Individualized 4-dimensional computed tomography proton treatment for pancreatic tumors

Knecht, Matthew; Wang, Ning; Vassantachart, April; Mifflin, Rachel; Slater, Jerry D.; Yang, Gary

doi:10.21037/jgo.2016.12.10

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…Volumetric kV IG is also used, and its use is becoming more widespread. 78 Other developmental IG or "direct" image verification systems include surface (or its surrogate) imaging systems, proton imaging, [79][80][81][82][83][84][85][86][87][88][89][90][91] prompt gamma (p,γ) imaging, [92][93][94][95][96][97][98][99][100] and proton-PET (p,β+). [101][102][103][104][105][106][107][108][109] If any of these complementary systems are to be used clinically, then special care must be taken during commissioning to align the complementary system to the standard system.…”

Section: Commissioning Image Guidance Systems For Proton Therapymentioning

confidence: 99%

Clinical commissioning of intensity‐modulated proton therapy systems: Report of AAPM Task Group 185

Farr¹,

Moyers²,

Allgower

et al. 2020

Medical Physics

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Proton therapy is an expanding radiotherapy modality in the United States and worldwide. With the number of proton therapy centers treating patients increasing, so does the need for consistent, high-quality clinical commissioning practices. Clinical commissioning encompasses the entire proton therapy system's multiple components, including the treatment delivery system, the patient positioning system, and the image-guided radiotherapy components. Also included in the commissioning process are the x-ray computed tomography scanner calibration for proton stopping power, the radiotherapy treatment planning system, and corresponding portions of the treatment management system. This commissioning report focuses exclusively on intensitymodulated scanning systems, presenting details of how to perform the commissioning of the proton therapy and ancillary systems, including the required proton beam measurements, treatment planning system dose modeling, and the equipment needed.

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Section: Commissioning Image Guidance Systems For Proton Therapymentioning

confidence: 99%

Clinical commissioning of intensity‐modulated proton therapy systems: Report of AAPM Task Group 185

Farr¹,

Moyers²,

Allgower

et al. 2020

Medical Physics

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“…For patients using 4DCT, an internal target volume (ITV) was defined to encompass the enhancing or hypoattenuating lesion on the maximum intensity projection (MIP) scan (31). For patients using SDX, gross tumor volume (GTV) was defined to encompass the enhancing or hypoattenuating lesion on the CT scan with contrast.…”

Section: Immobilization and Tumor Volume Definitionmentioning

confidence: 99%

Proton stereotactic body radiation therapy for liver metastases—results of 5-year experience for 81 hepatic lesions

Coffman

Sufficool

Kang

et al. 2021

J Gastrointest Oncol

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Background: To report on our institutional experience using Proton stereotactic body radiation therapy (SBRT) for patients with liver metastases.Methods: All patients with liver metastases treated with Proton SBRT between September 2012 and December 2017 were retrospectively analyzed. Local control (LC) and overall survival (OS) were estimated using the Kaplan-Meier method calculated from the time of completion of Proton SBRT. LC was defined according to Response Evaluation Criteria in Solid Tumors (RECIST) guidelines (version 1.1). Toxicity was graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.Results: Forty-six patients with 81 lesions were treated with Proton SBRT. The median age was 65.5 years old (range, 33-86 years) and the median follow up was 15 months (range, 1-54 months). The median size of the gross tumor volume (GTV) was 2.5 cm (range, 0.7-8.9 cm). Two or more lesions were treated in 56.5% of patients, with one patient receiving treatment to a total of five lesions. There were 37 lesions treated with a biologically effective dose (BED) ≤60, 9 lesions with a BED of 61-80, 22 lesions with a BED of 81-100, and 13 lesions with a BED >100. The 1-year and 2-year LC for all lesions was 92.5% (95% CI, 82.7% to 96.8%). The grade 1 and grade 2 toxicity rates were 37% and 6.5%, respectively. There were no grade 3 or higher toxicities and no cases of radiation-induced liver disease (RILD).Conclusions: Proton SBRT for the treatment of liver metastases has promising LC rates with the ability to safely treat multiple liver metastases. Accrual continues for our phase II trial treating liver metastases with Proton SBRT to 60 GyE (Gray equivalent) in 3 fractions.

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“…In this scope, robust planning strategies of pancreatic cancer patients have been investigated based on repeated 3DCT images to investigate inter-fractional motion (Steitz et al 2016, Batista 2017. Moreover, the suitability of 4DCT for planning purposes has been analyzed (Knecht et al 2017) and interfractional anatomical changes have been investigated by means of daily cone-beam CTs (Houweling et al 2016).…”

Section: Introductionmentioning

confidence: 99%

4D dose calculation for pencil beam scanning proton therapy of pancreatic cancer using repeated 4DMRI datasets

et al. 2018

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4D magnetic resonance imaging (4DMRI) has a high potential for pancreatic cancer treatments using proton therapy, by providing time-resolved volumetric images with a high soft-tissue contrast without exposing the patient to any additional imaging dose. In this study, we aim to show the feasibility of 4D treatment planning for pencil beam scanning (PBS) proton therapy of pancreatic cancer, based on five repeated 4DMRI datasets and 4D dose calculations (4DDC) for one pancreatic cancer patient. To investigate the dosimetric impacts of organ motion, deformation vector fields were extracted from 4DMRI, which were then used to warp a static CT of the patient, so as to generate synthetic 4DCT (4DCT-MRI). CTV motion amplitudes <15 mm were observed for this patient. The results from 4DDC show pronounced interplay effects in the CTV with dose homogeneity d5/d95 and dose coverage v95 being 1.14 and 91%, respectively, after a single fraction of the treatment. An averaging effect was further observed when increasing the number of fractions. Motion effects can become less dominant and dose homogeneity d5/d95 = 1.03 and dose coverage v95 = [Formula: see text] within the CTV can be achieved after 28 fractions. The observed inter-fractional organ and tumor motion variations underline the importance of 4D imaging before and during PBS proton therapy.

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Individualized 4-dimensional computed tomography proton treatment for pancreatic tumors

Cited by 3 publications

References 14 publications

Clinical commissioning of intensity‐modulated proton therapy systems: Report of AAPM Task Group 185

Clinical commissioning of intensity‐modulated proton therapy systems: Report of AAPM Task Group 185

Proton stereotactic body radiation therapy for liver metastases—results of 5-year experience for 81 hepatic lesions

4D dose calculation for pencil beam scanning proton therapy of pancreatic cancer using repeated 4DMRI datasets

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