Carbon ion beam radiotherapy with a regimen of four fractions during 1 week has been proven as a valid alternative to surgery for stage I NSCLC and to offer particular benefits, especially for elderly and inoperable patients.

No abstract

The aim of this study was to quantify the magnitude of intrafractional lung tumor motion under free-breathing conditions with an immobilization device using four-dimensional computed tomography (4DCT). 4DCT data sets were acquired for 17 patients with lung tumors receiving carbon ion beam therapy. A single respiratory cycle was subdivided into 10 phases, and intrafractional tumor motion was calculated by identifying the gross tumor volume (GTV) center of mass (COM) in two scenarios; respiratory-ungated and -gated treatments, which were based on a whole respiratory cycle and a 30% duty cycle around peak exhalation, respectively. For the respiratory-ungated case, the mean (± standard deviation) GTV-COM displacements from the peak exhalation position over the 17 patients were 0.6 (± 0.8) / 0.9 (± 1.2) mm, 2.0 (± 1.4) / 0.4 (± 0.7) mm, and 0.2 (± 0.5) / 7.8 (± 6.9) mm in left/right, anterior/posterior and superior/inferior directions, respectively, while these were reduced for the respiratory-gated case to 0.3 (± 0.4) / 0.4 (± 0.6) mm (left/right), 0.8 (± 0.7) / 0.3 (± 0.5) mm (anterior/posterior), and 0.1 (± 0.2) / 2.8 (± 2.9) mm (superior/inferior). Quantitative analysis of tumor motion with immobilization is valuable not only for particle beam therapy but also for photon beam therapy.

We have developed new design algorithms for compensating boli to facilitate the implementation of four-dimensional charged-particle lung therapy in clinical applications. Four-dimensional CT (4DCT) data for eight lung cancer patients were acquired with a 16-slice CT under free breathing. Six compensating boli were developed that may be categorized into three classes: (1) boli-based on contoured gross tumor volumes (GTV) from a 4DCT data set during each respiratory phase, subsequently combined into one (GTV-4DCT bolus); (2) boli-based on contoured internal target volume (ITV) from image-processed 3DCT data only [temporal-maximum-intensity-projection (TMIP)/temporal-average-intensity-projection (TAIP)] with calculated boli (ITV-TMIP and ITV-TAIP boli); and (3) boli-based on contoured ITV utilizing image-processed 3DCT data, applied to 4DCT for design of boli for each phase, which were then combined. The carbon beam dose distribution within each bolus was calculated as a function of time and compared to plans in which respiratory-ungated/gated strategies were used. The GTV-4DCT treatment plan required a prohibitively long time for contouring the GTV manually for each respiratory phase, but it delivered more than 95% of the prescribed dose to the target volume. The TMIP and TAIP treatments, although more time-efficient, resulted in an unacceptable excess dose to normal tissues and underdosing of the target volume. The dose distribution for the ITV-4DCT bolus was similar to that for the GTV-4DCT bolus and required significantly less practitioner time. The ITV-4DCT bolus treatment plan is time-efficient and provides a high-quality dose distribution, making it a practical alternative to the GTV-4DCT bolus treatment plan.

¹⁸FLT revealed that BM function decreased by small dose such as <4.2-4.4 GyE/1 fraction of CIRT and is eradicated by >4.2-4.4 GyE/1 fraction.