Redefine the role of range shifter in treating bilateral head and neck cancer in the era of Intensity Modulated Proton Therapy

Early generation dynamic and static proton arc treatment planning algorithms assessment in oropharyngeal cancer patients

“…31 Furthermore, the use of range shifters in the IMPT beams could be omitted, which avoids increased spot size caused by proton scatter in the range shifter. 32 The delivery time estimation showed auto beam sequencing delivery of static PAT plans and delivery of dynamic PAT plans is expected to be faster than current clinical IMPT delivery. IMPT delivery time could be reduced by approximately 2 min when automatic beam sequencing is available.…”

“… 31 Furthermore, the use of range shifters in the IMPT beams could be omitted, which avoids increased spot size caused by proton scatter in the range shifter. 32 …”

“…PAT NTCP could also be further reduced by reducing the uncertainty settings for robust optimization 31 . Furthermore, the use of range shifters in the IMPT beams could be omitted, which avoids increased spot size caused by proton scatter in the range shifter 32 …”

A study on the application of range shifter and bolus in spot-scanning proton arc (SPArc) therapy after modified radical mastectomy for left-sided breast cancer

“…This, however, introduces a potential risk of gantry-patient collision. Consequently, these drawbacks become more pronounced when treating tumors with complex surrounding anatomical structures, such as bilateral head and neck tumors or skull base tumors ( 30 ). For breast cancer, however, our statistics on the minimum air gap indicated that the use of RS does not significantly reduce the air gap between the treatment head and the patient.…”

Improve the dosimetric outcome in bilateral head and neck cancer (HNC) treatment using spot-scanning proton arc (SPArc) therapy: a feasibility study

“…Dosimetric improvements could potentially improve the treatment outcome by reducing acute and late toxicities. Recent studies have shown improved IMPT robustness associated with the increase of treatment fields while decreasing OARs sparing [12,30,31]. However, such approaches using numerous static beam angles were considered impractical due to the prolonged treatment delivery time, especially in a multi-room proton center where significant time will be spent in the room-switching time/waiting time [32].…”