FRoG—A New Calculation Engine for Clinical Investigations with Proton and Carbon Ion Beams at CNAO

Choi, Kyungdon; Mein, Stewart; Kopp, Benedikt; Magro, Giuseppe; Molinelli, S.; Ciocca, Mario; Mairani, A.

doi:10.3390/cancers10110395

Cited by 35 publications

(44 citation statements)

References 38 publications

(70 reference statements)

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“…These complication is clearly inherent to the protontherapy technical. The use of new tools such as FROG a graphics processing unit (GPU)-based forward calculation tool developed at CNAO (Centro Nazionale di Adroterapia Oncologica) and at HIT (Heidelberg Ion Beam Therapy Center) for fast and accurate calculation of both physical and biological dose could be useful to limit the risk of radionecrosis (13). The 3 years OS, local PFS and PFS rates were 78, 70, and 58%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Adenoid Cystic Carcinoma of the Lacrimal Gland: High Dose Adjuvant Proton Therapy to Improve Patients Outcomes

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Adenoid Cystic Carcinoma of the Lacrimal Gland: High Dose Adjuvant Proton Therapy to Improve Patients Outcomes

et al. 2020

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“…Other software architectures have been developed to specifically estimate the LETd and RBE distribution of a proton plan. Some of these implementations are based on fast and simplified Monte Carlo algorithms Toma-Dasu 2017a, Kohno et al 2019), while other are based on analytical LETd algorithms (Choi et al 2018, Wieser et al 2017. Even though they are faster than a full Monte Carlo simulation, the user should be aware of the limitations, as precision is traded against calculation time.…”

Section: Software Implementationsmentioning

confidence: 99%

Exploration and application of phenomenological RBE models for proton therapy

et al. 2018

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The relative biological effectiveness (RBE) of protons varies with multiple physical and biological factors. Phenomenological RBE models have been developed to include such factors in the estimation of a variable RBE, in contrast to the clinically applied constant RBE of 1.1. In this study, eleven published phenomenological RBE models and two plan-based models were explored and applied to simulated patient cases. All models were analysed with respect to the distribution and range of linear energy transfer (LET) and reference radiation fractionation sensitivity ((α/β) ) of their respective experimental databases. Proton therapy plans for a spread-out Bragg peak in water and three patient cases (prostate adenocarcinoma, pituitary adenoma and thoracic sarcoma) were optimised using an RBE of 1.1 in the Eclipse treatment planning system prior to recalculation and modelling in the FLUKA Monte Carlo code. Model estimated dose-volume parameters for the planning target volumes (PTVs) and organs at risk (OAR) were compared. The experimental in vitro databases for the various models differed greatly in the range of (α/β) values and dose-averaged LET (LET). There were significant variations between the model estimations, which arose from fundamental differences in the database definitions and model assumptions. The greatest variations appeared in organs with low (α/β) and high LET, e.g. biological doses given to late responding OARs located distal to the target in the treatment field. In general, the variation in maximum dose (D) was larger than the variation in mean dose and other dose metrics, with D of the left optic nerve ((α/β) = 2.1 Gy) in the pituitary adenoma case showing the greatest discrepancies between models: 28-52 Gy(RBE), while D for RBE was 30 Gy(RBE). For all patient cases, the estimated mean RBE to the PTV was in the range 1.09-1.29 ((α/β) = 1.5/3.1/10.6 Gy). There were considerable variations between the estimations of RBE and RBE-weighted doses from the different models. These variations were a consequence of fundamental differences in experimental databases, model assumptions and regression techniques. The results from the implementation of RBE models in dose planning studies should be evaluated in light of these deviations.

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“…The expected differences between NIRS and CNAO dose computation systems are, in part, the rationale underlying the over-conservative, no-correction approach applied to OARs constraints at the beginning of clinical activity at CNAO. Both Syngo and FRoG were validated against the Fluka-MC code [18,23] to guarantee dosimetric accuracy and, along with that, dosimetric agreement between the two systems. Finally, the translation of the D RBE|v values was performed in the same calculation frame (using FRoG) and was therefore not affected by the previously mentioned sources of dose deviation.…”

Section: Discussionmentioning

confidence: 99%

“…A fast-forward dose calculation system (FRoG), running on graphics processing units, capable of calculating both LEM and mMKM RBE-weighted doses (D LEM and D MKM ) for the same treatment plan, was developed in a collaboration between CNAO and the Heidelberg Ion Therapy Center (HIT, Heidelberg, Germany) [18,19]. In this work, FRoG was used to compute and analyze differences between LEM and mMKM RBE-weighted dose distribution (D RBE ) to the rectum for prostate AdC and sacral chordoma patients previously treated at CNAO.…”

Section: Introductionmentioning

confidence: 99%

Rectum Dose Constraints for Carbon Ion Therapy: Relative Biological Effectiveness Model Dependence in Relation to Clinical Outcomes

Choi

Molinelli

Russo

et al. 2019

Cancers

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The clinical application of different relative biological effectiveness (RBE) models for carbon ion RBE-weighted dose calculation hinders a global consensus in defining normal tissue constraints. This work aims to update the local effect model (LEM)-based constraints for the rectum using microdosimetric kinetic model (mMKM)-defined values, relying on RBE translation and the analysis of long-term clinical outcomes. LEM-optimized plans of treated patients, having suffered from prostate adenocarcinoma (n = 22) and sacral chordoma (n = 41), were recalculated with the mMKM using an in-house developed tool. The relation between rectum dose-volume points in the two RBE systems (DLEM|v and DMKM|v) was fitted to translate new LEM-based constraints. Normal tissue complication probability (NTCP) values, predicting late rectal toxicity, were obtained by applying published parameters. No late rectal toxicity events were reported within the patient cohort. The rectal toxicity outcome was confirmed using dosimetric analysis: DMKMVHs lay largely below original constraints; the translated DLEM|v values were 4.5%, 8.3%, 18.5%, and 35.4% higher than the nominal DMKM|v of the rectum volume, v—1%, 5%, 10% and 20%. The average NTCP value ranged from 5% for the prostate adenocarcinoma, to 0% for the sacral chordoma group. The redefined constraints, to be confirmed prospectively with clinical data, are DLEM|5cc ≤ 61 Gy(RBE) and DLEM|1cc ≤ 66 Gy(RBE).

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FRoG—A New Calculation Engine for Clinical Investigations with Proton and Carbon Ion Beams at CNAO

Cited by 35 publications

References 38 publications

Adenoid Cystic Carcinoma of the Lacrimal Gland: High Dose Adjuvant Proton Therapy to Improve Patients Outcomes

Adenoid Cystic Carcinoma of the Lacrimal Gland: High Dose Adjuvant Proton Therapy to Improve Patients Outcomes

Exploration and application of phenomenological RBE models for proton therapy

Rectum Dose Constraints for Carbon Ion Therapy: Relative Biological Effectiveness Model Dependence in Relation to Clinical Outcomes

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