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Zeng Y, Zhang Q, Pang B, Liu M, Chang Y, Wang Y, Quan H, Yang Z. Fractionation dose optimization facilities the implementation of transmission proton FLASH-RT. Phys Med Biol 2024; 69:195002. [PMID: 39214129 DOI: 10.1088/1361-6560/ad75e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/30/2024] [Indexed: 09/04/2024]
Abstract
Objective.The beam switching time and fractional dose influence the FLASH effect. A single-beam-per-fraction (SBPF) scheme using uniform fractional dose (UFD) has been proposed for FLASH- radiotherapy (FLASH-RT) to eliminate the beam switching time. Based on SBPF schemes, a fractionation dose optimization algorithm is proposed to optimize non-UFD plans to maximize the fractionation effect and dose-dependent FLASH effect.Approach.The UFD plan, containing five 236 MeV transmission proton beams, was optimized for 11 patients with peripheral lung cancer, with each beam delivering a uniform dose of 11 Gy to the target. Meanwhile, the non-UFD plan was optimized using fractionation dose optimization. To compare the two plans, the equivalent dose to 2 Gy (EQD2) for the target and normal tissues was calculated with anα/βratio of 10 and 3, respectively. Both UFD and non-UFD plans ensured that the target received an EQD2 of 96.3 Gy. To investigate the overall improvement in normal tissue sparing with the non-UFD plan, the FLASH-enhanced EQD2 was calculated.Main results.The fractional doses in non-UFD plans ranged between 5.0 Gy and 24.2 Gy. No significant differences were found in EQD22%and EQD298%of targets between UFD and non-UFD plans. However, theD95%of the target in non-UFD plans was significantly reduced by 15.1%. The sparing effect in non-UFD plans was significantly improved. The FLASH-enhanced EQD2meanin normal tissue and ipsilateral lung was significantly reduced by 3.5% and 10.4%, respectively, in non-UFD plans. The overall improvement is attributed to both the FLASH and fractionation effects.Significance.The fractionation dose optimization can address the limitation of multiple-beam FLASH-RT and utilize the relationship between fractional dose and FLASH effect. Consequently, the non-UFD scheme results in further improvements in normal tissue sparing compared to the UFD scheme, attributed to enhanced fractionation and FLASH effects.
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Affiliation(s)
- Yiling Zeng
- Department of Medical Physics, School of Physics and Technology, Wuhan University, Wuhan 430072, People's Republic of China
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Qi Zhang
- Department of Medical Physics, School of Physics and Technology, Wuhan University, Wuhan 430072, People's Republic of China
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Bo Pang
- Department of Medical Physics, School of Physics and Technology, Wuhan University, Wuhan 430072, People's Republic of China
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Muyu Liu
- Department of Medical Physics, School of Physics and Technology, Wuhan University, Wuhan 430072, People's Republic of China
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Yu Chang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Ye Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
| | - Hong Quan
- Department of Medical Physics, School of Physics and Technology, Wuhan University, Wuhan 430072, People's Republic of China
| | - Zhiyong Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, People's Republic of China
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Bookbinder A, Selvaraj B, Zhao X, Yang Y, Bell BI, Pennock M, Tsai P, Tomé WA, Isabelle Choi J, Lin H, Simone CB, Guha C, Kang M. Validation and reproducibility of in vivo dosimetry for pencil beam scanned FLASH proton treatment in mice. Radiother Oncol 2024; 198:110404. [PMID: 38942121 DOI: 10.1016/j.radonc.2024.110404] [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: 03/14/2024] [Revised: 06/07/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
PURPOSE To investigate quality assurance (QA) techniques for in vivo dosimetry and establish its routine uses for proton FLASH small animal experiments with a saturated monitor chamber. METHODS AND MATERIALS 227 mice were irradiated at FLASH or conventional (CONV) dose rates with a 250 MeV FLASH-capable proton beamline using pencil beam scanning to characterize the proton FLASH effect on abdominal irradiation and examining various endpoints. A 2D strip ionization chamber array (SICA) detector was positioned upstream of collimation and used for in vivo dose monitoring during irradiation. Before each irradiation series, SICA signal was correlated with the isocenter dose at each delivered dose rate. Dose, dose rate, and 2D dose distribution for each mouse were monitored with the SICA detector. RESULTS Calibration curves between the upstream SICA detector signal and the delivered dose at isocenter had good linearity with minimal R2 values of 0.991 (FLASH) and 0.985 (CONV), and slopes were consistent for each modality. After reassigning mice, standard deviations were less than 1.85 % (FLASH) and 0.83 % (CONV) for all dose levels, with no individual subject dose falling outside a ± 3.6 % range of the designated dose. FLASH fields had a field-averaged dose rate of 79.0 ± 0.8 Gy/s and mean local average dose rate of 160.6 ± 3.0 Gy/s. In vivo dosimetry allowed for the accurate detection of variation between the delivered and the planned dose. CONCLUSION In vivo dosimetry benefits FLASH experiments through enabling real-time dose and dose rate monitoring allowing mouse cohort regrouping when beam fluctuation causes delivered dose to vary from planned dose.
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Affiliation(s)
| | | | | | - Yunjie Yang
- New York Proton Center, New York, NY, USA; Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brett I Bell
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Pennock
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pingfang Tsai
- New York Proton Center, New York, NY, USA; Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wolfgang A Tomé
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - J Isabelle Choi
- New York Proton Center, New York, NY, USA; Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Haibo Lin
- New York Proton Center, New York, NY, USA; Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Charles B Simone
- New York Proton Center, New York, NY, USA; Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chandan Guha
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA; Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Minglei Kang
- New York Proton Center, New York, NY, USA; Departments of Radiation Oncology and Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Lövgren N, Fagerström Kristensen I, Petersson K. Feasibility and constraints of Bragg peak FLASH proton therapy treatment planning. Front Oncol 2024; 14:1369065. [PMID: 38737902 PMCID: PMC11082391 DOI: 10.3389/fonc.2024.1369065] [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: 01/11/2024] [Accepted: 04/02/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction FLASH proton therapy (FLASH-PT) requires ultra-high dose rate (≥ 40 Gy/s) protons to be delivered in a short timescale whilst conforming to a patient-specific target. This study investigates the feasibility and constraints of Bragg peak FLASH-PT treatment planning, and compares the in silico results produced to plans for intensity modulated proton therapy (IMPT). Materials and method Bragg peak FLASH-PT and IMPT treatment plans were generated for bone (n=3), brain (n=3), and lung (n=4) targets using the MIROpt research treatment planning system and the Conformal FLASH library developed by Applications SA from the open-source version of UCLouvain. FLASH-PT beams were simulated using monoenergetic spot-scanned protons traversing through a conformal energy modulator, a range shifter, and an aperture. A dose rate constraint of ≥ 40 Gy/s was included in each FLASH-PT plan optimisation. Results Space limitations in the FLASH-PT adapted beam nozzle imposed a maximum target width constraint, excluding 4 cases from the study. FLASH-PT plans did not satisfy the imposed target dose constraints (D95% ≥ 95% and D2%≤ 105%) but achieved clinically acceptable doses to organs at risk (OARs). IMPT plans adhered to all target and OAR dose constraints. FLASH-PT plans showed a reduction in both target homogeneity (p < 0.001) and dose conformity (non-significant) compared to IMPT. Conclusion Without accounting for a sparing effect, IMPT plans were superior in target coverage, dose conformity, target homogeneity, and OAR sparing compared to FLASH-PT. Further research is warranted in treatment planning optimisation and beam delivery for clinical implementation of Bragg peak FLASH-PT.
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Affiliation(s)
- Nathalie Lövgren
- Department of Oncology, Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - Ingrid Fagerström Kristensen
- Clinical Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Kristoffer Petersson
- Department of Oncology, Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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Kaulfers T, Lattery G, Cheng C, Zhao X, Selvaraj B, Wu H, Chhabra AM, Choi JI, Lin H, Simone CB, Hasan S, Kang M, Chang J. Pencil Beam Scanning Proton Bragg Peak Conformal FLASH in Prostate Cancer Stereotactic Body Radiotherapy. Cancers (Basel) 2024; 16:798. [PMID: 38398188 PMCID: PMC10886659 DOI: 10.3390/cancers16040798] [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: 12/18/2023] [Revised: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Bragg peak FLASH radiotherapy (RT) uses a distal tracking method to eliminate exit doses and can achieve superior OAR sparing. This study explores the application of this novel method in stereotactic body radiotherapy prostate FLASH-RT. An in-house platform was developed to enable intensity-modulated proton therapy (IMPT) planning using a single-energy Bragg peak distal tracking method. The patients involved in the study were previously treated with proton stereotactic body radiotherapy (SBRT) using the pencil beam scanning (PBS) technique to 40 Gy in five fractions. FLASH plans were optimized using a four-beam arrangement to generate a dose distribution similar to the conventional opposing beams. All of the beams had a small angle of two degrees from the lateral direction to increase the dosimetry quality. Dose metrics were compared between the conventional PBS and the Bragg peak FLASH plans. The dose rate histogram (DRVH) and FLASH metrics of 40 Gy/s coverage (V40Gy/s) were investigated for the Bragg peak plans. There was no significant difference between the clinical and Bragg peak plans in rectum, bladder, femur heads, large bowel, and penile bulb dose metrics, except for Dmax. For the CTV, the FLASH plans resulted in a higher Dmax than the clinical plans (116.9% vs. 103.3%). For the rectum, the V40Gy/s reached 94% and 93% for 1 Gy dose thresholds in composite and single-field evaluations, respectively. Additionally, the FLASH ratio reached close to 100% after the application of the 5 Gy threshold in composite dose rate assessment. In conclusion, the Bragg peak distal tracking method can yield comparable plan quality in most OARs while preserving sufficient FLASH dose rate coverage, demonstrating that the ultra-high dose technique can be applied in prostate FLASH SBRT.
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Affiliation(s)
- Tyler Kaulfers
- Department of Physics and Astronomy, Hofstra University, Hempstead, NY 11549, USA; (T.K.); (G.L.)
| | - Grant Lattery
- Department of Physics and Astronomy, Hofstra University, Hempstead, NY 11549, USA; (T.K.); (G.L.)
| | - Chingyun Cheng
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, USA;
| | - Xingyi Zhao
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Balaji Selvaraj
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Hui Wu
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China;
| | - Arpit M. Chhabra
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Jehee Isabelle Choi
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Haibo Lin
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Charles B. Simone
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Shaakir Hasan
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Minglei Kang
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (X.Z.); (B.S.); (A.M.C.); (J.I.C.); (H.L.); (S.H.)
| | - Jenghwa Chang
- Department of Physics and Astronomy, Hofstra University, Hempstead, NY 11549, USA; (T.K.); (G.L.)
- Northwell, 2000 Marcus Ave, Suite 300, New Hyde Park, NY 11042, USA
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Mascia A, McCauley S, Speth J, Nunez SA, Boivin G, Vilalta M, Sharma RA, Perentesis JP, Sertorio M. Impact of Multiple Beams on the FLASH Effect in Soft Tissue and Skin in Mice. Int J Radiat Oncol Biol Phys 2024; 118:253-261. [PMID: 37541394 DOI: 10.1016/j.ijrobp.2023.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/19/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE FLASH proton pencil beam scanning (p-PBS) showed a reduction in mouse skin toxicity and fibrosis when delivered as a single, uninterrupted, high-dose fraction. Clinical p-PBS treatment usually requires multiple beams to achieve good conformality, and these beams are separated by minutes to allow patient and equipment repositioning. We evaluate the impact of multibeam versus single-beam proton radiation on the FLASH sparing effect on skin toxicity. METHODS AND MATERIALS The right hind leg of 10-week-old female C57Bl/6j mice was irradiated using a Varian ProBeam proton beam scanning gantry system at conventional (1 Gy/s) or FLASH (100 Gy/s) average field dose rate. We scored the skin toxicity after different doses for 7 weeks. The treatment was delivered as 1, 2, or 3 equal beams with an interruption of 2 minutes. For each beam delivery, the equipment remained in the same position so that there was a full overlap of beams administered. RESULTS Single-beam delivery confirmed a benefit for p-PBS FLASH in this model at 30, 35, and 40 Gy. At 30 and 35 Gy, a single beam interruption of 2 minutes (2 × 15 Gy or 2 × 17.5 Gy) reduced the FLASH sparing effect, which remained significant (P < .001). However, 2 interruptions (3 × 10 Gy or 3 × 11.6 Gy) abrogated the normal tissue sparing effect. CONCLUSIONS Our results indicate that the FLASH sparing effect in areas of beam overlap can be compromised by interruptions in delivery time. Time gap between overlapping beams and spatial arrangement of the delivered beams are important parameters for FLASH studies. The effect of multibeam needs to be studied on different organs of interest.
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Affiliation(s)
- Anthony Mascia
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Shelby McCauley
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joseph Speth
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stefanno Alarcon Nunez
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Gael Boivin
- Varian, a Siemens Healthineers Company, Palo Alto, California
| | - Marta Vilalta
- Varian, a Siemens Healthineers Company, Palo Alto, California
| | - Ricky A Sharma
- Varian, a Siemens Healthineers Company, Palo Alto, California
| | | | - Mathieu Sertorio
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiation Oncology, University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Kneepkens E, Wolfs C, Wanders RG, Traneus E, Eekers D, Verhaegen F. Shoot-through proton FLASH irradiation lowers linear energy transfer in organs at risk for neurological tumors and is robust against density variations. Phys Med Biol 2023; 68:215020. [PMID: 37820687 DOI: 10.1088/1361-6560/ad0280] [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: 04/17/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023]
Abstract
Objective. The goal of the study was to test the hypothesis that shoot-through FLASH proton beams would lead to lower dose-averaged LET (LETD) values in critical organs, while providing at least equal normal tissue sparing as clinical proton therapy plans.Approach. For five neurological tumor patients, pencil beam scanning (PBS) shoot-through plans were made, using the maximum energy of 227 MeV and assuming a hypothetical FLASH protective factor (FPF) of 1.5. The effect of different FPF ranging from 1.2 to 1.8 on the clinical goals were also considered. LETDwas calculated for the clinical plan and the shoot-through plan, applying a 2 Gy total dose threshold (RayStation 8 A/9B and 9A-IonRPG). Robust evaluation was performed considering density uncertainty (±3% throughout entire volume).Main results.Clinical plans showed large LETDvariations compared to shoot-through plans and the maximum LETDin OAR is 1.2-8 times lower for the latter. Although less conformal, shoot-through plans met the same clinical goals as the clinical plans, for FLASH protection factors above 1.4. The FLASH shoot-through plans were more robust to density uncertainties with a maximum OAR D2%increase of 0.6 Gy versus 5.7 Gy in the clinical plans.Significance.Shoot-through proton FLASH beams avoid uncertainties in LETDdistributions and proton range, provide adequate target coverage, meet planning constraints and are robust to density variations.
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Affiliation(s)
- Esther Kneepkens
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Cecile Wolfs
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Roel-Germ Wanders
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Erik Traneus
- RaySearch Laboratories AB, SE-103 65, Stockholm, Sweden
| | - Danielle Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Kang M, Choi JI, Souris K, Zhou J, Yu G, Shepherd AF, Ohri N, Lazarev S, Lin L, Lin H, Simone CB. Advances in treatment planning and management for the safety and accuracy of lung stereotactic body radiation therapy using proton pencil beam scanning: Simulation, planning, quality assurance, and delivery recommendations. JOURNAL OF RADIOSURGERY AND SBRT 2023; 9:53-62. [PMID: 38029008 PMCID: PMC10681141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/09/2023] [Indexed: 12/01/2023]
Abstract
This study presents the clinical experiences of the New York Proton Center in employing proton pencil beam scanning (PBS) for the treatment of lung stereotactic body radiation therapy. It encompasses a comprehensive examination of multiple facets, including patient simulation, delineation of target volumes and organs at risk, treatment planning, plan evaluation, quality assurance, and motion management strategies. By sharing the approaches of the New York Proton Center and providing recommendations across simulation, treatment planning, and treatment delivery, it is anticipated that the valuable experience will be provided to a broader proton therapy community, serving as a useful reference for future clinical practice and research endeavors in the field of stereotactic body proton therapy for lung tumors.
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Affiliation(s)
| | - J. Isabelle Choi
- New York Proton Center, New York, NY, USA
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York NY, USA
| | | | - Jun Zhou
- Emory University, Department of Radiation Oncology, Atlanta, GA, USA|
| | - Gang Yu
- New York Proton Center, New York, NY, USA
| | - Annemarie F. Shepherd
- New York Proton Center, New York, NY, USA
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York NY, USA
| | - Nitin Ohri
- New York Proton Center, New York, NY, USA
- Montefiore Medical Center, Department of Radiation Oncology, Bronx, NY, USA
| | - Stanislav Lazarev
- New York Proton Center, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, Department of Radiation Oncology, New York, NY, USA
| | - Liyong Lin
- Emory University, Department of Radiation Oncology, Atlanta, GA, USA|
| | - Haibo Lin
- New York Proton Center, New York, NY, USA
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York NY, USA
- Montefiore Medical Center, Department of Radiation Oncology, Bronx, NY, USA
| | - Charles B. Simone
- New York Proton Center, New York, NY, USA
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York NY, USA
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McMillan MT, Kang M, Shepherd AF, Liu W, Lin L, Lin H, Simone CB. Stereotactic body proton therapy for non-small cell lung cancer: Clinical indications and recommendations. JOURNAL OF RADIOSURGERY AND SBRT 2023; 9:17-32. [PMID: 38029014 PMCID: PMC10681144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/11/2023] [Indexed: 12/01/2023]
Abstract
Stereotactic body radiation therapy (SBRT) has emerged as a standard treatment approach for early-stage lung cancer and intrathoracic oligometastatic or oligoprogressive disease. While local control is often excellent with this modality when delivered with photon therapy, toxicities for select patients can be significant. Proton therapy offers a unique opportunity to widen the therapeutic window when treating patients with thoracic malignancies requiring or benefitting from ultra-high doses per fraction. Thoracic proton SBRT may be particularly beneficial in cases requiring dose escalation, for tumors >5 cm, for central or ultra-central tumors, for reirradiation, in patients with interstitial lung diseases, and when combining radiation with immunotherapy. These clinical indications are detailed, along with supporting literature and clinical recommendations. Other considerations, future directions and potential benefits of proton SBRT, including sparing lymphocytes, when delivered as intensity-modulated proton therapy or as FLASH, and for the treatment of locally advanced non-small cell lung cancer or in patients with homologous recombination repair deficiencies, are also discussed.
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Affiliation(s)
- Matthew T. McMillan
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY, USA
| | | | - Annemarie F. Shepherd
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY, USA
- New York Proton Center, New York, NY, USA
| | - Wei Liu
- Mayo Clinic, Department of Radiation Oncology, Phoenix, AZ, USA
| | - Liyong Lin
- Emory University, Department of Radiation Oncology, Atlanta, GA, USA
| | - Haibo Lin
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY, USA
- New York Proton Center, New York, NY, USA
| | - Charles B. Simone
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY, USA
- New York Proton Center, New York, NY, USA
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