Proton vs Hyperarc™ radiosurgery: A planning comparison

Boczkowski, Amanda; Kelly, Patrick; Meeks, Sanford L.; Erhart, Kevin; Bova, Francis J.; Willoughby, Twyla R.

doi:10.1002/acm2.13075

Cited by 5 publications

(9 citation statements)

References 21 publications

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“…Boczkowskiet et al. determined the optimal plan parameters (define the aperture with a tight margin of 0.5mm and use of compensators to better shape distally) on a single metastatic lesion by comparing the proton SRS and photon VMAT SRS treatment plans ( 48 , 49 ). Righetto et al.…”

Section: Discussionmentioning

confidence: 99%

Redefine the Role of Spot-Scanning Proton Beam Therapy for the Single Brain Metastasis Stereotactic Radiosurgery

et al. 2022

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PurposeTo explore the role of using Pencil Beam Scanning (PBS) proton beam therapy in single lesion brain stereotactic radiosurgery (SRS), we developed and validated a dosimetric in silico model to assist in the selection of an optimal treatment approach among the conventional Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Proton Therapy (IMPT) and Spot-scanning Proton Arc (SPArc).Material and MethodsA patient’s head CT data set was used as an in silico model. A series of targets (volume range from 0.3 cc to 33.03 cc) were inserted in the deep central and peripheral region, simulating targets with different sizes and locations. Three planning groups: IMPT, VMAT, and SPArc were created for dosimetric comparison purposes and a decision tree was built based on this in silico model. Nine patients with single brain metastases were retrospectively selected for validation. Multiple dosimetric metrics were analyzed to assess the plan quality, such as dose Conformity Index (CI) (ratio of the target volume to 100% prescription isodose volume); R50 (ratio of 50% prescription isodose volume to the target volume); V12Gy (volume of brain tissue minus GTV receiving 12 Gy), and mean dose of the normal brain. Normal tissue complication probability (NTCP) of brain radionecrosis (RN) was calculated using the Lyman-Kutcher-Burman (LKB) model and total treatment delivery time was calculated. Six physicians from different institutions participated in the blind survey to evaluate the plan quality and rank their choices.ResultsThe study showed that SPArc has a dosimetric advantage in the V12Gy and R50 with target volumes > 9.00 cc compared to VMAT and IMPT. A significant clinical benefit can be found in deep centrally located lesions larger than 20.00 cc using SPArc because of the superior dose conformity and mean dose reduction in healthy brain tissue. Nine retrospective clinical cases and the blind survey showed good agreement with the in silico dosimetric model and decision tree. Additionally, SPArc significantly reduced the treatment delivery time compared to VMAT (SPArc 184.46 ± 59.51s vs. VMAT: 1574.78 ± 213.65s).ConclusionThe study demonstrated the feasibility of using Proton beam therapy for single brain metastasis patients utilizing the SPArc technique. At the current stage of technological development, VMAT remains the current standard modality of choice for single lesion brain SRS. The in silico dosimetric model and decision tree presented here could be used as a practical clinical decision tool to assist the selection of the optimal treatment modality among VMAT, IMPT, and SPArc in centers that have both photon and proton capabilities.

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Section: Discussionmentioning

confidence: 99%

Redefine the Role of Spot-Scanning Proton Beam Therapy for the Single Brain Metastasis Stereotactic Radiosurgery

et al. 2022

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“…In reality, many patients receiving SRS for brain metastasis are being treated to multiple targets at the same time. Although limited literature has shown that proton SRS is technically feasible, 34 their comparison to the photon counterpart did not reflect the modern SRS technolog using photons.…”

Section: Opening Statementmentioning

confidence: 98%

“…Although limited literature has shown that proton SRS is technically feasible, 34 their comparison to the photon counterpart did not reflect the modern SRS technolog using photons.…”

Section: Clinical Benefit Of Proton Srs Is Unclearmentioning

confidence: 98%

“…Boczkowski et al. compared proton SRS with state‐of‐the‐art photon SRS using the HyperArc platform for a single target and concluded that proton is inferior in terms of plan quality and delivery uncertainties 34 . The best use of proton is for large targets adjacent to critical parallel organs, as opposed to small targets next to serial organs, which is very typical for cranial radiosurgery.…”

Section: Opening Statementmentioning

confidence: 99%

“…In terms of the dosimetric plan quality for SRS, it has been a challenging topic for the entire proton therapy society, 20 but we need to point out that proton therapy planning and delivery technology continues to evolve 23,24 . The dosimetric comparison study mentioned in the opening statement between proton versus HyperArc was based on a passive‐scattering system that may not represent the outcome of the most advanced proton treatment techniques 34 . SRS’ precision seems to be incompatible with the uncertainties associated with PBT, such as range, LET, and motion.…”

Section: Rebuttalmentioning

confidence: 99%

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