for proton therapy dose calculation in lung. Phys Med 2021; 86:66-74. [PMID: 34058719 DOI: 10.1016/j.ejmp.2021.05.021] [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: 10/01/2020] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To benchmark and evaluate the clinical viability of novel analytical GPU-accelerated and CPU-based Monte Carlo (MC) dose-engines for spot-scanning intensity-modulated-proton-therapy (IMPT) towards the improvement of lung cancer treatment. METHODS Nine patient cases were collected from the CNAO clinical experience and The Cancer Imaging Archive-4D-Lung-Database for in-silico study. All plans were optimized with 2 orthogonal beams in RayStation (RS) v.8. Forward calculations were performed with FRoG, an independent dose calculation system using a fast robust approach to the pencil beam algorithm (PBA), RS-MC (CPU for v.8) and general-purpose MC (gp-MC). Dosimetric benchmarks were acquired via irradiation of a lung-like phantom and ionization chambers for both a single-field-uniform-dose (SFUD) and IMPT plans. Dose-volume-histograms, dose-difference and γ-analyses were conducted. RESULTS With respect to reference gp-MC, the average dose to the GTV was 1.8% and 2.3% larger for FRoG and the RS-MC treatment planning system (TPS). FRoG and RS-MC showed a local γ-passing rate of ~96% and ~93%. Phantom measurements confirmed FRoG's high accuracywith a deviation < 0.1%. CONCLUSIONS Dose calculation performance using the GPU-accelerated analytical PBA, MC-TPS and gp-MC code were well within clinical tolerances. FRoG predictions were in good agreement with both the full gp-MC and experimental data for proton beams optimized for thoracic dose calculations. GPU-accelerated dose-engines like FRoG may alleviate current issues related to deficiencies in current commercial analytical proton beam models. The novel approach to the PBA implemented in FRoG is suitable for either clinical TPS or as an auxiliary dose-engine to support clinical activity for lung patients.
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Affiliation(s)
- Giuseppe Magro
- National Centre for Oncological Hadrontherapy (CNAO), Clinical Department, Pavia, Italy
| | - Stewart Mein
- Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Molecular and Translational Radiation Oncology, Department of Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Benedikt Kopp
- Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Molecular and Translational Radiation Oncology, Department of Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg, Germany; German Cancer Consortium (DKTK) Core-Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg University and German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Physics and Astronomy, Heidelberg University, Germany
| | - Edoardo Mastella
- National Centre for Oncological Hadrontherapy (CNAO), Clinical Department, Pavia, Italy
| | - Andrea Pella
- National Centre for Oncological Hadrontherapy (CNAO), Clinical Department, Pavia, Italy
| | - Mario Ciocca
- National Centre for Oncological Hadrontherapy (CNAO), Clinical Department, Pavia, Italy
| | - Andrea Mairani
- National Centre for Oncological Hadrontherapy (CNAO), Clinical Department, Pavia, Italy; Clinical Cooperation Unit Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
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10
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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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McGunigal M, Margolis M, Forsthoefel M, Singh T, Amarell K, Deblois D, Campbell L, Kim C, Liu S, Bergquist PJ, Debrito P, Collins BT, Giaccone G, Lischalk JW. Thymic malignancies treated with active scanning proton beam radiation and Monte Carlo planning: early clinical experience. Acta Oncol 2021; 60:649-652. [PMID: 33629926 DOI: 10.1080/0284186x.2021.1887516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mary McGunigal
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Marc Margolis
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Georgetown University Hospital, Washington, DC, USA
| | - Matthew Forsthoefel
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Tanvee Singh
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - David Deblois
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Lloyd Campbell
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Chul Kim
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA
| | - Stephen Liu
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA
| | - Peter J. Bergquist
- Department of Radiology, Georgetown University Hospital, Washington, DC, USA
| | - Pedro Debrito
- Department of Pathology, Georgetown University Hospital, Washington, DC, USA
| | - Brian T. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Giuseppe Giaccone
- Department of Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - Jonathan W. Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Winthrop Hospital, New York, NY, USA
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12
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Paganetti H, Grassberger C, Sharp GC. Physics of Particle Beam and Hypofractionated Beam Delivery in NSCLC. Semin Radiat Oncol 2021; 31:162-169. [PMID: 33610274 PMCID: PMC7905707 DOI: 10.1016/j.semradonc.2020.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The dosimetric advantages of particle therapy lead to significantly reduced integral dose to normal tissues, making it an attractive treatment option for body sites such as the thorax. With reduced normal tissue dose comes the potential for dose escalation, toxicity reduction, or hypofractionation. While proton and heavy ion therapy have been used extensively for NSCLC, there are challenges in planning and delivery compared with X-ray-based radiation therapy. Particularly, range uncertainties compounded by breathing motion have to be considered. This article summarizes the current state of particle therapy for NSCLC with a specific focus on the impact of dosimetric uncertainties in planning and delivery.
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Affiliation(s)
- Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| | - Clemens Grassberger
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Gregory C Sharp
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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13
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Nenoff L, Matter M, Amaya EJ, Josipovic M, Knopf AC, Lomax AJ, Persson GF, Ribeiro CO, Visser S, Walser M, Weber DC, Zhang Y, Albertini F. Dosimetric influence of deformable image registration uncertainties on propagated structures for online daily adaptive proton therapy of lung cancer patients. Radiother Oncol 2021; 159:136-143. [PMID: 33771576 DOI: 10.1016/j.radonc.2021.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE A major burden of introducing an online daily adaptive proton therapy (DAPT) workflow is the time and resources needed to correct the daily propagated contours. In this study, we evaluated the dosimetric impact of neglecting the online correction of the propagated contours in a DAPT workflow. MATERIAL AND METHODS For five NSCLC patients with nine repeated deep-inspiration breath-hold CTs, proton therapy plans were optimised on the planning CT to deliver 60 Gy-RBE in 30 fractions. All repeated CTs were registered with six different clinically used deformable image registration (DIR) algorithms to the corresponding planning CT. Structures were propagated rigidly and with each DIR algorithm and reference structures were contoured on each repeated CT. DAPT plans were optimised with the uncorrected, propagated structures (propagated DAPT doses) and on the reference structures (ideal DAPT doses), non-adapted doses were recalculated on all repeated CTs. RESULTS Due to anatomical changes occurring during the therapy, the clinical target volume (CTV) coverage of the non-adapted doses reduces on average by 9.7% (V95) compared to an ideal DAPT doses. For the propagated DAPT doses, the CTV coverage was always restored (average differences in the CTV V95 < 1% compared to the ideal DAPT doses). Hotspots were always reduced with any DAPT approach. CONCLUSION For the patients presented here, a benefit of online DAPT was shown, even if the daily optimisation is based on propagated structures with some residual uncertainties. However, a careful (offline) structure review is necessary and corrections can be included in an offline adaption.
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Affiliation(s)
- Lena Nenoff
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland; Department of Physics, ETH Zurich, Switzerland.
| | - Michael Matter
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland; Department of Physics, ETH Zurich, Switzerland
| | | | - Mirjana Josipovic
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Denmark
| | - Antje-Christin Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Antony John Lomax
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland; Department of Physics, ETH Zurich, Switzerland
| | - Gitte F Persson
- Department of Oncology, Rigshospitalet Copenhagen University Hospital, Denmark; Department of Oncology, Herlev-Gentofte Hospital Copenhagen University Hospital, Denmark; Department of Clinical Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark
| | - Cássia O Ribeiro
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Sabine Visser
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Marc Walser
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland
| | - Damien Charles Weber
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland; Department of Radiation Oncology, University Hospital Bern, Switzerland
| | - Ye Zhang
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland
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14
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Wu C, Nguyen D, Xing Y, Montero AB, Schuemann J, Shang H, Pu Y, Jiang S. Improving Proton Dose Calculation Accuracy by Using Deep Learning. MACHINE LEARNING: SCIENCE AND TECHNOLOGY 2021; 2:015017. [PMID: 35965743 PMCID: PMC9374098 DOI: 10.1088/2632-2153/abb6d5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/18/2020] [Accepted: 09/09/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction Pencil beam (PB) dose calculation is fast but inaccurate due to the approximations when dealing with inhomogeneities. Monte Carlo (MC) dose calculation is the most accurate method but it is time consuming. The aim of this study was to develop a deep learning model that can boost the accuracy of PB dose calculation to the level of MC dose by converting PB dose to MC dose for different tumor sites. Methods The proposed model uses the PB dose and CT image as inputs to generate the MC dose. We used 290 patients (90 head and neck, 93 liver, 75 prostate and 32 lung) to train, validate, and test the model. For each tumor site, we performed four numerical experiments to explore various combinations of training datasets. Results Training the model on data from all tumor sites together and using the dose distribution of each individual beam as input yielded the best performance for all four tumor sites. The average gamma passing rate (1mm/1%) between the converted and the MC dose was 92.8%, 92.7%, 89.7% and 99.6% for head and neck, liver, lung, and prostate test patients, respectively. The average dose conversion time for a single field was less than 4 seconds. The trained model can be adapted to new datasets through transfer learning. Conclusions Our deep learning-based approach can quickly boost the accuracy of PB dose to that of MC dose. The developed model can be added to the clinical workflow of proton treatment planning to improve dose calculation accuracy.
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Affiliation(s)
- Chao Wu
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
- Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai, People’s Republic of China
- University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Dan Nguyen
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Yixun Xing
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Ana Barragan Montero
- University of Chinese Academy of Sciences, Beijing, People’s Republic of China
- Molecular Imaging Radiation Oncology (MIRO) Laboratory, UCLouvain, Brussels, Belgium
| | - Jan Schuemann
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Haijiao Shang
- Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai, People’s Republic of China
- University of Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Yuehu Pu
- Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai, People’s Republic of China
| | - Steve Jiang
- Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
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Analytical modeling of depth-dose degradation in heterogeneous lung tissue for intensity-modulated proton therapy planning. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 14:32-38. [PMID: 33458311 PMCID: PMC7807882 DOI: 10.1016/j.phro.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 01/06/2023]
Abstract
Background and purpose Proton therapy may be promising for treating non-small-cell lung cancer due to lower doses to the lung and heart, as compared to photon therapy. A reported challenge is degradation, i.e., a smoothing of the depth-dose distribution due to heterogeneous lung tissue. For pencil beams, this causes a distal falloff widening and a peak-to-plateau ratio decrease, not considered in clinical treatment planning systems. Materials and methods We present a degradation model implemented into an analytical dose calculation, fully integrated into a treatment planning workflow. Degradation effects were investigated on target dose, distal dose falloffs, and mean lung dose for ten patient cases with varying anatomical characteristics. Results For patients with pronounced range straggling (in our study large tumors, or lesions close to the mediastinum), degradation effects were restricted to a maximum decrease in target coverage (D 95 of the planning target volume) of 1.4%. The median broadening of the distal 80-20% dose falloffs was 0.5 mm at the maximum. For small target volumes deep inside lung tissue, however, the target underdose increased considerably by up to 26%. The mean lung dose was not negatively affected by degradation in any of the investigated cases. Conclusion For most cases, dose degradation due to heterogeneous lung tissue did not yield critical organ at risk overdosing or overall target underdosing. However, for small and deep-seated tumors which can only be reached by penetrating lung tissue, we have seen substantial local underdose, which deserves further investigation, also considering other prevalent sources of uncertainty.
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Dumlu HS, Meschini G, Kurz C, Kamp F, Baroni G, Belka C, Paganelli C, Riboldi M. Dosimetric impact of geometric distortions in an MRI-only proton therapy workflow for lung, liver and pancreas. Z Med Phys 2020; 32:85-97. [PMID: 33168274 PMCID: PMC9948883 DOI: 10.1016/j.zemedi.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/02/2020] [Accepted: 10/01/2020] [Indexed: 12/25/2022]
Abstract
In a radiation therapy workflow based on Magnetic Resonance Imaging (MRI), dosimetric errors may arise due to geometric distortions introduced by MRI. The aim of this study was to quantify the dosimetric effect of system-dependent geometric distortions in an MRI-only workflow for proton therapy applied at extra-cranial sites. An approach was developed, in which computed tomography (CT) images were distorted using an MRI displacement map, which represented the MR distortions in a spoiled gradient-echo sequence due to gradient nonlinearities and static magnetic field inhomogeneities. A retrospective study was conducted on 4DCT/MRI digital phantoms and 18 4DCT clinical datasets of the thoraco-abdominal site. The treatment plans were designed and separately optimized for each beam in a beam specific Planning Target Volume on the distorted CT, and the final dose distribution was obtained as the average. The dose was then recalculated in undistorted CT using the same beam geometry and beam weights. The analysis was performed in terms of Dose Volume Histogram (DVH) parameters. No clinically relevant dosimetric impact was observed on organs at risk, whereas in the target structure, geometric distortions caused statistically significant variations in the planned dose DVH parameters and dose homogeneity index (DHI). The dosimetric variations in the target structure were smaller in abdominal cases (ΔD2%, ΔD98%, and ΔDmean all below 0.1% and ΔDHI below 0.003) compared to the lung cases. Indeed, lung patients with tumors isolated inside lung parenchyma exhibited higher dosimetric variations (ΔD2%≥0.3%, ΔD98%≥15.9%, ΔDmean≥3.3% and ΔDHI≥0.102) than lung patients with tumor close to soft tissue (ΔD2%≤0.4%, ΔD98%≤5.6%, ΔDmean≤0.9% and ΔDHI≤0.027) potentially due to higher density variations along the beam path. Results suggest the potential applicability of MRI-only proton therapy, provided that specific analysis is applied for isolated lung tumors.
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Affiliation(s)
- Hatice Selcen Dumlu
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Ponzio 34/5, 20133 Milano, Italy; Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, 85748 Garching bei München, Germany
| | - Giorgia Meschini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Ponzio 34/5, 20133 Milano, Italy
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Florian Kamp
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Ponzio 34/5, 20133 Milano, Italy; Centro Nazionale di Adroterapia Oncologica, Strada Campeggi 53, 27100 Pavia, Italy
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany; German Cancer Consortium (DKTK) partner site Munich, Germany and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Ponzio 34/5, 20133 Milano, Italy
| | - Marco Riboldi
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, 85748 Garching bei München, Germany.
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Experimental benchmarking of RayStation proton dose calculation algorithms inside and outside the target region in heterogeneous phantom geometries. Phys Med 2020; 76:182-193. [DOI: 10.1016/j.ejmp.2020.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 11/18/2022] Open
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Nenoff L, Matter M, Jarhall AG, Winterhalter C, Gorgisyan J, Josipovic M, Persson GF, Munck af Rosenschold P, Weber DC, Lomax AJ, Albertini F. Daily Adaptive Proton Therapy: Is it Appropriate to Use Analytical Dose Calculations for Plan Adaption? Int J Radiat Oncol Biol Phys 2020; 107:747-755. [DOI: 10.1016/j.ijrobp.2020.03.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/26/2020] [Accepted: 03/27/2020] [Indexed: 12/25/2022]
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Zeng J, Badiyan SN, Garces YI, Wong T, Zhang X, Simone CB, Chang JY, Knopf AC, Mori S, Iwata H, Meijers A, Li H, Bues M, Liu W, Schild SE, Rengan R. Consensus Statement on Proton Therapy in Mesothelioma. Pract Radiat Oncol 2020; 11:119-133. [PMID: 32461036 DOI: 10.1016/j.prro.2020.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/26/2020] [Accepted: 05/13/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Radiation therapy for mesothelioma remains challenging, as normal tissue toxicity limits the amount of radiation that can be safely delivered to the pleural surfaces, especially radiation dose to the contralateral lung. The physical properties of proton therapy result in better sparing of normal tissues when treating the pleura, both in the postpneumonectomy setting and the lung-intact setting. Compared with photon radiation, there are dramatic reductions in dose to the contralateral lung, heart, liver, kidneys, and stomach. However, the tissue heterogeneity in the thorax, organ motion, and potential for changing anatomy during the treatment course all present challenges to optimal irradiation with protons. METHODS The clinical data underlying proton therapy in mesothelioma are reviewed here, including indications, advantages, and limitations. RESULTS The Particle Therapy Cooperative Group Thoracic Subcommittee task group provides specific guidelines for the use of proton therapy for mesothelioma. CONCLUSIONS This consensus report can be used to guide clinical practice, insurance approval, and future research.
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Affiliation(s)
- Jing Zeng
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington.
| | - Shahed N Badiyan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, Minnesota
| | - Tony Wong
- Seattle Cancer Care Alliance Proton Therapy Center, Seattle, Washington
| | - Xiaodong Zhang
- Department of Radiation Physics, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Joe Y Chang
- Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Antje C Knopf
- Division of Radiotherapy, University of Groningen, Groningen, Netherlands
| | - Shinichiro Mori
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Arturs Meijers
- Division of Radiotherapy, University of Groningen, Groningen, Netherlands
| | - Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, Maryland
| | - Martin Bues
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
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20
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Teoh S, Fiorini F, George B, Vallis KA, Van den Heuvel F. Is an analytical dose engine sufficient for intensity modulated proton therapy in lung cancer? Br J Radiol 2020; 93:20190583. [PMID: 31696729 PMCID: PMC7066954 DOI: 10.1259/bjr.20190583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To identify a subgroup of lung cancer plans where the analytical dose calculation (ADC) algorithm may be clinically acceptable compared to Monte Carlo (MC) dose calculation in intensity modulated proton therapy (IMPT). METHODS Robust-optimised IMPT plans were generated for 20 patients to a dose of 70 Gy (relative biological effectiveness) in 35 fractions in Raystation. For each case, four plans were generated: three with ADC optimisation using the pencil beam (PB) algorithm followed by a final dose calculation with the following algorithms: PB (PB-PB), MC (PB-MC) and MC normalised to prescription dose (PB-MC scaled). A fourth plan was generated where MC optimisation and final dose calculation was performed (MC-MC). Dose comparison and γ analysis (PB-PB vs PB-MC) at two dose thresholds were performed: 20% (D20) and 99% (D99) with PB-PB plans as reference. RESULTS Overestimation of the dose to 99% and mean dose of the clinical target volume was observed in all PB-MC compared to PB-PB plans (median: 3.7 Gy(RBE) (5%) (range: 2.3 to 6.9 Gy(RBE)) and 1.8 Gy(RBE) (3%) (0.5 to 4.6 Gy(RBE))). PB-MC scaled plans resulted in significantly higher CTVD2 compared to PB-PB (median difference: -4 Gy(RBE) (-6%) (-5.3 to -2.4 Gy(RBE)), p ≤ .001). The overall median γ pass rates (3%-3 mm) at D20 and D99 were 93.2% (range:62.2-97.5%) and 71.3 (15.4-92.0%). On multivariate analysis, presence of mediastinal disease and absence of range shifters were significantly associated with high γ pass rates. Median D20 and D99 pass rates with these predictors were 96.0% (95.3-97.5%) and 85.4% (75.1-92.0%). MC-MC achieved similar target coverage and doses to OAR compared to PB-PB plans. CONCLUSION In the presence of mediastinal involvement and absence of range shifters Raystation ADC may be clinically acceptable in lung IMPT. Otherwise, MC algorithm would be recommended to ensure accuracy of treatment plans. ADVANCES IN KNOWLEDGE Although MC algorithm is more accurate compared to ADC in lung IMPT, ADC may be clinically acceptable where there is mediastinal involvement and absence of range shifters.
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21
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Han Y. Current status of proton therapy techniques for lung cancer. Radiat Oncol J 2019; 37:232-248. [PMID: 31918460 PMCID: PMC6952710 DOI: 10.3857/roj.2019.00633] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/26/2019] [Indexed: 12/11/2022] Open
Abstract
Proton beams have been used for cancer treatment for more than 28 years, and several technological advancements have been made to achieve improved clinical outcomes by delivering more accurate and conformal doses to the target cancer cells while minimizing the dose to normal tissues. The state-of-the-art intensity modulated proton therapy is now prevailing as a major treatment technique in proton facilities worldwide, but still faces many challenges in being applied to the lung. Thus, in this article, the current status of proton therapy technique is reviewed and issues regarding the relevant uncertainty in proton therapy in the lung are summarized.
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Affiliation(s)
- Youngyih Han
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
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22
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Tseng YD, Maes SM, Kicska G, Sponsellor P, Traneus E, Wong T, Stewart RD, Saini J. Comparative photon and proton dosimetry for patients with mediastinal lymphoma in the era of Monte Carlo treatment planning and variable relative biological effectiveness. Radiat Oncol 2019; 14:243. [PMID: 31888769 PMCID: PMC6937683 DOI: 10.1186/s13014-019-1432-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/27/2019] [Indexed: 12/25/2022] Open
Abstract
Background Existing pencil beam analytical (PBA) algorithms for proton therapy treatment planning are not ideal for sites with heterogeneous tissue density and do not account for the spatial variations in proton relative biological effectiveness (vRBE). Using a commercially available Monte Carlo (MC) treatment planning system, we compared various dosimetric endpoints between proton PBA, proton MC, and photon treatment plans among patients with mediastinal lymphoma. Methods Eight mediastinal lymphoma patients with both free breathing (FB) and deep inspiration breath hold (DIBH) CT simulation scans were analyzed. The original PBA plans were re-calculated with MC. New proton plans that used MC for both optimization and dose calculation with equivalent CTV/ITV coverage were also created. A vRBE model, which uses a published model for DNA double strand break (DSB) induction, was applied on MC plans to study the potential impact of vRBE on cardiac doses. Comparative photon plans were generated on the DIBH scan. Results Re-calculation of FB PBA plans with MC demonstrated significant under coverage of the ITV V99 and V95. Target coverage was recovered by re-optimizing the PT plan with MC with minimal change to OAR doses. Compared to photons with DIBH, MC-optimized FB and DIBH proton plans had significantly lower dose to the mean lung, lung V5, breast tissue, and spinal cord for similar target coverage. Even with application of vRBE in the proton plans, the putative increase in RBE at the end of range did not decrease the dosimetric advantages of proton therapy in cardiac substructures. Conclusions MC should be used for PT treatment planning of mediastinal lymphoma to ensure adequate coverage of target volumes. Our preliminary data suggests that MC-optimized PT plans have better sparing of the lung and breast tissue compared to photons. Also, the potential for end of range RBE effects are unlikely to be large enough to offset the dosimetric advantages of proton therapy in cardiac substructures for mediastinal targets, although these dosimetric findings require validation with late toxicity data.
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Affiliation(s)
- Yolanda D Tseng
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA. .,Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA, USA.
| | - Shadonna M Maes
- Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA, USA
| | - Gregory Kicska
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Patricia Sponsellor
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA
| | | | - Tony Wong
- Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA, USA
| | - Robert D Stewart
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA
| | - Jatinder Saini
- Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA, USA
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23
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Rana S, Bennouna J. Impact of Air Gap on Intensity-Modulated Proton Therapy Breast Plans. J Med Imaging Radiat Sci 2019; 50:499-505. [DOI: 10.1016/j.jmir.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 08/28/2019] [Accepted: 09/12/2019] [Indexed: 11/25/2022]
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24
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Brooks ED, Ning MS, Verma V, Zhu XR, Chang JY. Proton therapy for non-small cell lung cancer: the road ahead. Transl Lung Cancer Res 2019; 8:S202-S212. [PMID: 31673525 PMCID: PMC6795573 DOI: 10.21037/tlcr.2019.07.08] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/17/2019] [Indexed: 12/14/2022]
Abstract
Proton therapy is an evolving radiotherapy modality with indication for numerous cancer types. With the benefits of reducing dose and sparing normal tissue, protons offer a clear physical and dosimetric advantage over photon radiotherapy for many patients. However, its impact on one type of disease, non-small cell lung cancer (NSCLC), is still not fully understood. Our review aims to highlight the data for using proton therapy in NSCLC, with a focus on the clinical data-or lack thereof-supporting proton treatment for early and advanced stage disease. In evaluating these data, we consider how future directions and advances in proton technology give rise for hope in defining a role for protons in improving NSCLC outcomes. We close with considerations for next steps and the challenges ahead in using proton therapy for this unique patient population.
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Affiliation(s)
- Eric D. Brooks
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew S. Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - X. Ronald Zhu
- Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joe Y. Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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25
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Nystrom H, Jensen MF, Nystrom PW. Treatment planning for proton therapy: what is needed in the next 10 years? Br J Radiol 2019; 93:20190304. [PMID: 31356107 DOI: 10.1259/bjr.20190304] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Treatment planning is the process where the prescription of the radiation oncologist is translated into a deliverable treatment. With the complexity of contemporary radiotherapy, treatment planning cannot be performed without a computerized treatment planning system. Proton therapy (PT) enables highly conformal treatment plans with a minimum of dose to tissues outside the target volume, but to obtain the most optimal plan for the treatment, there are a multitude of parameters that need to be addressed. In this review areas of ongoing improvements and research in the field of PT treatment planning are identified and discussed. The main focus is on issues of immediate clinical and practical relevance to the PT community highlighting the needs for the near future but also in a longer perspective. We anticipate that the manual tasks performed by treatment planners in the future will involve a high degree of computational thinking, as many issues can be solved much better by e.g. scripting. More accurate and faster dose calculation algorithms are needed, automation for contouring and planning is required and practical tools to handle the variable biological efficiency in PT is urgently demanded just to mention a few of the expected improvements over the coming 10 years.
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Affiliation(s)
- Hakan Nystrom
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.,Skandionkliniken, Uppsala, Sweden
| | | | - Petra Witt Nystrom
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.,Skandionkliniken, Uppsala, Sweden
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26
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Rana S, Greco K, Samuel EJJ, Bennouna J. Radiobiological and dosimetric impact of RayStation pencil beam and Monte Carlo algorithms on intensity-modulated proton therapy breast cancer plans. J Appl Clin Med Phys 2019; 20:36-46. [PMID: 31343826 PMCID: PMC6698765 DOI: 10.1002/acm2.12676] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/07/2019] [Accepted: 06/11/2019] [Indexed: 01/06/2023] Open
Abstract
PURPOSE RayStation treatment planning system employs pencil beam (PB) and Monte Carlo (MC) algorithms for proton dose calculations. The purpose of this study is to evaluate the radiobiological and dosimetric impact of RayStation PB and MC algorithms on the intensity-modulated proton therapy (IMPT) breast plans. METHODS The current study included ten breast cancer patients, and each patient was treated with 1-2 proton beams to the whole breast/chestwall (CW) and regional lymph nodes in 28 fractions for a total dose of 50.4 Gy relative biological effectiveness (RBE). A total clinical target volume (CTV_Total) was generated by combining individual CTVs: AxI, AxII, AxIII, CW, IMN, and SCVN. All beams in the study were treated with a range shifter (7.5 cm water equivalent thickness). For each patient, three sets of plans were generated: (a) PB optimization followed by PB dose calculation (PB-PB), (b) PB optimization followed by MC dose calculation (PB-MC), and (c) MC optimization followed by MC dose calculation (MC-MC). For a given patient, each plan was robustly optimized on the CTVs with same parameters and objectives. Treatment plans were evaluated using dosimetric and radiobiological indices (equivalent uniform dose (EUD), tumor control probability (TCP), and normal tissue complication probability (NTCP)). RESULTS The results are averaged over ten breast cancer patients. In comparison to PB-PB plans, PB-MC plans showed a reduction in CTV target dose by 5.3% for D99% and 4.1% for D95% , as well as a reduction in TCP by 1.5-2.1%. Similarly, PB overestimated the EUD of target volumes by 1.8─3.2 Gy(RBE). In contrast, MC-MC plans achieved similar dosimetric and radiobiological (EUD and TCP) results as the ones in PB-PB plans. A selection of one dose calculation algorithm over another did not produce any noticeable differences in the NTCP of the heart, lung, and skin. CONCLUSION If MC is more accurate than PB as reported in the literature, dosimetric and radiobiological results from the current study suggest that PB overestimates the target dose, EUD, and TCP for IMPT breast cancer treatment. The overestimation of dosimetric and radiobiological results of the target volume by PB needs to be further interpreted in terms of clinical outcome.
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Affiliation(s)
- Suresh Rana
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.,Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.,Department of Physics, School of Advanced Sciences, Vellore Institute of Technology (VIT) University, Vellore, Tamil Nadu, India
| | - Kevin Greco
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - E James Jebaseelan Samuel
- Department of Physics, School of Advanced Sciences, Vellore Institute of Technology (VIT) University, Vellore, Tamil Nadu, India
| | - Jaafar Bennouna
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.,Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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27
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Sasidharan BK, Aljabab S, Saini J, Wong T, Laramore G, Liao J, Parvathaneni U, Bowen SR. Clinical Monte Carlo versus Pencil Beam Treatment Planning in Nasopharyngeal Patients Receiving IMPT. Int J Part Ther 2019; 5:32-40. [PMID: 31773039 PMCID: PMC6871622 DOI: 10.14338/ijpt-18-00039.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/07/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Pencil beam (PB) analytical algorithms have been the standard of care for proton therapy dose calculations. The introduction of Monte Carlo (MC) algorithms may provide more robust and accurate planning and can improve therapeutic benefit. We conducted a dosimetric analysis to quantify the differences between MC and PB algorithms in the clinical setting of dose-painted nasopharyngeal cancer intensity-modulated proton radiotherapy. PATIENTS AND METHODS Plans of 14 patients treated with PB analytical algorithm optimized and calculated (PBPB) were retrospectively analyzed. The PBPB plans were recalculated using MC to generate PBMC plans and, finally, reoptimized and recalculated with MC to generate MCMC plans. The plans were compared across several dosimetric endpoints and correlated with documented toxicity. Robustness of the planning scenarios (PBPB, PBMC, MCMC) in the presence of setup and range uncertainties was compared. RESULTS A median decrease of up to 5 Gy (P < .05) was observed in coverage of planning target volume high-risk, intermediate-risk, and low-risk volumes when PB plans were recalculated using the MC algorithm. This loss in coverage was regained by reoptimizing with MC, albeit with a slightly higher dose to normal tissues but within the standard tolerance limits. The robustness of both PB and MC plans remained similar in the presence of setup and range uncertainties. The MC-calculated mean dose to the oral avoidance structure, along with changes in global maximum dose between PB and MC dosimetry, may be associated with acute toxicity-related events. CONCLUSION Retrospective analyses of plan dosimetry quantified a loss of coverage with PB that could be recovered under MC optimization. MC optimization should be performed for the complex dosimetry in patients with nasopharyngeal carcinoma before plan acceptance and should also be used in correlative studies of proton dosimetry with clinical endpoints.
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Affiliation(s)
| | - Saif Aljabab
- Radiation Oncology, University of Washington/Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA, USA
| | - Jatinder Saini
- Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA, USA
| | - Tony Wong
- Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA, USA
| | - George Laramore
- Radiation Oncology, University of Washington/Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA, USA
| | - Jay Liao
- Radiation Oncology, University of Washington/Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA, USA
| | - Upendra Parvathaneni
- Radiation Oncology, University of Washington/Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA, USA
| | - Stephen R. Bowen
- Radiation Oncology and Radiology, University of Washington School of Medicine, Seattle, WA, USA
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28
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Maneval D, Ozell B, Després P. pGPUMCD: an efficient GPU-based Monte Carlo code for accurate proton dose calculations. ACTA ACUST UNITED AC 2019; 64:085018. [DOI: 10.1088/1361-6560/ab0db5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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29
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Liang X, Li Z, Zheng D, Bradley JA, Rutenberg M, Mendenhall N. A comprehensive dosimetric study of Monte Carlo and pencil-beam algorithms on intensity-modulated proton therapy for breast cancer. J Appl Clin Med Phys 2019; 20:128-136. [PMID: 30488548 PMCID: PMC6333133 DOI: 10.1002/acm2.12497] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 01/02/2023] Open
Abstract
PB algorithms are commonly used for proton therapy. Previously reported limitations of the PB algorithm for proton therapy are mainly focused on high-density gradients and small-field dosimetry, the effect of PB algorithms on intensity-modulated proton therapy (IMPT) for breast cancer has yet to be illuminated. In this study, we examined 20 patients with breast cancer and systematically investigated the dosimetric impact of MC and PB algorithms on IMPT. Four plans were generated for each patient: (a) a PB plan that optimized and computed the final dose using a PB algorithm; (b) a MC-recomputed plan that recomputed the final dose of the PB plan using a MC algorithm; (c) a MC-renormalized plan that renormalized the MC-recomputed plan to restore the target coverage; and (d) a MC-optimized plan that optimized and computed the final dose using a MC algorithm. The DVH on CTVs and on organ-at-risks (OARs) from each plan were studied. The Mann-Whitney U-test was used for testing the differences between any two types of plans. We found that PB algorithms significantly overestimated the target dose in breast IMPT plans. The median value of the CTV D99% , D95% , and Dmean dropped by 3.7%, 3.4%, and 2.1%, respectively, of the prescription dose in the MC-recomputed plans compared with the PB plans. The magnitude of the target dose overestimation by the PB algorithm was higher for the breast CTV than for the chest wall CTV. In the MC-renormalized plans, the target dose coverage was comparable with the original PB plans, but renormalization led to a significant increase in target hot spots as well as skin dose. The MC-optimized plans led to sufficient target dose coverage, acceptable target hot spots, and good sparing of skin and other OARs. Utilizing the MC algorithm for both plan optimization and final dose computation in breast IMPT treatment planning is therefore desirable.
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Affiliation(s)
- Xiaoying Liang
- Department of Radiation OncologyUniversity of Florida College of MedicineGainesvilleFLUSA
| | - Zuofeng Li
- Department of Radiation OncologyUniversity of Florida College of MedicineGainesvilleFLUSA
| | - Dandan Zheng
- Department of Radiation OncologyUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Julie A. Bradley
- Department of Radiation OncologyUniversity of Florida College of MedicineGainesvilleFLUSA
| | - Michael Rutenberg
- Department of Radiation OncologyUniversity of Florida College of MedicineGainesvilleFLUSA
| | - Nancy Mendenhall
- Department of Radiation OncologyUniversity of Florida College of MedicineGainesvilleFLUSA
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30
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Zeng C, Sine K, Mah D. Contour-based lung dose prediction for breast proton therapy. J Appl Clin Med Phys 2018; 19:53-59. [PMID: 30141230 PMCID: PMC6236820 DOI: 10.1002/acm2.12436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/12/2018] [Accepted: 07/25/2018] [Indexed: 11/11/2022] Open
Abstract
PURPOSE This study evaluates the feasibility of lung dose prediction based on target contour and patient anatomy for breast patients treated with proton therapy. METHODS Fifty-two randomly selected patients were included in the cohort, who were treated to 50.4-66.4 Gy(RBE) to the left (36), right (15), or bilateral (1) breast with uniform scanning (32) or pencil beam scanning (20). Anterior-oblique beams were used for each patient. The prescription doses were all scaled to 50.4 Gy(RBE) for the current analysis. Isotropic expansions of the planning target volume of various margins m were retrospectively generated and compared with isodose volumes in the ipsilateral lung. The fractional volume V of each expansion contour within the ipsilateral lung was compared with dose-volume data of clinical plans to establish the relationship between the margin m and dose D for the ipsilateral lung such that VD = V(m). This relationship enables prediction of dose-volume VD from V(m), which could be derived from contours before any plan is generated, providing a goal of plan quality. Lung V20 Gy( RBE ) and V5 Gy( RBE ) were considered for this pilot study, while the results could be generalized to other dose levels and/or other organs. RESULTS The actual V20 Gy( RBE ) ranged from 6% to 23%. No statistically significant difference in V20 Gy( RBE ) was found between breast irradiation and chest wall irradiation (P = 0.8) or between left-side and right-side treatment (P = 0.9). It was found that V(1.1 cm) predicted V20 Gy( RBE ) to within 5% root-mean-square deviation (RMSD) and V(2.2 cm) predicted V5 Gy( RBE ) to within 6% RMSD. CONCLUSION A contour-based model was established to predict dose to ipsilateral lung in breast treatment. Clinically relevant accuracy was demonstrated. This model facilitates dose prediction before treatment planning. It could serve as a guide toward realistic clinical goals in the planning stage.
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Affiliation(s)
- Chuan Zeng
- ProCure Proton Therapy CenterSomersetNJUSA
| | - Kevin Sine
- ProCure Proton Therapy CenterSomersetNJUSA
| | - Dennis Mah
- ProCure Proton Therapy CenterSomersetNJUSA
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