Initial Report of Pencil Beam Scanning Proton Therapy for Posthysterectomy Patients With Gynecologic Cancer

Lin, Lilie L.; Kirk, Maura; Scholey, Jonathan M.; Taku, Nicolette; Kiely, J Blanco; White, Benjamin; Both, Stefan

doi:10.1016/j.ijrobp.2015.07.2205

Cited by 35 publications

(40 citation statements)

References 28 publications

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“…These findings are consistent with those of prior dosimetric studies for proton therapy, which demonstrated lower PBM dose compared with IMRT in this dose region [7,8]. The PBM, which accounts for up to 50% of total body bone marrow by weight [13], is significantly impacted by pelvic irradiation due to its anatomical proximity to the RT target.…”

Section: Discussionsupporting

confidence: 90%

“…We have previously shown the clinical feasibility, toxicity, and dosimetric advantages of proton therapy for women requiring pelvic RT for gynecologic cancers. Our results demonstrated that pencil beam scanning (PBS) proton therapy is able to significantly reduce dose to normal tissues in the pelvis, particularly the PBM, bladder, and small bowel (SB) compared with IMRT while maintaining adequate target coverage [7]. In an early dosimetric study, we also compared IMRT and 2 different proton therapy techniques for PALN irradiation, demonstrating that both proton therapy techniques resulted in statistically significant dose reduction to SB, large bowel (LB), and kidney dose compared with IMRT [8].…”

Section: Introductionmentioning

confidence: 92%

“…The planned dose was 45.0 to 50.4 Gy in 1.8 Gy fractions (or GyE for proton plans). Proton treatment plans were developed using 2 PBS posterior oblique beams at 158 to 308 [7]. As described in Lin et al [7], a PBS treatment volume was created to correct for beam calibration and Hounsfield Unit (HU) conversion uncertainty upfront.…”

Section: Treatment Planningmentioning

confidence: 99%

“…Proton treatment plans were developed using 2 PBS posterior oblique beams at 158 to 308 [7]. As described in Lin et al [7], a PBS treatment volume was created to correct for beam calibration and Hounsfield Unit (HU) conversion uncertainty upfront. The PBS treatment volume included the PTV with a 3.5% range margin in the beam direction to correct for HU to proton stopping power calibration uncertainties and an additional 1-mm margin to correct for beam calibration uncertainty.…”

Section: Treatment Planningmentioning

confidence: 99%

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Proton Therapy Reduces Normal Tissue Dose in Extended-Field Pelvic Radiation for Endometrial Cancer

Maity

Vogel

et al. 2017

International Journal of Particle Therapy

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Purpose: We dosimetrically compared pencil beam scanning (PBS) proton therapy and intensity-modulated radiation therapy (IMRT) for pelvic and para-aortic lymph node disease in endometrial carcinoma and present acute toxicities associated with extendedfield PBS. Patients and Methods: Twenty-five patients with locally advanced endometrial malignancies were enrolled in an image-guided registry study. Seven of these patients were treated with PBS, and 18 patients were treated with IMRT. Organs at risk included pelvic bone marrow (PBM), small bowel (SB), large bowel (LB), rectum, bladder, and kidneys. The IMRT and PBS dosimetric parameters were compared using Wilcoxon rank-sum tests. Results: Compared with IMRT PBM dose-volume histograms, PBS resulted in significantly lower dose volumes from 0 to 26.0 Gy (P , .05) and higher dose volumes from 33.9 to 42.9 Gy (P , .05). Overall, PBS resulted in 22% lower median PBM volume irradiated to 10 Gy (RBE) (PBS 71.3% versus IMRT 93.4%, P , .001) and 14% lower median volume irradiated to 20 Gy (RBE) (PBS 65.1% versus IMRT 79.4%, P , .001). Compared with IMRT, PBS also significantly reduced SB dose volumes from 0 to 27.5 Gy, LB dose volumes from 0 to 31.6 Gy, bladder dose volumes from 0 to 27.3 Gy, and rectal dose volumes from 0 to 7.6 Gy (all P , .05). However, PBS resulted in higher rectal dose volumes compared with IMRT from 26.0 to 48.4 Gy. Grade 3þ hematologic toxicities were present in 2 (11%) IMRT-treated patients and no PBS-treated patients. No grade 3þ gastrointestinal or genitourinary toxicities were present in either treatment group. Conclusion: In endometrial carcinoma, extended-field PBS is clinically feasible, resulting in statistically significant dose reduction to PBM as well as SB, LB, and bladder in the lower dose regions.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 92%

Section: Treatment Planningmentioning

confidence: 99%

Section: Treatment Planningmentioning

confidence: 99%

See 2 more Smart Citations

Proton Therapy Reduces Normal Tissue Dose in Extended-Field Pelvic Radiation for Endometrial Cancer

Maity

Vogel

et al. 2017

International Journal of Particle Therapy

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“…Recent studies, however, have demonstrated that proton therapy (PT) offers dosimetric advantages compared with conventional radiation therapy (RT) using photons for patients with gynecologic cancers [3]. By reducing the radiation dose to healthy tissues, protons may reduce long-term treatment-related morbidities without compromising efficacy.…”

Section: Introductionmentioning

confidence: 99%

Proton Therapy for Vaginal Reirradiation

Kirk

Lin

2016

International Journal of Particle Therapy

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Primary or recurrent gynecologic cancers in operable patients with a history of prior pelvic radiation are typically treated with surgery based on the risk of late toxicities historically associated with reirradiation. A number of studies have demonstrated that, compared with conventional radiation therapy (RT) using photons, proton therapy (PT) offers dosimetric advantages for patients with gynecologic cancers by reducing radiation dose to healthy tissues. Thereby, we expect that, in appropriately selected cases, PT may reduce long-term treatment-related morbidities without compromising treatment efficacy. Herein, we describe the treatment planning, technique, and long-term follow-up of a patient who was treated with PT for a primary vaginal carcinoma nearly 30 years after a prior course of pelvic RT. Using this case, we illustrate the utility and advantages of PT in the treatment of cancers that occur at less favorable sites, adjacent to normal structures with low radiation tolerance, or in paients with a history of prior irradiation. Additionally, we provide a brief discussion and review of literature of prior case series of pelvic reirradiation, illustrating the value of identifying treatment approaches that can reduce treatment-related morbidities, particularly late treatment toxicities.

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Quantitative analysis of treatments using real‐time image gated spot‐scanning with synchrotron‐based proton beam therapy system log data

Yoshimura

Shimizu

Hashimoto

et al. 2020

J Applied Clin Med Phys

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A synchrotron-based real-time image gated spot-scanning proton beam therapy (RGPT) system with inserted fiducial markers can irradiate a moving tumor with high accuracy. As gated treatments increase the beam delivery time, this study aimed to investigate the frequency of intra-field adjustments corresponding to the baseline shift or drift and the beam delivery efficiency of a synchrotron-based RGPT system. Data from 118 patients corresponding to 127 treatment plans and 2810 sessions between October 2016 and March 2019 were collected. We quantitatively analyzed the proton beam delivery time, the difference between the ideal beam delivery time based on a simulated synchrotron magnetic excitation pattern and the actual treatment beam delivery time, frequency corresponding to the baseline shift or drift, and the gating efficiency of the synchrotron-based RGPT system according to the proton beam delivery machine log data. The mean actual beam delivery time was 7.1 min, and the simulated beam delivery time in an ideal environment with the same treatment plan was 2.9 min. The average difference between the actual and simulated beam delivery time per session was 4.3 min. The average frequency of intra-field adjustments corresponding to baseline shift or drift and beam delivery efficiency were 21.7% and 61.8%, respectively. Based on our clinical experience with a synchrotron-based RGPT system, we determined the frequency corresponding to baseline shift or drift and the beam delivery efficiency using the beam delivery machine log data. To maintain treatment accuracy within AE 2.0 mm, intra-field adjustments corresponding to baseline shift or drift were required in approximately 20% of cases. Further improvements in beam delivery efficiency may be realized by shortening the beam delivery time.

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Initial Report of Pencil Beam Scanning Proton Therapy for Posthysterectomy Patients With Gynecologic Cancer

Cited by 35 publications

References 28 publications

Proton Therapy Reduces Normal Tissue Dose in Extended-Field Pelvic Radiation for Endometrial Cancer

Proton Therapy Reduces Normal Tissue Dose in Extended-Field Pelvic Radiation for Endometrial Cancer

Proton Therapy for Vaginal Reirradiation

Quantitative analysis of treatments using real‐time image gated spot‐scanning with synchrotron‐based proton beam therapy system log data

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