Pencil beam scanning proton therapy of Hodgkin’s lymphoma in deep inspiration breath-hold: A case series report

Andersson, Karin; Edvardsson, A.; Hall, Annika; Enmark, Marika; Kristensen, Ingrid

doi:10.1016/j.tipsro.2019.11.006

Cited by 6 publications

(8 citation statements)

References 11 publications

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“… 1 , 2 , 3 , 4 However, dose uncertainty induced by respiratory motion remains a major concern for treating these patients using particle beams. 5 , 6 , 7 , 8 Motion‐induced dose uncertainties have been extensively studied in the particle therapy setting, 6 , 9 , 10 , 11 , 12 , 13 , 14 and strategies such as 4‐dimensional (4D) treatment planning, 15 , 16 , 17 , 18 , 19 rescanning, 6 , 20 , 21 , 22 , 23 breath holding [BH], 24 gating, 25 tumor tracking, 26 and combinations of these techniques 27 have been proposed and implemented at different particle therapy centers. These studies all underlined the importance of implementing proper motion‐management techniques to ensure the safety and effectiveness of particle therapy.…”

Section: Introductionmentioning

confidence: 99%

AAPM Task Group Report 290: Respiratory motion management for particle therapy

Dong

Bert

et al. 2022

Medical Physics

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Dose uncertainty induced by respiratory motion remains a major concern for treating thoracic and abdominal lesions using particle beams. This Task Group report reviews the impact of tumor motion and dosimetric considerations in particle radiotherapy, current motion‐management techniques, and limitations for different particle‐beam delivery modes (i.e., passive scattering, uniform scanning, and pencil‐beam scanning). Furthermore, the report provides guidance and risk analysis for quality assurance of the motion‐management procedures to ensure consistency and accuracy, and discusses future development and emerging motion‐management strategies. This report supplements previously published AAPM report TG76, and considers aspects of motion management that are crucial to the accurate and safe delivery of particle‐beam therapy. To that end, this report produces general recommendations for commissioning and facility‐specific dosimetric characterization, motion assessment, treatment planning, active and passive motion‐management techniques, image guidance and related decision‐making, monitoring throughout therapy, and recommendations for vendors. Key among these recommendations are that: (1) facilities should perform thorough planning studies (using retrospective data) and develop standard operating procedures that address all aspects of therapy for any treatment site involving respiratory motion; (2) a risk‐based methodology should be adopted for quality management and ongoing process improvement.

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Section: Introductionmentioning

confidence: 99%

AAPM Task Group Report 290: Respiratory motion management for particle therapy

Dong

Bert

et al. 2022

Medical Physics

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“…Furthermore for patients requiring motion management the reduction in beam delivery time may allow the use of deep inspiration breath hold treatment which can achieve greater sparing of healthy tissue and prevent the loss of dose homogeneity in the target arising from the interplay effect. 7,8 Reducing beam delivery time can also potentially address challenges in implementation of proton arc therapy, which is currently an active field of research. A reduction in beam delivery time has been previously demonstrated for synchrotron systems.…”

Section: Discussionmentioning

confidence: 99%

“…Reducing beam delivery time can potentially allow patients to receive DIBH treatment who might not otherwise be suitable candidates. DIBH for proton therapy may provide great benefit for patients receiving treatment to the liver, lung, mediastinum, and possibly breast 6–8 . Breast treatment would see the most benefit from a MRF as it combines large field sizes, superficial targets, and potentially DIBH.…”

Section: Introductionmentioning

confidence: 99%

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The use of a mini‐ridge filter with cyclotron‐based pencil beam scanning proton therapy

et al. 2023

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Background: Pencil beam scanning (PBS) proton therapy allows for far superior dose conformality compared with passive scattering techniques. However, one drawback of PBS is that the beam delivery time can be long, particularly when treating superficial disease. Minimizing beam delivery time is important for patient comfort and precision of treatment delivery. Mini-ridge filters (MRF) have been shown to reduce beam delivery time for synchrotron-based PBS. Given that cyclotron systems are widely used in proton therapy it is necessary to investigate the potential clinical benefit of mini-ridge filters in such systems. Purpose: To demonstrate the clinical benefit of using a MRF to reduce beam delivery time for patients with large target volumes and superficial disease in cyclotron-based PBS proton therapy. Methods: A MRF beam model was generated by simulating the effect of a MRF on our clinical beam data assuming a fixed snout position relative to the isocenter. The beam model was validated with a series of measurements. The model was used to optimize treatment plans in a water phantom and on six patient DICOM datasets to further study the effect of the MRF and for comparison with physician-approved clinical treatment plans. Beam delivery time was measured for six plans with and without the MRF to demonstrate the reduction achievable. Plans with and without MRF were reviewed to confirm clinical acceptability by a radiation oncologist. Patient-specific QA measurements were carried out with a two-dimensional ionization chamber array detector for one representative patient's plan optimized with the MRF beam model. Results: Results show good agreement between the simulated beam model and measurements with mean and maximum deviations of 0.06 mm (0.45%) and 0.61 mm (4.9%). The increase in Bragg peak width (FWHM) ranged from 2.7 mm at 226 MeV to 6.1 mm at 70 MeV. The mean and maximum reduction in beam delivery time observed per field was 29.1 s (32.2%) and 79.7 s (55.3%). Conclusion: MRFs can be used to reduce treatment time in cyclotron-based PBS proton therapy without sacrificing plan quality. This is particularly beneficial for patients with large targets and superficial disease such as in breast cancer where treatment times are generally long, as well as patients treated with deep inspiration breath hold (DIBH).

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“…To adhere to these challenges, robust optimization (RO) and motionmitigation techniques, for example, Deep Inspiration Breath-Hold (DIBH), can be used. If successfully applied, DIBH has the potential to generate a geometrical situation that is almost static as well as reducing the dose to OARs (particular the heart and lungs) and normal tissue because the target volume is placed in a more favorable position throughout irradiation [5,6,15].…”

Section: Introductionmentioning

confidence: 99%

Pencil beam scanning proton therapy for mediastinal lymphomas in deep inspiration breath-hold: a retrospective assessment of plan robustness

Hörberger,

Andersson,

Enmark

et al. 2024

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Purpose/background: The aim of this study was to evaluate pencil beam scanning (PBS) proton therapy (PT) in deep inspiration breath-hold (DIBH) for mediastinal lymphoma patients, by retrospectively evaluating plan robustness to the clinical target volume (CTV) and organs at risk (OARs) on repeated CT images acquired throughout treatment. Methods: Sixteen mediastinal lymphoma patients treated with PBS-PT in DIBH were included. Treatment plans (TPs) were robustly optimized on the CTV (7 mm/4.5%). Repeated verification CTs (vCT) were acquired during the treatment course, resulting in 52 images for the entire patient cohort. The CTV and OARs were transferred from the planning CT to the vCTs with deformable image registration and the TPs were recalculated on the vCTs. Target coverage and OAR doses at the vCTs were compared to the nominal plan. Deviation in lung volume was also calculated. Results: The TPs demonstrated high robust target coverage throughout treatment with D98%,CTV deviations within 2% for 14 patients and above the desired requirement of 95% for 49/52 vCTs. However, two patients did not achieve a robust dose to CTV due to poor DIBH reproducibility, with D98%,CTV at 78 and 93% respectively, and replanning was performed for one patient. Adequate OAR sparing was achieved for all patients. Total lung volume variation was below 10% for 39/52 vCTs. Conclusion: PBS PT in DIBH is generally a robust technique for treatment of mediastinal lymphomas. However, closely monitoring the DIBH-reproducibility during treatment is important to avoid underdosing CTV and achieve sufficient dose-sparing of the OARs.

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Pencil beam scanning proton therapy of Hodgkin’s lymphoma in deep inspiration breath-hold: A case series report

Cited by 6 publications

References 11 publications

AAPM Task Group Report 290: Respiratory motion management for particle therapy

AAPM Task Group Report 290: Respiratory motion management for particle therapy

The use of a mini‐ridge filter with cyclotron‐based pencil beam scanning proton therapy

Pencil beam scanning proton therapy for mediastinal lymphomas in deep inspiration breath-hold: a retrospective assessment of plan robustness

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