1
|
Yagi M, Beltran CJ, Shimizu S, Hamatani N, Tsubouchi T, Takashina M, Kanai T, Ogawa K, Furutani KM. Carbon ion therapy for laterally located tumors require multiple fixed ports or a rotating gantry. Med Dosim 2024:S0958-3947(24)00013-X. [PMID: 38824052 DOI: 10.1016/j.meddos.2024.02.003] [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: 06/03/2023] [Revised: 01/30/2024] [Accepted: 02/24/2024] [Indexed: 06/03/2024]
Abstract
Mayo Clinic Florida will initially open with the capability to treat with a single horizontal port for carbon ion therapy. Carbon ion therapy is traditionally done using a multi fixed port treatment approach. In this study, for nine treatment sites, clinically approved treatment plan of Osaka Heavy Ion Therapy Center was compared to a treatment plan using only a horizontal port. The treatment sites evaluated in this study were prostate cancer, pancreatic cancer, cervical cancer, recurrent rectal cancer, liver cancer, head and neck cancer, bone cancer (sarcoma and chordoma), and lung cancer. As expected, the prostate plans are identical and are only included for completeness. The DVH results for the pancreas and cervical cancer were very similar. The results for recurrent rectal, head and neck, sarcoma, chordoma, and lung cancer indicate that a single horizontal port with couch roll and yaw will accommodate certain medial targets but will be challenging to treat for laterally located targets without creative mitigations.
Collapse
Affiliation(s)
- Masashi Yagi
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Chris J Beltran
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Division of Medical Physics, Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Shinichi Shimizu
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriaki Hamatani
- Department of Medical Physics, Osaka Heavy Ion Center, Osaka, Osaka, Japan
| | - Toshiro Tsubouchi
- Department of Medical Physics, Osaka Heavy Ion Center, Osaka, Osaka, Japan
| | - Masaaki Takashina
- Department of Medical Physics, Osaka Heavy Ion Center, Osaka, Osaka, Japan
| | - Tatsuaki Kanai
- Department of Medical Physics, Osaka Heavy Ion Center, Osaka, Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keith M Furutani
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Division of Medical Physics, Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA.
| |
Collapse
|
2
|
Clasie BM, Letourneau D, Schwarz M, Seuntjens J, Maughan RL. Proton Therapy Equipment Installation, Upgrades, and Building Design. Pract Radiat Oncol 2024; 14:e249-e254. [PMID: 37967747 DOI: 10.1016/j.prro.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/28/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE This work aims at reviewing challenges and pitfalls in proton facility design related to equipment upgrade or replacement. Proton therapy was initially developed at research institutions in the 1950s which ushered in the use of hospital-based machines in 1990s. We are approaching an era where older commercial machines are reaching the end of their life and require replacement. The future widespread application of proton therapy depends on cost reduction; customized building design and installation are significant expenses. METHODS AND MATERIALS We take this opportunity to discuss how commercial proton machines have been installed and how buildings housing the equipment have been designed. RESULTS Data on dimensions and weights of the larger components of proton systems (cyclotron main magnet and gantries) are presented and innovative, non-gantry-based, patient positioning systems are discussed. CONCLUSIONS We argue that careful consideration of the building design to include larger elevators, hoistways from above, wide corridors and access slopes to below grade installations, generic vault and treatment room layouts to accommodate multiple vendor's equipment, and modular system design can provide specific benefits during planning, installation, maintenance, and replacement phases of the project. Room temperature magnet coils can be constructed in a more modular manner: a potential configuration is presented. There is scope for constructing gantries and magnet yokes from smaller modular sub-units. These considerations would allow a hospital to replace a commercial machine at its end of life in a manner similar to a linac.
Collapse
Affiliation(s)
- Benjamin M Clasie
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Daniel Letourneau
- Princess Margaret Cancer Centre, University Health Network & Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Marco Schwarz
- Department of Radiation Oncology, University of Washington-Fred Hutchinson Cancer Center, Seattle, Washington
| | - Jan Seuntjens
- Princess Margaret Cancer Centre, University Health Network & Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Richard L Maughan
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
3
|
Duetschler A, Safai S, Weber DC, Lomax AJ, Zhang Y. The impact of motion on onboard MRI-guided pencil beam scanned proton therapy treatments. Phys Med Biol 2024; 69:095003. [PMID: 38537287 DOI: 10.1088/1361-6560/ad3885] [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: 10/09/2023] [Accepted: 03/26/2024] [Indexed: 04/16/2024]
Abstract
Objective.Online magnetic resonance imaging (MRI) guidance could be especially beneficial for pencil beam scanned (PBS) proton therapy of tumours affected by respiratory motion. For the first time to our knowledge, we investigate the dosimetric impact of respiratory motion on MRI-guided proton therapy compared to the scenario without magnetic field.Approach.A previously developed analytical proton dose calculation algorithm accounting for perpendicular magnetic fields was extended to enable 4D dose calculations. For two geometrical phantoms and three liver and two lung patient cases, static treatment plans were optimised with and without magnetic field (0, 0.5 and 1.5 T). Furthermore, plans were optimised using gantry angle corrections (0.5 T +5° and 1.5 T +15°) to reproduce similar beam trajectories compared to the 0 T reference plans. The effect of motion was then considered using 4D dose calculations without any motion mitigation and simulating 8-times volumetric rescanning, with motion for the patient cases provided by 4DCT(MRI) data sets. Each 4D dose calculation was performed for different starting phases and the CTV dose coverageV95%and homogeneityD5%-D95%were analysed.Main results.For the geometrical phantoms with rigid motion perpendicular to the beam and parallel to the magnetic field, a comparable dosimetric effect was observed independent of the magnetic field. Also for the five 4DCT(MRI) cases, the influence of motion was comparable for all magnetic field strengths with and without gantry angle correction. On average, the motion-induced decrease in CTVV95%from the static plan was 17.0% and 18.9% for 1.5 T and 0.5 T, respectively, and 19.9% without magnetic field.Significance.For the first time, this study investigates the combined impact of magnetic fields and respiratory motion on MR-guided proton therapy. The comparable dosimetric effects irrespective of magnetic field strength indicate that the effects of motion for future MR-guided proton therapy may not be worse than for conventional PBS proton therapy.
Collapse
Affiliation(s)
- Alisha Duetschler
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland
- Department of Physics, ETH Zürich, 8092 Zürich, CH, Switzerland
| | - Sairos Safai
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland
- Department of Radiation Oncology, University Hospital of Zürich, 8091 Zürich, CH, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, CH, Switzerland
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland
- Department of Physics, ETH Zürich, 8092 Zürich, CH, Switzerland
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, CH, Switzerland
| |
Collapse
|
4
|
Shierlaw E, Penfold M, Crain R, Santos AM, Penfold SN. Dosimetric comparison of gantry and horizontal fixed-beam proton therapy treatment plans for base of skull chordoma. J Med Radiat Sci 2024; 71 Suppl 2:19-26. [PMID: 38037893 PMCID: PMC11011589 DOI: 10.1002/jmrs.742] [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: 07/28/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Australia's first proton beam therapy (PBT) centre will house a fixed-beam room and two gantry rooms. As the only PBT facility in Australia for at least the short term, there is a need to efficiently allocate treatment appointments between the gantry and fixed-beam rooms. This planning study assesses the dosimetric differences between fixed-beam and gantry-based treatment plans for base of skull chordoma, one of the core indications likely to be referred for PBT in Australia. METHODS Retrospective gantry-based and fixed-beam treatment plans were generated for five patients with base of skull chordoma. Fixed-beam plans were generated with a conventional horizontal patient positioning system. Robust intensity modulated proton therapy (IMPT) optimisation and evaluation techniques were used for both delivery systems. Plans were designed to maximise target coverage while adhering to maximum dose constraints to neighbouring critical organs at risk. RESULTS Robust target coverage and integral dose were found to be approximately equivalent for the gantry-based and fixed-beam plans. Doses to specific organs at risk could be reduced with the gantry-based geometry; however, the gantry-based plans did not exhibit a general decrease in doses to organs at risk. CONCLUSION A fixed-beam treatment plan was found to be non-inferior to a gantry-based treatment plan for all base of skull patients included in the current study.
Collapse
Affiliation(s)
- Emma Shierlaw
- Australian Bragg Centre for Proton Therapy and ResearchAdelaideSouth AustraliaAustralia
- Radiation OncologyCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
| | - Melanie Penfold
- Australian Bragg Centre for Proton Therapy and ResearchAdelaideSouth AustraliaAustralia
| | - Rosanna Crain
- Australian Bragg Centre for Proton Therapy and ResearchAdelaideSouth AustraliaAustralia
- Radiation OncologyCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
| | - Alexandre M.C. Santos
- Australian Bragg Centre for Proton Therapy and ResearchAdelaideSouth AustraliaAustralia
- Radiation OncologyCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
- Department of PhysicsUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Scott N. Penfold
- Australian Bragg Centre for Proton Therapy and ResearchAdelaideSouth AustraliaAustralia
- Department of PhysicsUniversity of AdelaideAdelaideSouth AustraliaAustralia
| |
Collapse
|
5
|
Thwaites DI, Prokopovich DA, Garrett RF, Haworth A, Rosenfeld A, Ahern V. The rationale for a carbon ion radiation therapy facility in Australia. J Med Radiat Sci 2024; 71 Suppl 2:59-76. [PMID: 38061984 PMCID: PMC11011608 DOI: 10.1002/jmrs.744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/17/2023] [Indexed: 04/13/2024] Open
Abstract
Australia has taken a collaborative nationally networked approach to achieve particle therapy capability. This supports the under-construction proton therapy facility in Adelaide, other potential proton centres and an under-evaluation proposal for a hybrid carbon ion and proton centre in western Sydney. A wide-ranging overview is presented of the rationale for carbon ion radiation therapy, applying observations to the case for an Australian facility and to the clinical and research potential from such a national centre.
Collapse
Affiliation(s)
- David I. Thwaites
- Institute of Medical Physics, School of PhysicsUniversity of SydneySydneyNew South WalesAustralia
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
- Radiotherapy Research Group, Institute of Medical ResearchSt James's Hospital and University of LeedsLeedsUK
| | | | - Richard F. Garrett
- Australian Nuclear Science and Technology OrganisationLucas HeightsNew South WalesAustralia
| | - Annette Haworth
- Institute of Medical Physics, School of PhysicsUniversity of SydneySydneyNew South WalesAustralia
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, School of PhysicsUniversity of WollongongSydneyNew South WalesAustralia
| | - Verity Ahern
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
- Westmead Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| |
Collapse
|
6
|
Gordon K, Gulidov I, Smyk D, Semenov A, Golubev K, Lemaeva A, Koryakin S, Jumaniyazova E, Vishnyakova P, Eremina I, Fatkhudinov T, Kaprin A. Upright proton therapy for esthesioneuroblastoma: a single-institution experience. Front Oncol 2024; 14:1348291. [PMID: 38352894 PMCID: PMC10861767 DOI: 10.3389/fonc.2024.1348291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Aim This study presents an analysis (efficacy and toxicity) of outcomes in patients with esthesioneuroblastoma after pencil beam proton therapy with a fixed beamline in the upright position. Background Esthesioneuroblastoma (ENB) is an extremely rare tumor of sinonasal area located in critical proximity to vital structures. Proton therapy (PT) is often considered the optimal radiation treatment for head-and-neck tumors, although of limited availability. Upright PT delivered using fixed pencil beamline and rotating chair is a fairly promising option. Methods This is a single-center experience describing the outcomes of PT in 14 patients with ENB treated between January 2016 and October 2022; half of the cases had a history of previous irradiation. The therapy was applied using a fixed pencil beamline with 6D-chair for positioning. The median dose was 63 GyRBE (total range 48-70 GyRBE; based on 1.1 RBE multiplier for protons) with 2.0 GyRBE per fraction. The mean gross tumor volume was 109.5 cm3 (17.1-257.7 cm3). Patient demography, pathology, treatment parameters and toxicity data were analyzed. Radiation-induced reactions were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v 4.0. Results The median follow-up time was 28 months. The 1- and 2-year locoregional control rates constituted 100% and 88.9%, respectively; the median duration of local control was 52 months. The 1- and 2-year progression-free survival (PFS) rates constituted 92.9% and 75.0%, respectively; the median PFS duration was 52 months. The 1- and 2-year overall survival (OS) rates constituted 92.9% and 84.4%, respectively. Two patients died of non-cancer-related causes (coronavirus-induced pneumonia) and 1 patient died of tumor progression. All patients tolerated PT well without any treatment gaps. Serious late toxicity reactions included glaucoma in 1 patient and cataract in 2 patients, in over half a year since irradiation. Conclusion PT with upright design of the unit affords promising outcomes in terms of disease control and toxicity rates in ENB, a sinonasal tumor of complicated localization.
Collapse
Affiliation(s)
- Konstantin Gordon
- Proton Therapy Department, A. Tsyb Medical Radiological Research Center - Branch of the National Medical Radiological Research Center, Obninsk, Russia
- Research Institute of Molecular and Cellular Medicine, Medical Institution, P. Lumumba People’s Friendship University of Russia, Moscow, Russia
| | - Igor Gulidov
- Proton Therapy Department, A. Tsyb Medical Radiological Research Center - Branch of the National Medical Radiological Research Center, Obninsk, Russia
| | - Daniil Smyk
- Proton Therapy Department, A. Tsyb Medical Radiological Research Center - Branch of the National Medical Radiological Research Center, Obninsk, Russia
- Research Institute of Molecular and Cellular Medicine, Medical Institution, P. Lumumba People’s Friendship University of Russia, Moscow, Russia
| | - Alexey Semenov
- Proton Therapy Department, A. Tsyb Medical Radiological Research Center - Branch of the National Medical Radiological Research Center, Obninsk, Russia
| | - Kirill Golubev
- Proton Therapy Department, A. Tsyb Medical Radiological Research Center - Branch of the National Medical Radiological Research Center, Obninsk, Russia
| | - Alyona Lemaeva
- Proton Therapy Department, A. Tsyb Medical Radiological Research Center - Branch of the National Medical Radiological Research Center, Obninsk, Russia
| | - Sergey Koryakin
- Proton Therapy Department, A. Tsyb Medical Radiological Research Center - Branch of the National Medical Radiological Research Center, Obninsk, Russia
| | - Enar Jumaniyazova
- Research Institute of Molecular and Cellular Medicine, Medical Institution, P. Lumumba People’s Friendship University of Russia, Moscow, Russia
| | - Polina Vishnyakova
- Research Institute of Molecular and Cellular Medicine, Medical Institution, P. Lumumba People’s Friendship University of Russia, Moscow, Russia
| | - Irina Eremina
- Research Institute of Molecular and Cellular Medicine, Medical Institution, P. Lumumba People’s Friendship University of Russia, Moscow, Russia
| | - Timur Fatkhudinov
- Research Institute of Molecular and Cellular Medicine, Medical Institution, P. Lumumba People’s Friendship University of Russia, Moscow, Russia
| | - Andrey Kaprin
- Proton Therapy Department, A. Tsyb Medical Radiological Research Center - Branch of the National Medical Radiological Research Center, Obninsk, Russia
- Research Institute of Molecular and Cellular Medicine, Medical Institution, P. Lumumba People’s Friendship University of Russia, Moscow, Russia
| |
Collapse
|
7
|
Bonaccorsi SG, Tessonnier T, Hoeltgen L, Meixner E, Harrabi S, Hörner-Rieber J, Haberer T, Abdollahi A, Debus J, Mairani A. Exploring Helium Ions' Potential for Post-Mastectomy Left-Sided Breast Cancer Radiotherapy. Cancers (Basel) 2024; 16:410. [PMID: 38254899 PMCID: PMC10814201 DOI: 10.3390/cancers16020410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Proton therapy presents a promising modality for treating left-sided breast cancer due to its unique dose distribution. Helium ions provide increased conformality thanks to a reduced lateral scattering. Consequently, the potential clinical benefit of both techniques was explored. An explorative treatment planning study involving ten patients, previously treated with VMAT (Volumetric Modulated Arc Therapy) for 50 Gy in 25 fractions for locally advanced, node-positive breast cancer, was carried out using proton pencil beam therapy with a fixed relative biological effectiveness (RBE) of 1.1 and helium therapy with a variable RBE described by the mMKM (modified microdosimetric kinetic model). Results indicated that target coverage was improved with particle therapy for both the clinical target volume and especially the internal mammary lymph nodes compared to VMAT. Median dose value analysis revealed that proton and helium plans provided lower dose on the left anterior descending artery (LAD), heart, lungs and right breast than VMAT. Notably, helium therapy exhibited improved ipsilateral lung sparing over protons. Employing NTCP models as available in the literature, helium therapy showed a lower probability of grade ≤ 2 radiation pneumonitis (22% for photons, 5% for protons and 2% for helium ions), while both proton and helium ions reduce the probability of major coronary events with respect to VMAT.
Collapse
Affiliation(s)
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Line Hoeltgen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Semi Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Thomas Haberer
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Amir Abdollahi
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Jürgen Debus
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Andrea Mairani
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Centro Nazionale di Adroterapia Oncologica (CNAO), 27100 Pavia, Italy
| |
Collapse
|
8
|
Amstutz F, Krcek R, Bachtiary B, Weber DC, Lomax AJ, Unkelbach J, Zhang Y. Treatment planning comparison for head and neck cancer between photon, proton, and combined proton-photon therapy - From a fixed beam line to an arc. Radiother Oncol 2024; 190:109973. [PMID: 37913953 DOI: 10.1016/j.radonc.2023.109973] [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: 01/11/2023] [Revised: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND PURPOSE This study investigates whether combined proton-photon therapy (CPPT) improves treatment plan quality compared to single-modality intensity-modulated radiation therapy (IMRT) or intensity-modulated proton therapy (IMPT) for head and neck cancer (HNC) patients. Different proton beam arrangements for CPPT and IMPT are compared, which could be of specific interest concerning potential future upright-positioned treatments. Furthermore, it is evaluated if CPPT benefits remain under inter-fractional anatomical changes for HNC treatments. MATERIAL AND METHODS Five HNC patients with a planning CT and multiple (4-7) repeated CTs were studied. CPPT with simultaneously optimized photon and proton fluence, single-modality IMPT, and IMRT treatment plans were optimized on the planning CT and then recalculated and reoptimized on each repeated CT. For CPPT and IMPT, plans with different degrees of freedom for the proton beams were optimized. Fixed horizontal proton beam line (FHB), gantry-like, and arc-like plans were compared. RESULTS The target coverage for CPPT without adaptation is insufficient (average V95%=88.4 %), while adapted plans can recover the initial treatment plan quality for target (average V95%=95.5 %) and organs-at-risk. CPPT with increased proton beam flexibility increases plan quality and reduces normal tissue complication probability of Xerostomia and Dysphagia. On average, Xerostomia NTCP reductions compared to IMRT are -2.7 %/-3.4 %/-5.0 % for CPPT FHB/CPPT Gantry/CPPT Arc. The differences for IMPT FHB/IMPT Gantry/IMPT Arc are + 0.8 %/-0.9 %/-4.3 %. CONCLUSION CPPT for HNC needs adaptive treatments. Increasing proton beam flexibility in CPPT, either by using a gantry or an upright-positioned patient, improves treatment plan quality. However, the photon component is substantially reduced, therefore, the balance between improved plan quality and costs must be further determined.
Collapse
Affiliation(s)
- Florian Amstutz
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Physics, ETH Zurich, Switzerland
| | - Reinhardt Krcek
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Physics, ETH Zurich, Switzerland
| | - Jan Unkelbach
- Department of Radiation Oncology, University Hospital Zurich, Switzerland
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland.
| |
Collapse
|
9
|
Schreuder A(N, Hsi W, Greenhalgh J, Kissick M, Lis M, Underwood TSA, Freeman H, Bauer M, Towe S, Mackie R. Anatomical changes in the male pelvis between the supine and upright positions-A feasibility study for prostate treatments in the upright position. J Appl Clin Med Phys 2023; 24:e14099. [PMID: 37488974 PMCID: PMC10647982 DOI: 10.1002/acm2.14099] [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: 10/31/2022] [Revised: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023] Open
Abstract
Treating and imaging patients in the upright orientation is gaining acceptance in radiation oncology and radiology and has distinct advantages over the recumbent position. An IRB approved study to investigate the positions and orientations of the male pelvic organs between the supine and upright positions was conducted. The study comprised of scanning 15 male volunteers (aged 55-75 years) on a 0.6 T Fonar MRI scanner in the supine and upright positions with a full bladder and in the upright position with an empty bladder. The Pelvic study revealed that in the upright position the 1. Position and shape of the prostate are not impacted significantly by bladder fill. 2. Distance between the sacrum and the anterior bladder wall is significantly smaller. 3. Anterior-Posterior length and the bladder width is significantly larger. 4. Seminal vesicles are pushed down by the bladder. 5. Top of the penile bulb is further away from the apex of the prostate. These observed differences could positively impact upright prostate treatments by 1. Reducing the risk of small bowel approximating the treatment volume. 2. Prostate treatments can be done with a reduced focus on bladder fill. 3. Radiation beams for treating intermediate risk prostrate can be made smaller or a larger portion of the seminal vesicles can be treated with the same beam size than typically used for supine treatments. 4. Reducing the average dose to the penile bulb.
Collapse
Affiliation(s)
| | - Wen‐Chien Hsi
- University of Arkansas for Medical Sciences (UAMS)Department of Radiation OncologyLittle Rock, ArkansasUSA
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Boisbouvier S, Underwood T, McNamara J, Probst H. Upright patient positioning for gantry-free breast radiotherapy: feasibility tests using a robotic chair and specialised bras. Front Oncol 2023; 13:1250678. [PMID: 37810987 PMCID: PMC10556698 DOI: 10.3389/fonc.2023.1250678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023] Open
Abstract
For external beam radiotherapy using photons or particles, upright patient positioning on a rotating, robotic chair (a gantry-less system) could offer substantial cost savings. In this study, we considered the feasibility of upright breast radiotherapy using a robotic radiotherapy chair, for (i) a cohort of 9 patients who received conventional supine radiotherapy using photons for a diagnosis of primary breast cancer, plus (ii) 7 healthy volunteers, selected to have relatively large bra cup sizes. We studied: overall body positioning, arm positioning, beam access, breast reproducibility, and comfort. Amongst the healthy volunteer cohort, the impact of specialised radiotherapy bras upon inframammary skinfolds (ISF) was also determined, for upright treatment positions. In conclusion, upright body positioning for breast radiotherapy appears to be comfortable and feasible. Of the 9 patients who received conventional, supine radiotherapy (mean age 63.5 years, maximum age 90 years), 7 reported that they preferred upright positioning. Radiotherapy bras were effective in reducing/eliminating ISF for upright body positions, including for very large breasted volunteers. For upright proton radiotherapy to the breast, beam access should be straightforward, even for arms-down treatments, as en-face field directions are typically used. For photon radiotherapy, additional research is now required to investigate beam paths and whether, for certain patients, additional immobilisation will be required to keep the contralateral breast free from exposure. Future research should also investigate arm supports custom-designed for upright radiotherapy.
Collapse
Affiliation(s)
- Sophie Boisbouvier
- Radiation Oncology Department, Centre Léon Bérard, Lyon, France
- Université Sorbonne Paris Nord, Laboratoire Educations et Promotion de la santé (LEPS), Bobigny, France
| | - Tracy Underwood
- Research Depatment, Leo Cancer Care Ltd, Horley, United Kingdom
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Joanna McNamara
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
| | - Heidi Probst
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
| |
Collapse
|
11
|
Sokol O, Durante M. Carbon Ions for Hypoxic Tumors: Are We Making the Most of Them? Cancers (Basel) 2023; 15:4494. [PMID: 37760464 PMCID: PMC10526811 DOI: 10.3390/cancers15184494] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Hypoxia, which is associated with abnormal vessel growth, is a characteristic feature of many solid tumors that increases their metastatic potential and resistance to radiotherapy. Carbon-ion radiation therapy, either alone or in combination with other treatments, is one of the most promising treatments for hypoxic tumors because the oxygen enhancement ratio decreases with increasing particle LET. Nevertheless, current clinical practice does not yet fully benefit from the use of carbon ions to tackle hypoxia. Here, we provide an overview of the existing experimental and clinical evidence supporting the efficacy of C-ion radiotherapy in overcoming hypoxia-induced radioresistance, followed by a discussion of the strategies proposed to enhance it, including different approaches to maximize LET in the tumors.
Collapse
Affiliation(s)
- Olga Sokol
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforchung, Planckstraße 1, 64291 Darmstadt, Germany;
| | - Marco Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforchung, Planckstraße 1, 64291 Darmstadt, Germany;
- Institute for Condensed Matter Physics, Technische Universität Darmstadt, Hochschulstraße 8, 64289 Darmstadt, Germany
| |
Collapse
|
12
|
Boisbouvier S, Corbin S, Charpentier M, Billaud P, Dolpierre B, Douir N, De Oliveira A, Sousa F. [The first steps towards advanced practice for radiation therapists]. Cancer Radiother 2023; 27:583-587. [PMID: 37481343 DOI: 10.1016/j.canrad.2023.06.014] [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: 05/31/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Abstract
The implementation of advanced practice in RT requires evidence regarding the clinical practices of radiation therapists (RTT) in the field. In this context, the goal of this article is to report the roles assigned to RTT in order to meet the demands of patients, RT services, and/or healthcare professionals. As part of the French Society of Oncologic Radiotherapy's congress, the Radiotherapy Committee of the French Association of radiographers presented a scientific program encompassing three main themes: patient follow-up by a RTT, the expertise of an RTT in Image Guided Radiation Therapy (IGRT), Adaptive Radiotherapy (ART), and the involvement of a RTT in research. This article presents an overview of five oral presentations that highlight concrete examples of roles assigned to RTTs in these specific domains. The follow-up of patients has been assigned to RTT. Research and development have been recognized as activities in which RTT play a significant role. The establishment of RTT specializing in IGRT has been reported to facilitate decision-making and is essential in ensuring professional expertise. Lastly, there is a need to enhance RTT skills in adaptive RT to support the implementation of this technique. These roles described as advanced practice meet needs and require a specific organisational framework and appropriate education and training (master type). Activities such as post-RT follow-up, validation of positioning imaging, delineation, writing research protocols, and involvement in the development of technological innovations were identified as essential tasks that can be assigned to RTT.
Collapse
Affiliation(s)
- S Boisbouvier
- Département de radiothérapie, centre Léon-Bérard, rue Laënnec, 69008 Lyon, France.
| | - S Corbin
- Département de radiothérapie, institut Gustave-Roussy, Villejuif, France
| | - M Charpentier
- Département de radiothérapie, assistance publique des hôpitaux de Marseille, Marseille, France
| | - P Billaud
- Département de radiothérapie, institut régional du cancer de Montpellier, Montpellier, France
| | - B Dolpierre
- Département de radiothérapie, institut régional du cancer de Montpellier, Montpellier, France
| | - N Douir
- Département de radiothérapie, institut Gustave-Roussy, Villejuif, France
| | - A De Oliveira
- Département de radiothérapie, institut Curie, Paris, France
| | - F Sousa
- Département de radiothérapie, institut Jules-Bordet, université libre de Bruxelles (ULB), hôpital universitaire de Bruxelles (H.U.B), rue Meylemeersch, 90, 1070 Bruxelles, Belgique
| |
Collapse
|
13
|
Graeff C, Volz L, Durante M. Emerging technologies for cancer therapy using accelerated particles. PROGRESS IN PARTICLE AND NUCLEAR PHYSICS 2023; 131:104046. [PMID: 37207092 PMCID: PMC7614547 DOI: 10.1016/j.ppnp.2023.104046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Cancer therapy with accelerated charged particles is one of the most valuable biomedical applications of nuclear physics. The technology has vastly evolved in the past 50 years, the number of clinical centers is exponentially growing, and recent clinical results support the physics and radiobiology rationale that particles should be less toxic and more effective than conventional X-rays for many cancer patients. Charged particles are also the most mature technology for clinical translation of ultra-high dose rate (FLASH) radiotherapy. However, the fraction of patients treated with accelerated particles is still very small and the therapy is only applied to a few solid cancer indications. The growth of particle therapy strongly depends on technological innovations aiming to make the therapy cheaper, more conformal and faster. The most promising solutions to reach these goals are superconductive magnets to build compact accelerators; gantryless beam delivery; online image-guidance and adaptive therapy with the support of machine learning algorithms; and high-intensity accelerators coupled to online imaging. Large international collaborations are needed to hasten the clinical translation of the research results.
Collapse
Affiliation(s)
- Christian Graeff
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Planckstraße 1, 64291 Darmstadt, Germany
- Technische Universität Darmstadt, Darmstadt, Germany
| | - Lennart Volz
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Planckstraße 1, 64291 Darmstadt, Germany
| | - Marco Durante
- GSI Helmholtzzentrum für Schwerionenforschung, Biophysics Department, Planckstraße 1, 64291 Darmstadt, Germany
- Technische Universität Darmstadt, Darmstadt, Germany
- Dipartimento di Fisica “Ettore Pancini”, University Federico II, Naples, Italy
| |
Collapse
|
14
|
Yan S, Ngoma TA, Ngwa W, Bortfeld TR. Global democratisation of proton radiotherapy. Lancet Oncol 2023; 24:e245-e254. [PMID: 37269856 DOI: 10.1016/s1470-2045(23)00184-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 06/05/2023]
Abstract
Proton radiotherapy is an advanced treatment option compared with conventional x-ray treatment, delivering much lower doses of radiation to healthy tissues surrounding the tumour. However, proton therapy is currently not widely available. In this Review, we summarise the evolution of proton therapy to date, together with the benefits to patients and society. These developments have led to an exponential growth in the number of hospitals using proton radiotherapy worldwide. However, the gap between the number of patients who should be treated with proton radiotherapy and those who have access to it remains large. We summarise the ongoing research and development that is contributing to closing this gap, including the improvement of treatment efficiency and efficacy, and advances in fixed-beam treatments that do not require an enormously large, heavy, and costly gantry. The ultimate goal of decreasing the size of proton therapy machines to fit into standard treatment rooms appears to be within reach, and we discuss future research and development opportunities to achieve this goal.
Collapse
Affiliation(s)
- Susu Yan
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Twalib A Ngoma
- Department Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wilfred Ngwa
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Information and Sciences, ICT University, Yaoundé, Cameroon
| | - Thomas R Bortfeld
- Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
15
|
Lane SA, Slater JM, Yang GY. Image-Guided Proton Therapy: A Comprehensive Review. Cancers (Basel) 2023; 15:cancers15092555. [PMID: 37174022 PMCID: PMC10177085 DOI: 10.3390/cancers15092555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Image guidance for radiation therapy can improve the accuracy of the delivery of radiation, leading to an improved therapeutic ratio. Proton radiation is able to deliver a highly conformal dose to a target due to its advantageous dosimetric properties, including the Bragg peak. Proton therapy established the standard for daily image guidance as a means of minimizing uncertainties associated with proton treatment. With the increasing adoption of the use of proton therapy over time, image guidance systems for this modality have been changing. The unique properties of proton radiation present a number of differences in image guidance from photon therapy. This paper describes CT and MRI-based simulation and methods of daily image guidance. Developments in dose-guided radiation, upright treatment, and FLASH RT are discussed as well.
Collapse
Affiliation(s)
- Shelby A Lane
- James M. Slater, MD Proton Treatment and Research Center, Loma Linda University, Loma Linda, CA 92354, USA
| | - Jason M Slater
- James M. Slater, MD Proton Treatment and Research Center, Loma Linda University, Loma Linda, CA 92354, USA
| | - Gary Y Yang
- James M. Slater, MD Proton Treatment and Research Center, Loma Linda University, Loma Linda, CA 92354, USA
| |
Collapse
|