Inter-fractional monitoring of $$^{12}$$C ions treatments: results from a clinical trial at the CNAO facility

Fischetti, M.; Baroni, Guido; Battistoni, G.; Bisogni, G.; Cerello, Piergiorgio; Ciocca, Mario; Maria, Patrizia De; Simoni, Micol De; Lullo, B. Di; Donetti, M.; Dong, Yunsheng; Embriaco, Alessia; Ferrero, Veronica; Fiorina, Elisa; Franciosini, G.; Galante, Federica; Kraan, A.; Luongo, Carmela; Magi, Marco; Mancini‐Terracciano, C.; Marafini, M.; Malekzadeh, Etesam; Mattei, I.; Mazzoni, E.; Mirabelli, R.; Mirandola, A.; Morrocchi, M.; Muraro, S.; Patera, V.; Pennazio, Francesco; Schiavi, A.; Sciubba, A.; Camillocci, E. Solfaroli; Sportelli, Giancarlo; Tampellini, S.; Toppi, M.; Traini, G.; Valle, S.M.; Vischioni, Barbara; Vitolo, Viviana; Sarti, A.

doi:10.1038/s41598-020-77843-z

Cited by 16 publications

(23 citation statements)

References 26 publications

(26 reference statements)

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“…The INSIDE collaboration built an innovative bimodal device able to perform in vivo verification of both proton and carbon ion treatments during the irradiation [18,19]. It relies on a planar PET system with two heads [20] and a tracker for secondary charged particles, named Dose Profiler, that exploits the secondary protons emitted during ion treatments (e.g., carbon ion treatments) [21,22].…”

Section: Introductionmentioning

confidence: 99%

Detection of Interfractional Morphological Changes in Proton Therapy: A Simulation and In Vivo Study With the INSIDE In-Beam PET

et al. 2021

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In particle therapy, the uncertainty of the delivered particle range during the patient irradiation limits the optimization of the treatment planning. Therefore, an in vivo treatment verification device is required, not only to improve the plan robustness, but also to detect significant interfractional morphological changes during the treatment itself. In this article, an effective and robust analysis to detect regions with a significant range discrepancy is proposed. This study relies on an in vivo treatment verification by means of in-beam Positron Emission Tomography (PET) and was carried out with the INSIDE system installed at the National Center of Oncological Hadrontherapy (CNAO) in Pavia, which is under clinical testing since July 2019. Patients affected by head-and-neck tumors treated with protons have been considered. First, in order to tune the analysis parameters, a Monte Carlo (MC) simulation was carried out to reproduce a patient who required a replanning because of significant morphological changes found during the treatment. Then, the developed approach was validated on the experimental measurements of three patients recruited for the INSIDE clinical trial (ClinicalTrials.gov ID: NCT03662373), showing the capability to estimate the treatment compliance with the prescription both when no morphological changes occurred and when a morphological change did occur, thus proving to be a promising tool for clinicians to detect variations in the patients treatments.

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Section: Introductionmentioning

confidence: 99%

Detection of Interfractional Morphological Changes in Proton Therapy: A Simulation and In Vivo Study With the INSIDE In-Beam PET

et al. 2021

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“…Most of the recently published experiments have been measured at either 30° (10,11), or at 60°and 90° (12)(13)(14). The first results of a clinical study were taken at a composite detection angle of 60°(horizontal plane) and 30°(vertical plane) relative to the beam direction (15). However, no systematic investigation of the influence of the detection angle on the performance of the detection system in a realistic clinical setting has been published to this date.…”

Section: Introductionmentioning

confidence: 99%

Investigation of Suitable Detection Angles for Carbon-Ion Radiotherapy Monitoring in Depth by Means of Secondary-Ion Tracking

et al. 2021

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The dose conformity of carbon-ion beam radiotherapy, which allows the reduction of the dose deposition in healthy tissue and the escalation of the dose to the tumor, is associated with a high sensitivity to anatomical changes during and between treatment irradiations. Thus, the monitoring of inter-fractional anatomical changes is crucial to ensure the dose conformity, to potentially reduce the size of the safety margins around the tumor and ultimately to reduce the irradiation of healthy tissue. To do so, monitoring methods of carbon-ion radiotherapy in depth using secondary-ion tracking are being investigated. In this work, the detection and localization of a small air cavity of 2 mm thickness were investigated at different detection angles of the mini-tracker relative to the beam axis. The experiments were conducted with a PMMA head phantom at the Heidelberg Ion-Beam Therapy Center (HIT) in Germany. In a clinic-like irradiation of a single field of 3 Gy (RBE), secondary-ion emission profiles were measured by a 2 cm2 mini-tracker composed of two silicon pixel detectors. Two positions of the cavity in the head phantom were studied: in front and in the middle of the tumor volume. The significance of the cavity detection was found to be increased at smaller detection angles, while the accuracy of the cavity localization was improved at larger detection angles. Detection angles of 20° – 30° were found to be a good compromise for accessing both, the detectability and the position of the air cavity along the depth in the head of a patient.

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“…We have analyzed the data of three patients affected by an Adenoid Cystic Carcinoma (ACC) of salivary glands, monitored during the clinical trial and already examined in Fischetti et al ( 13 ) with the names PZA, PZB, and PZC. While the reader can found the full treatment plans description in the cited manuscript, the number of monitored treatment fraction, the number of delivered PB, the number of ions per PB as well as the beam energies foreseen by each plan are reported in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

“…A binning of 3 ×3 mm 2 , comparable with the CNAO carbon ion beam spot size ( 24 ), has been chosen. According to the MC simulation of the full treatment, performed with the FLUKA software ( 25 , 26 ) and described in ( 13 ), the average angular deflection of the escaped fragments provoked by the multiple scattering is of the order of 60 mrad. For this reason the track density distributions do not present an evident peak for PBs with a low number of reconstructed tracks.…”

Section: Methodsmentioning

confidence: 99%

“…In 2019 a clinical trial started with the aim of evaluating the system capability to detect the morphological changes occurred in the patient during the several session of a full treatment delivery. The results obtained monitoring the first three patients can be found in Fischetti et al (13), where the authors discuss the case of a patient for which internal morphological changes were detected by comparing the fragments spatial emission maps measured in different treatment fractions. In this manuscript, instead, we focus on a completely different matter: the possibility to exploit the secondary fragments produced during the treatment to monitor the beam position at the entrance point in the patient body.…”

Section: Introductionmentioning

confidence: 99%

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Monitoring Carbon Ion Beams Transverse Position Detecting Charged Secondary Fragments: Results From Patient Treatment Performed at CNAO

et al. 2021

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Particle therapy in which deep seated tumours are treated using 12C ions (Carbon Ions RadioTherapy or CIRT) exploits the high conformity in the dose release, the high relative biological effectiveness and low oxygen enhancement ratio of such projectiles. The advantages of CIRT are driving a rapid increase in the number of centres that are trying to implement such technique. To fully profit from the ballistic precision achievable in delivering the dose to the target volume an online range verification system would be needed, but currently missing. The 12C ions beams range could only be monitored by looking at the secondary radiation emitted by the primary beam interaction with the patient tissues and no technical solution capable of the needed precision has been adopted in the clinical centres yet. The detection of charged secondary fragments, mainly protons, emitted by the patient is a promising approach, and is currently being explored in clinical trials at CNAO. Charged particles are easy to detect and can be back-tracked to the emission point with high efficiency in an almost background-free environment. These fragments are the product of projectiles fragmentation, and are hence mainly produced along the beam path inside the patient. This experimental signature can be used to monitor the beam position in the plane orthogonal to its flight direction, providing an online feedback to the beam transverse position monitor chambers used in the clinical centres. This information could be used to cross-check, validate and calibrate, whenever needed, the information provided by the ion chambers already implemented in most clinical centres as beam control detectors. In this paper we study the feasibility of such strategy in the clinical routine, analysing the data collected during the clinical trial performed at the CNAO facility on patients treated using 12C ions and monitored using the Dose Profiler (DP) detector developed within the INSIDE project. On the basis of the data collected monitoring three patients, the technique potential and limitations will be discussed.

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Inter-fractional monitoring of $$^{12}$$C ions treatments: results from a clinical trial at the CNAO facility

Cited by 16 publications

References 26 publications

Detection of Interfractional Morphological Changes in Proton Therapy: A Simulation and In Vivo Study With the INSIDE In-Beam PET

Detection of Interfractional Morphological Changes in Proton Therapy: A Simulation and In Vivo Study With the INSIDE In-Beam PET

Investigation of Suitable Detection Angles for Carbon-Ion Radiotherapy Monitoring in Depth by Means of Secondary-Ion Tracking

Monitoring Carbon Ion Beams Transverse Position Detecting Charged Secondary Fragments: Results From Patient Treatment Performed at CNAO

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