FLASH instead of proton arc therapy is a more promising advancement for the next generation proton radiotherapy

Kang, Min Jueng; Ding, Xuanfeng; Rong, Yi

doi:10.1002/acm2.14091

Cited by 8 publications

(3 citation statements)

References 86 publications

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“…The long-term effects of FLASH are not yet well-known; FLASH is a new treatment approach, and thus, not many patients have been treated with the new techniques [21]. As new studies are conducted and current research advances, the long-term effects, if any, will become evident within a decade or two [22,23].…”

Section: Background Of Flash Radiotherapymentioning

confidence: 99%

Pencil Beam Scanning Proton Bragg Peak Conformal FLASH in Prostate Cancer Stereotactic Body Radiotherapy

Kaulfers,

Lattery,

Cheng

et al. 2024

Cancers

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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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Section: Background Of Flash Radiotherapymentioning

confidence: 99%

Pencil Beam Scanning Proton Bragg Peak Conformal FLASH in Prostate Cancer Stereotactic Body Radiotherapy

Kaulfers,

Lattery,

Cheng

et al. 2024

Cancers

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“…Proton arc therapy (PAT) is an emerging radiation therapy treatment technique delivering the protons in pencil beam scanning mode while the gantry moves, as opposed to intensity modulated proton therapy (IMPT) where the gantry is stationary while irradiating. One of the perceived improvements of PAT over IMPT is its reduced delivery time (Kang et al 2023), however there is no publicly open algorithm to estimate the delivery time of PAT plans. Therefore, optimization algorithms for creating PAT treatment plans often try to reduce the delivery time indirectly by reducing the number of energy switches to higher energies (Gu et al 2020, Liu et al 2020, Engwall et al 2022.…”

Section: Introductionmentioning

confidence: 99%

Optimizing the traversal time for gantry trajectories for proton arc therapy treatment plans

Wase,

Marthin,

Fredriksson

et al. 2024

Phys. Med. Biol.

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Abstract. Background. Proton arc therapy is an emerging radiation therapy technique where either the gantry or the patient continuously rotates during the irradiation treatment. One of the perceived advantages of proton arc therapy is the reduced treatment time, but it is still unclear exactly how long these treatment times will be, given that no machine capable of its delivery is available on the market at the time of writing. Objective. We introduce the algorithm Arc Trajectory Optimization Method (ATOM), which aims to determine an efficient velocity profile for the gantry for rapid delivery of a given proton arc treatment plan. This algorithm could be used to minimize the delivery time of a proton arc plan without changing the plan or updating the machine. Approach. ATOM computes the trajectory with the shortest delivery time while ensuring there is enough time to deliver all spots in each energy layer and switch energy between layers. The feasibility of the dynamic gantry movement was assured by enforcing maximum and minimum limits for velocity, acceleration, and jerk. This was achieved by discretizing the gantry velocity and combining the A* algorithm with the open-source motion generation library Ruckig. The algorithm was tested on a synthetic data set as well as a liver case, a prostate case and a head and neck case. Main Results. Arc trajectories for plans with 360 energy layers were calculated in under a second using 256 discrete velocities. The delivery time of the liver case, the prostate case and the head and neck case were 284, 288 and 309 s respectively, for 180 energy layers. Significance. ATOM is an open-source C++ library with a Python interface that rapidly generates velocity profiles, making it a highly efficient tool for determining proton arc delivery times, which could be integrated into the treatment planning process.

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“…16 Most recently, adaptive radiotherapy (ART) 17 and biological guided radiotherapy (BGRT) 18,19 have improved the precision of radiotherapy, but there is still a long way to go before reaching the cellular level achievable compared to chemodynamic therapy. Advancements in radiobiology, such as the immunological effects resulting from hypofractionation and stereotactic body radiotherapy (SBRT), 20,21 safety assurances for normal tissues provided by spatial fractionation radiotherapy (SFRT) 2 2 and ultrahigh dose rate radiotherapy (FLASH), 23,24 and particle therapies like protons and heavy ions, offer enhanced linear energy transfer (LET) and relative biological effectiveness (RBE), 25 highlighting the trend of combining radiotherapy with synergistic antitumor therapies like chemotherapy and immunotherapy. 15,26 Considering the limitations of current radiotherapy in terms of precision, excellent research work has focused on the fancy radiosensitive strategy, including combined tumor therapy mediated by supramolecular options and liposome 27−29 or exogenous energy.…”

Section: Introductionmentioning

confidence: 99%

Camouflaged Nanoreactors Mediated Radiotherapy-Adjuvant Chemodynamic Synergistic Therapy

Lu,

Wu,

Liu

et al. 2023

ACS Nano

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FLASH instead of proton arc therapy is a more promising advancement for the next generation proton radiotherapy

Abstract: Minglei Kang and Xuanfeng Ding contributed equally to the manuscript.

Cited by 8 publications

References 86 publications

Pencil Beam Scanning Proton Bragg Peak Conformal FLASH in Prostate Cancer Stereotactic Body Radiotherapy

Pencil Beam Scanning Proton Bragg Peak Conformal FLASH in Prostate Cancer Stereotactic Body Radiotherapy

Optimizing the traversal time for gantry trajectories for proton arc therapy treatment plans

Camouflaged Nanoreactors Mediated Radiotherapy-Adjuvant Chemodynamic Synergistic Therapy

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