Have we reached proton beam therapy dosimetric limitations? – A novel robust, delivery-efficient and continuous spot-scanning proton arc (SPArc) therapy is to improve the dosimetric outcome in treating prostate cancer

Ding, Xuanfeng; Li, Xiaoqiang; Qin, An; Zhou, Jun; Yan, Di; Stevens, Craig W.; Krauss, Daniel; Kabolizdeh, Peyman

doi:10.1080/0284186x.2017.1358463

Cited by 54 publications

(58 citation statements)

References 13 publications

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“…In addition to the plan quality improvement, one of the driven motivation of SPArc is to shorten the treatment delivery time and simplify the clinical work ow. The results from this study agree with previous ndings that SPArc could shorten the total treatment delivery time based on the modern proton therapy machines where the average of ELST is less than 0.5s [25][26][27][28]40]. In the presence of the large target size, which requires multi-isoenter eld matching, SPArc technique could utilize a single-isoenter to simplify the clinical treatment work ow.…”

Section: Discussionsupporting

confidence: 89%

“…Spot-scanning proton arc therapy (SPArc) is an emerging technique that is able to deliver the proton beam through a dynamic rotational gantry [24]. Preliminary results demonstrated the potential clinical bene ts for various disease sites, including prostate, head and neck, lung, and brain cancers [25][26][27][28]. This study is the rst to exploit the feasibility and potential bene ts of utilizing SPArc in the treatment of left-sided breast cancer patients compared to the conventional IMPT technique.…”

Section: Introductionmentioning

confidence: 98%

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Feasibility study: Spot-scanning Proton Arc therapy (SPArc) for left-sided whole breast radiotherapy

Chang

Liu

Zhao

et al. 2020

Preprint

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Background : This study investigated the feasibility and potential clinical benefit of utilizing a new proton treatment technique: Spot-scanning Proton Arc (SPArc) therapy for left-sided whole breast radiotherapy (WBRT) to further reduce radiation dose to healthy tissue and mitigate the probability of normal tissue complications compared to conventional Intensity Modulated Proton Therapy (IMPT). Methods : Eight patients diagnosed with left-sided breast cancer and treated with breast-preserving surgery followed by whole breast irradiation without regional nodal irradiation were included in this retrospective planning. Two proton treatment plans were generated for each patient: vertical intensity-modulated proton therapy used for clinical treatment (vIMPT, gantry angle 10°-30°) and SPArc for comparison purpose. Both SPArc and vIMPT plans were optimized using the robust optimization of ±3.5% range and 5mm setup uncertainties. Root-mean-square deviation dose (RMSD) volume histogram s were used for plan robustness evaluation. All dosimetric results were evaluated based on dose-volume histograms (DVH), and the interplay effect was evaluated based on the accumulation of single-fraction 4D dynamic dose on CT50. The treatment beam delivery time was simulated based on a gantry rotation with energy-layer-switching-time (ELST) from 0.2 to 5s. Results: The average D1 to the heart and LAD were reduced to 53.63cGy and 82.25cGy compared with vIMPT 110.38cGy (p = 0.001) and 170.38cGy (p = 0.001), respectively. The average V5Gy and V20Gy of ipsilateral lung was reduced to 16.77% and 3.07% compared to vIMPT 25.56% (p = 0.001) and 4.68% (p = 0.003). Skin3mm mean and maximum dose were reduced to 3999.38cGy and 4395.63cGy compared to vIMPT 4104.25cGy (p=0.039) and 4411.63cGy (p=0.043), respectively. A significant relative risk reduction (RNTCP = NTCP SPArc / NTCP vIMPT ) for organs at risk (OARs) was obtained with SPArc ranging from 0.61 to 0.86 depending on the clinical endpoint. The RMSD Volume Histogram (RVH) analysis shows SPArc provided better plan robustness in OARs sparing, including the heart, LAD, ipsilateral lung, and skin. The average estimated treatment beam delivery times were comparable to vIMPT plans when the ELST is about 0.5s. Conclusion: SPArc technique can further reduce dose delivered to OARs and the probability of normal tissue complications in patient treated for left-sided WBRT.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 98%

Feasibility study: Spot-scanning Proton Arc therapy (SPArc) for left-sided whole breast radiotherapy

Chang

Liu

Zhao

et al. 2020

Preprint

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“…The root-mean-square dose (RMSD) for each voxel was calculated as a measure of the robustness. The RMSD volume histograms (RVHs) and the Areas Under the RVH Curve (AUC) were compared to quantitatively evaluate the robustness [11,20,22,23]. The smaller the AUC value indicated better plan robustness.…”

Section: Plan Quality and Robustness Evaluationmentioning

confidence: 99%

“…Due to the current technique limitation of proton treatment delivery efficiency, only a few beam angles are utilized for the treatment of bilateral HNC [11,12]. Furthermore, the inherent characteristic of increased lateral penumbra due to the scattering may result in undesirable plan quality and conformity, which become very challenging to spare the critical structures adjacent treatment site using IMPT, such as the parotid and oral cavity in HNC [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, such a proposal and approach with numerous beam angles may not be practically feasible in a proton therapy center due to prolonged treatment time. However, the idea of delivering the proton beam therapy through arc(s) trajectory with a continuously rotational gantry may overcome such limitation [11,16]. A new treatment technique, Spot-scanning Proton Arc therapy (SPArc) introduced by Ding et al in 2016 could generate robust and delivery efficient proton arc therapy plans.…”

Section: Introductionmentioning

confidence: 99%

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Improve the dosimetric outcome in bilateral head and neck cancer (HNC) treatment using spot-scanning proton arc (SPArc) therapy: a feasibility study

Liu

Qin

et al. 2020

Radiat Oncol

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Background: To explore the dosimetric improvement, delivery efficiency, and plan robustness for bilateral head and neck cancer (HNC) treatment utilizing a novel proton therapy techniquethe spot-scanning proton arc (SPArc) therapy. Methods: We evaluated fourteen bilateral HNC patients retrospectively. Both SPArc and 3-field Intensity Modulated Proton Therapy (IMPT) plans were generated for each patient using the same robust optimization parameters. The prescription doses were 70Gy (relative biological effectiveness (RBE) for CTV_high and 60Gy[RBE] for CTV_low. Clinically significant dosimetric parameters were extracted and compared. Root-mean-square deviation dose (RMSDs) Volume Histogram(RVH) was used to evaluate the plan robustness. Total treatment delivery time was estimated based on the machine parameters. Results: The SPArc plan was able to provide equivalent or better robust target coverage while showed significant dosimetric improvements over IMPT in most of the organs at risk (OARs). More specifically, it reduced the mean dose of the ipsilateral parotid, contralateral parotid, and oral cavity by 25.8%(p = 0.001), 20.8%(p = 0.001) and 20.3%(p = 0.001) respectively compared to IMPT. This technique reduced D1 (the maximum dose covering 1% volume of a structure) of cord and brain stem by 20.8% (p = 0.009) and 10.7% (p = 0.048), respectively. SPArc also reduced the average integral dose by 17.2%(p = 0.001) and external V3Gy (the volume received 3Gy[RBE]) by 8.3%(p = 0.008) as well. RVH analysis showed that the SPArc plans reduced the dose uncertainties in most OARs compared to IMPT, such as cord: 1.1 ± 0.4Gy[RBE] vs 0.7 ± 0.3Gy[RBE](p = 0.001), brain stem: 0.9 ± 0.7Gy[RBE] vs 0.7 ± 0.7Gy[RBE](p = 0.019), contralateral parotid: 2.5 ± 0.5Gy[RBE] vs 2.2 ± 0.6Gy[RBE](p = 0.022) and ipsilateral parotid: 3.1 ± 0.7Gy[RBE] vs 2.8 ± 0.6Gy[RBE](p = 0.004) respectively. The average total estimated treatment delivery time were 283.4 ± 56.2 s, 469.2 ± 62.0 s and 1294.9 ± 106.7 s based on energy-layer-switching-time (ELST) of 0.1 s, 1 s, and 5 s respectively for SPArc plans, compared to the respective values of 328.0 ± 47.6 s(p = 0.002), 434.1 ± 52.0 s(p = 0.002), and 901.7 ± 74.8 s(p = 0.001) for 3-field IMPT plans. The potential clinical benefit of utilizing SPArc will lead to a decrease in the mean probability of salivary flow dysfunction by 31.3%(p = 0.001) compared with IMPT.

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Redefine the role of range shifter in treating bilateral head and neck cancer in the era of Intensity Modulated Proton Therapy

Ding

Qin

et al. 2018

J Applied Clin Med Phys

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Have we reached proton beam therapy dosimetric limitations? – A novel robust, delivery-efficient and continuous spot-scanning proton arc (SPArc) therapy is to improve the dosimetric outcome in treating prostate cancer

Cited by 54 publications

References 13 publications

Feasibility study: Spot-scanning Proton Arc therapy (SPArc) for left-sided whole breast radiotherapy

Feasibility study: Spot-scanning Proton Arc therapy (SPArc) for left-sided whole breast radiotherapy

Improve the dosimetric outcome in bilateral head and neck cancer (HNC) treatment using spot-scanning proton arc (SPArc) therapy: a feasibility study

Redefine the role of range shifter in treating bilateral head and neck cancer in the era of Intensity Modulated Proton Therapy

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