Proton arc therapy increases the benefit of proton therapy for oropharyngeal cancer patients in the model based clinic

Jong, BA de; Korevaar, EW; Maring, A; Werkman, CI; Scandurra, D.; Janssens, Guillaume; Both, Stefan; Langendijk, Johannes A.

doi:10.1016/j.radonc.2023.109670

Cited by 12 publications

(12 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…76 Based on the Normal Tissue Complication Probability (NTCP) model prediction, an extra 15% of oropharyngeal cancer patients in the Netherland will be qualified and benefit from using proton arc therapy. 84 In addition, numerous disease sites and clinical indications could potentially benefit from proton arc therapy through in silico simulations. [55][56][57][58]60,61,86 As we move closer to the clinical implementation of proton arc therapy, our vendors, including proton therapy machines, treatment planning systems, and quality assurance devices, are motivated to develop the best product solution for a safe and effective clinical operation.…”

Section: Rebuttalmentioning

confidence: 99%

“…While proton arc therapy certainly offers advantages, such as enhanced dosimetric conformity and expanded patient eligibility, 84 it is crucial to recognize that proton FLASH therapy also has the potential to revolutionize the field. The ultra‐high dose‐rate delivery of proton FLASH therapy enables shorter treatment times, reduced toxicities, and improved patient comfort, presenting compelling advantages that should not be overlooked.…”

Section: Rebuttalmentioning

confidence: 99%

“…On the other hand, before any new technology is clinically implemented, we must address these questions “effectiveness, efficiency, and safety.” With the mounting global interests, multi‐institutional efforts, and investigations, the merging data shine a light on the effectiveness and efficiency improvements where a 30% increase in the daily patient treatment throughput is now expected for a single room system 76 . Based on the Normal Tissue Complication Probability (NTCP) model prediction, an extra 15% of oropharyngeal cancer patients in the Netherland will be qualified and benefit from using proton arc therapy 84 . In addition, numerous disease sites and clinical indications could potentially benefit from proton arc therapy through in silico simulations 55–58,60,61,86 .…”

Section: Rebuttalmentioning

confidence: 99%

See 2 more Smart Citations

FLASH instead of proton arc therapy is a more promising advancement for the next generation proton radiotherapy

Kang

Ding²,

Rong

2023

J Applied Clin Med Phys

View full text Add to dashboard Cite

show abstract

Section: Rebuttalmentioning

confidence: 99%

Section: Rebuttalmentioning

confidence: 99%

Section: Rebuttalmentioning

confidence: 99%

See 1 more Smart Citation

FLASH instead of proton arc therapy is a more promising advancement for the next generation proton radiotherapy

Kang

Ding²,

Rong

2023

J Applied Clin Med Phys

View full text Add to dashboard Cite

show abstract

“…When this method was employed to 10 oropharyngeal cancer patients, it was found that 360 layers distributed over 30 directions produced near optimal plans with reduced toxicity to normal tissue. 9,10 The disadvantage of this method is that a large number of beams will lead to very long and possibly even unacceptable treatment times, if introduced using conventional IMPT delivery. Technological advances, such as automatic sequencing of consecutive IMPT beams or delivery as a single stepand-shoot arc beam with no additional time between discrete directions other than the rotational time, could remove part of this problem.…”

Section: Introductionmentioning

confidence: 99%

“…In treatment planning studies proton arcs have shown potential benefits with respect to reduced organ-at-risk (OAR) doses, 9,[11][12][13][14][15][16][17] reduced normal tissue complication (NTCP), 9,10 improved LET distributions, [18][19][20] and consequently improved variable radiobiological effective (RBE) dose distributions compared to IMPT. 21 More recently, there have been indications that proton arc treatments on the other hand could suffer from worse interfractional target robustness compared to conventional IMPT, as has been seen in studies for head and neck cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Partitioning of discrete proton arcs into interlaced subplans can bring proton arc advances to existing proton facilities

et al. 2023

Self Cite

View full text Add to dashboard Cite

BackgroundProton arcs have shown potential to reduce the dose to organs at risks (OARs) by delivering the protons from many different directions. While most previous studies have been focused on dynamic arcs (delivery during rotation), an alternative approach is discrete arcs, where step‐and‐shoot delivery is used over a large number of beam directions. The major advantage of discrete arcs is that they can be delivered at existing proton facilities. However, this advantage comes at the expense of longer treatment times.PurposeTo exploit the dosimetric advantages of proton arcs, while achieving reasonable delivery times, we propose a partitioning approach where discrete arc plans are split into subplans to be delivered over different fractions in the treatment course.MethodsFor three oropharyngeal cancer patients, four different arc plans have been created and compared to the corresponding clinical IMPT plan. The treatment plans are all planned to be delivered in 35 fractions, but with different delivery approaches over the fractions. The first arc plan (1×30) has 30 directions to be delivered every fraction, while the others are partitioned into subplans with 10 and 6 beam directions, each to be delivered every third (3×10), fifth fraction (5×6), or seventh fraction (7×10). All plans are assessed with respect to delivery time, target robustness over the treatment course, doses to OARs and NTCP for dysphagia and xerostomia.ResultsThe delivery time (including an additional delay of 30 s between the discrete directions to simulate manual interaction with the treatment control system) is reduced from on average 25.2 min for the 1×30 plan to 9.2 min for the 3×10 and 7×10 plans and 5.7 min for the 5×6 plans. The delivery time for the IMPT plan is 7.9 min. When accounting for the combination of delivery time, target robustness, OAR sparing, and NTCP reduction, the plans with 10 directions in each fraction are the preferred choice. Both the 3×10 and 7×10 plans show improved target robustness compared to the 1×30 plans, while keeping OAR doses and NTCP values at almost as low levels as for the 1×30 plans. For all patients the NTCP values for dysphagia are lower for the partitioned plans with 10 directions compared to the IMPT plans. NTCP reduction for xerostomia compared to IMPT is seen in two of the three patients. The best results are seen for the first patient, where the NTCP reductions for the 7×10 plan are 1.6 p.p. (grade 2 xerostomia) and 1.5 p.p. (grade 2 dysphagia). The corresponding NTCP reductions for the 1×30 plan are 2.7 p.p. (xerostomia, grade 2) and 2.0 p.p. (dysphagia, grade 2).ConclusionsDiscrete proton arcs can be implemented at any proton facility with reasonable treatment times using a partitioning approach. The technique also makes the proton arc treatments more robust to changes in the patient anatomy.

show abstract

Efficient proton arc optimization and delivery through energy layer pre‐selection and post‐filtering

Wuyckens,

Wase,

Marthin

et al. 2024

Medical Physics

Self Cite

View full text Add to dashboard Cite

BackgroundProton arc therapy (PAT) has emerged as a promising approach for improving dose distribution, but also enabling simpler and faster treatment delivery in comparison to conventional proton treatments. However, the delivery speed achievable in proton arc relies on dedicated algorithms, which currently do not generate plans with a clear speed‐up and sometimes even result in increased delivery time.PurposeThis study aims to address the challenge of minimizing delivery time through a hybrid method combining a fast geometry‐based energy layer (EL) pre‐selection with a dose‐based EL filtering, and comparing its performance to a baseline approach without filtering.MethodsThree methods of EL filtering were developed: unrestricted, switch‐up (SU), and switch‐up gap (SU gap) filtering. The unrestricted method filters the lowest weighted EL while the SU gap filtering removes the EL around a new SU to minimize the gantry rotation braking. The SU filtering removes the lowest weighted group of EL that includes a SU. These filters were combined with the RayStation dynamic proton arc optimization framework energy layer selection and spot assignment (ELSA). Four bilateral oropharyngeal and four lung cancer patients' data were used for evaluation. Objective function values, target coverage robustness, organ‐at‐risk doses and normal tissue complication probability evaluations, as well as comparisons to intensity‐modulated proton therapy (IMPT) plans, were used to assess plan quality.ResultsThe SU gap filtering algorithm performed best in five out of the eight cases, maintaining plan quality within tolerance while reducing beam delivery time, in particular for the oropharyngeal cohort. It achieved up to approximately 22% and 15% reduction in delivery time for oropharyngeal and lung treatment sites, respectively. The unrestricted filtering algorithm followed closely. In contrast, the SU filtering showed limited improvement, suppressing one or two SU without substantial delivery time shortening. Robust target coverage was kept within 1% of variation compared to the PAT baseline plan while organs‐at‐risk doses slightly decreased or kept about the same for all patients.ConclusionsThis study provides insights to accelerate PAT delivery without compromising plan quality. These advancements could enhance treatment efficiency and patient throughput.

show abstract

Proton arc therapy increases the benefit of proton therapy for oropharyngeal cancer patients in the model based clinic

Cited by 12 publications

References 23 publications

FLASH instead of proton arc therapy is a more promising advancement for the next generation proton radiotherapy

FLASH instead of proton arc therapy is a more promising advancement for the next generation proton radiotherapy

Partitioning of discrete proton arcs into interlaced subplans can bring proton arc advances to existing proton facilities

Efficient proton arc optimization and delivery through energy layer pre‐selection and post‐filtering

Contact Info

Product

Resources

About