Anatomic change over the course of treatment for non–small cell lung cancer patients and its impact on intensity-modulated radiation therapy and passive-scattering proton therapy deliveries

Chen, Mei; Yang, Jinzhong; Liao, Zhongxing; Chen, Jiayi; Che, Xu; He, Xiaodong; Zhang, Xiaodong; Zhu, Ronald X.; Li, Heng

doi:10.1186/s13014-020-01503-9

Cited by 17 publications

(16 citation statements)

References 33 publications

(45 reference statements)

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“…Comparisons for, e.g., patient selection between protons and photons are also usually carried out on the planning scan, even though it is known that robustness towards changes matters [25]. A few studies have focused on the impact of anatomical changes occurring during the six weeks of treatment that should be handled by means of adaptive radiotherapy (ART) [26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Substantial Sparing of Organs at Risk with Modern Proton Therapy in Lung Cancer, but Altered Breathing Patterns Can Jeopardize Target Coverage

Boer

Fjellanger

Sandvik

et al. 2022

Cancers

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Enhancing treatment of locally advanced non-small cell lung cancer (LA-NSCLC) by using pencil beam scanning proton therapy (PBS-PT) is attractive, but little knowledge exists on the effects of uncertainties occurring between the planning (Plan) and the start of treatment (Start). In this prospective simulation study, we investigated the clinical potential for PBS-PT under the influence of such uncertainties. Imaging with 4DCT at Plan and Start was carried out for 15 patients that received state-of-the-art intensity-modulated radiotherapy (IMRT). Three PBS-PT plans were created per patient: 3D robust single-field uniform dose (SFUD), 3D robust intensity-modulated proton therapy (IMPT), and 4D robust IMPT (4DIMPT). These were exposed to setup and range uncertainties and breathing motion at Plan, and changes in breathing motion and anatomy at Start. Target coverage and dose-volume parameters relevant for toxicity were compared. The organ at risk sparing at Plan was greatest with IMPT, followed by 4DIMPT, SFUD and IMRT, and persisted at Start. All plans met the preset criteria for target robustness at Plan. At Start, three patients had a lack of CTV coverage with PBS-PT. In conclusion, the clinical potential for heart and lung toxicity reduction with PBS-PT was substantial and persistent. Altered breathing patterns between Plan and Start jeopardized target coverage for all PBS-PT techniques.

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Section: Introductionmentioning

confidence: 99%

Substantial Sparing of Organs at Risk with Modern Proton Therapy in Lung Cancer, but Altered Breathing Patterns Can Jeopardize Target Coverage

Boer

Fjellanger

Sandvik

et al. 2022

Cancers

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“…These studies provide a range of timings for adaptive planning that have shown the most promising results. Other studies generally support the 40-45 Gy range, as seen in studies that identify 20 fractions (11,23,24) or Week 3/4 (6,25,26) as an optimal time for adaptation. A few other studies identified either a slightly earlier range such as after 15 fractions (27,28) or if feasible weekly scans (15).…”

Section: Timing Of Implementation Of Artmentioning

confidence: 82%

Adaptive Radiation Therapy in the Treatment of Lung Cancer: An Overview of the Current State of the Field

et al. 2021

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Lung cancer treatment is constantly evolving due to technological advances in the delivery of radiation therapy. Adaptive radiation therapy (ART) allows for modification of a treatment plan with the goal of improving the dose distribution to the patient due to anatomic or physiologic deviations from the initial simulation. The implementation of ART for lung cancer is widely varied with limited consensus on who to adapt, when to adapt, how to adapt, and what the actual benefits of adaptation are. ART for lung cancer presents significant challenges due to the nature of the moving target, tumor shrinkage, and complex dose accumulation because of plan adaptation. This article presents an overview of the current state of the field in ART for lung cancer, specifically, probing topics of: patient selection for the greatest benefit from adaptation, models which predict who and when to adapt plans, best timing for plan adaptation, optimized workflows for implementing ART including alternatives to re-simulation, the best radiation techniques for ART including magnetic resonance guided treatment, algorithms and quality assurance, and challenges and techniques for dose reconstruction. To date, the clinical workflow burden of ART is one of the major reasons limiting its widespread acceptance. However, the growing body of evidence demonstrates overwhelming support for reduced toxicity while improving tumor dose coverage by adapting plans mid-treatment, but this is offset by the limited knowledge about tumor control. Progress made in predictive modeling of on-treatment tumor shrinkage and toxicity, optimizing the timing of adaptation of the plan during the course of treatment, creating optimal workflows to minimize staffing burden, and utilizing deformable image registration represent ways the field is moving toward a more uniform implementation of ART.

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“…Chen et al. ( 41 ) did analyze the correlation between anatomic change and the need to adopt adaptive radiotherapy (ART).…”

Section: Resultsmentioning

confidence: 99%

Imaging Strategies in Proton Therapy for Thoracic Tumors: A Mini Review

Algranati

Strigari

2022

Front. Oncol.

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Proton beam therapy (PBT) is often more attractive for its high gradient dose distributions than other treatment modalities with external photon beams. However, in thoracic lesions treated particularly with pencil beam scanning (PBS) proton beams, several dosimetric issues are addressed. The PBS approach may lead to large hot or cold spots in dose distributions delivered to the patients, potentially affecting the tumor control and/or increasing normal tissue side effects. This delivery method particularly benefits image-guided approaches. Our paper aims at reviewing imaging strategies and their technological trends for PBT in thoracic lesions. The focus is on the use of imaging strategies in simulation, planning, positioning, adaptation, monitoring, and delivery of treatment and how changes in the anatomy of thoracic tumors are handled with the available tools and devices in PBT. Starting from bibliographic research over the past 5 years, retrieving 174 papers, major key questions, and implemented solutions were identified and discussed; the results aggregated and presented following the methodology of analysis of expert interviews.

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Anatomic change over the course of treatment for non–small cell lung cancer patients and its impact on intensity-modulated radiation therapy and passive-scattering proton therapy deliveries

Cited by 17 publications

References 33 publications

Substantial Sparing of Organs at Risk with Modern Proton Therapy in Lung Cancer, but Altered Breathing Patterns Can Jeopardize Target Coverage

Substantial Sparing of Organs at Risk with Modern Proton Therapy in Lung Cancer, but Altered Breathing Patterns Can Jeopardize Target Coverage

Adaptive Radiation Therapy in the Treatment of Lung Cancer: An Overview of the Current State of the Field

Imaging Strategies in Proton Therapy for Thoracic Tumors: A Mini Review

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