4D Proton treatment planning strategy for mobile lung tumors

Kang, Young Ae; Zhang, Xiaodong; Chang, Joe Y.; Wang, He; Xiong, Wei; Liao, Zhongxing; Komaki, Ritsuko; Cox, James D.; Balter, Peter A; Liu, Helen; Zhu, Xiaorong Ronald; Mohan, Radhe; Dong, Lei

doi:10.1016/j.ijrobp.2006.10.045

Cited by 173 publications

(178 citation statements)

References 19 publications

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“…PBS treatment planning for thoracic tumors can achieve better sparing of organs at risk (OAR) than IMRT techniques 13 , 14 , 15 . Despite the dosimetric advantages of PBS, DS and IMRT remain the methods of choice for treating complex thoracic tumors.…”

Section: Introductionmentioning

confidence: 99%

Beam‐specific planning target volumes incorporating 4D CT for pencil beam scanning proton therapy of thoracic tumors

Lin

Kang

Huang

et al. 2015

J Applied Clin Med Phys

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The purpose of this study is to determine whether organ sparing and target coverage can be simultaneously maintained for pencil beam scanning (PBS) proton therapy treatment of thoracic tumors in the presence of motion, stopping power uncertainties, and patient setup variations. Ten consecutive patients that were previously treated with proton therapy to 66.6/1.8 Gy (RBE) using double scattering (DS) were replanned with PBS. Minimum and maximum intensity images from 4D CT were used to introduce flexible smearing in the determination of the beam specific PTV (BSPTV). Datasets from eight 4D CT phases, using ±3% uncertainty in stopping power and ±3 mm uncertainty in patient setup in each direction, were used to create 8×12×10=960 PBS plans for the evaluation of 10 patients. Plans were normalized to provide identical coverage between DS and PBS. The average lung V20, V5, and mean doses were reduced from 29.0%, 35.0%, and 16.4 Gy with DS to 24.6%, 30.6%, and 14.1 Gy with PBS, respectively. The average heart V30 and V45 were reduced from 10.4% and 7.5% in DS to 8.1% and 5.4% for PBS, respectively. Furthermore, the maximum spinal cord, esophagus, and heart doses were decreased from 37.1 Gy, 71.7 Gy, and 69.2 Gy with DS to 31.3 Gy, 67.9 Gy, and 64.6 Gy with PBS. The conformity index (CI), homogeneity index (HI), and global maximal dose were improved from 3.2, 0.08, 77.4 Gy with DS to 2.8, 0.04, and 72.1 Gy with PBS. All differences are statistically significant, with p‐values <0.05, with the exception of the heart V45 (p=0.146). PBS with BSPTV achieves better organ sparing and improves target coverage using a repainting method for the treatment of thoracic tumors. Incorporating motion‐related uncertainties is essential.PACS number: 87.55.D

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Section: Introductionmentioning

confidence: 99%

Beam‐specific planning target volumes incorporating 4D CT for pencil beam scanning proton therapy of thoracic tumors

Lin

Kang

Huang

et al. 2015

J Applied Clin Med Phys

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“…These motions occurred predominantly in the cranial–caudal direction, with the magnitude of peak‐to‐peak motion of the liver‐dome apex ranging from 0.5 cm to 1.3 cm, which is comparable to tumor motion in lung cancer patients. ( 15 ) …”

Section: Methodsmentioning

confidence: 99%

“…This is the same for the respiration‐induced anatomical change because it can also lead to relative change in density distribution and, consequently, to miscalculation of proton dose distribution. ( 12 , 13 ) To date, however, a proper dose calculation method, such as a four‐dimensional dose (4D dose) calculation combined with deformable image registration, ( 14 , 15 ) has not been developed in proton planning systems.…”

Section: Introductionmentioning

confidence: 99%

“…( 12 , 15 – 18 ) Among them, the density‐override method, ( 12 , 15 ) in which the CT density of the treatment target volume was replaced by the average density of the gross tumor volume to account for internal gross tumor motion, has been reported to be very successful in mobile lung cancer treatment. However, the effectiveness of this method has not been widely evaluated at other treatment sites.…”

Section: Introductionmentioning

confidence: 99%

“…We also evaluated the dosimetric effectiveness of the previously proposed methods, including density‐override method, ( 12 , 15 ) to compensate the respiration motion, but none of them was fully successful in the present liver cancer patients. We have, therefore, proposed an alternative that uses the concept of field‐specific proton margin, which yielded better result than any of the previous models.…”

Section: Introductionmentioning

confidence: 99%

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Compensation method for respiratory motion in proton treatment planning for mobile liver cancer

Jeong

Lee

Yoo

et al. 2013

J Applied Clin Med Phys

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We evaluated the dosimetric effect of a respiration motion, and sought an effective planning strategy to compensate the motion using four‐dimensional computed tomography (4D CT) dataset of seven selected liver patients. For each patient, we constructed four different proton plans based on: (1) average (AVG) CT, (2) maximum‐intensity projection (MIP) CT, (3) AVG CT with density override of tumor volume (OVR), and (4) AVG CT with field‐specific proton margin which was determined by the range difference between AVG and MIP plans (mAVG). The overall effectiveness of each planning strategy was evaluated by calculating the cumulative dose distribution over an entire breathing cycle. We observed clear differences between AV G and MIP CT‐based plans, with significant underdosages at expiratory and inspiratory phases, respectively. Only the mAVG planning strategy was fully successful as the field‐specific proton margin applied in the planning strategy complemented both the limitations of AVG and MIP CT‐based strategies. These results demonstrated that respiration motion induced significant changes in dose distribution of 3D proton plans for mobile liver cancer and the changes can be effectively compensated by applying field‐specific proton margin to each proton field.PACS numbers: 87.55.D; 87.53.Bn; 87.53.Jw; 87.55.dk

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Proton Beam Radiotherapy and Concurrent Chemotherapy for Unresectable Stage III Non–Small Cell Lung Cancer

et al. 2017

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4D Proton treatment planning strategy for mobile lung tumors

Cited by 173 publications

References 19 publications

Beam‐specific planning target volumes incorporating 4D CT for pencil beam scanning proton therapy of thoracic tumors

Beam‐specific planning target volumes incorporating 4D CT for pencil beam scanning proton therapy of thoracic tumors

Compensation method for respiratory motion in proton treatment planning for mobile liver cancer

Proton Beam Radiotherapy and Concurrent Chemotherapy for Unresectable Stage III Non–Small Cell Lung Cancer

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