The Role of Intensity Modulated Proton Therapy in Postmastectomy Radiation of Reconstructed Breasts: A Treatment Planning Study

Jimenez, Rachel; Gomà, Carles; Nyamwanda, Jacqueline A.; Napolitano, Brian; Kooy, Hanne M.; Taghian, Alphonse G.; Lu, Hsiao‐Ming; MacDonald, Shannon M.

doi:10.1016/j.ijrobp.2011.06.457

Cited by 1 publication

(1 citation statement)

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“…theBraggpeak,offersnew possibilitiesin meetingthe challengesof PMRT. Severaltreatmentplanningstudies have demonstratedsigni ficant dosimetric advantagesfor reducing heart and lung doseswhile improving targetcoverage [13][14][15][16][17]. Thus, a proton PMRT clinical trial was startedat theinstitutionand early outcomesshowedthat the treatmentwas well tolerated [18].…”

Section: Introductionmentioning

confidence: 99%

A Novel Approach to Postmastectomy Radiation Therapy Using Scanned Proton Beams

Depauw

Batin

Daartz

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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A novel approach to postmastectomy radiation therapy using scanned proton beams AbstractPurpose: Postmastectomy radiation therapy (PMRT), currently offered at Massachusetts General Hospital, uses proton pencil beam scanning (PBS) with intensity modulation, achieving complete target coverage of the chest wall and all nodal regions and reduced dose to the cardiac structures. This work presents the current methodology for such treatment and the ongoing effort for its improvements. Methods and Materials: A single PBS field is optimized to ensure appropriate target coverage and heart/lung sparing, using an in-housedeveloped proton planning system with the capability of multicriteria optimization. The dose to the chest wall skin is controlled as a separate objective in the optimization. Surface imaging is used for setup because it is a suitable surrogate for superficial target volumes. In order to minimize the effect of beam range uncertainties, the relative proton stopping power ratio of the material in breast implants was determined through separate measurements. Phantom measurements were also made to validate the accuracy of skin dose calculation in the treatment planning system. Additionally, the treatment planning robustness was evaluated relative to setup perturbations and patient breathing motion. Results: PBS PMRT planning resulted in appropriate target coverage and organ sparing, comparable to treatments by passive scattering (PS) beams but much improved in nodal coverage and cardiac sparing compared to conventional treatments by photon/electron beams. The overall treatment time was much shorter than PS and also shorter than conventional photon/electron treatment. The accuracy of the skin dose calculation by the planning system was within ±2%. The treatment was shown to be adequately robust relative to both setup uncertainties and patient breathing motion, resulting in clinically satisfying dose distributions. Conclusions: More than 25 PMRT patients have been successfully treated at Massachusetts General Hospital by using single-PBS fields. The methodology and robustness of both the setup and the treatment have been discussed. Disciplines Engineering | Science and Technology Studies Publication DetailsDepauw, N., Batin, E., Daartz, J., Rosenfeld, A., Adams, J., Kooy, H., Macdonald, S. & Lu, H. (2015). A novel approach to postmastectomy radiation therapy using scanned proton beams. A novel approach to post-mastectomyradiation therapy using scannedproton beams.

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Section: Introductionmentioning

confidence: 99%