Adaptive Replanning is Required During Intensity Modulated Proton Therapy For Head-and-Neck Cancers

Yeh, Brian; Georges, R.; Zhu, Xiaorong Ronald; Palmer, Matthew; Amin, M.; Cheung, Jpy; Dong, Lei; Nuanjing, Jenny; Garcia, J.; Frank, Steven J.

doi:10.1016/j.ijrobp.2012.07.354

Cited by 4 publications

(6 citation statements)

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“…However, compared to photon therapy, the highly modulated IMPT plans are significantly more sensitive to patient anatomy changes, such as tumor and normaltissue shrinkage due to treatment and weight loss. 1,24 As a result, more than 30% of H&N cases need to be replanned at least once during their treatments. The current clinical practice for many proton centers is to monitor anatomy changes with weekly or bi-weekly QACT images, which (1) introduces addition imaging doses and appointment time to the patients, ( 2) involves significant extra resources like CT simulator and therapist staff time for the QACT procedure, and (3) has low specificity (as shown in Figure 4b and Figure 6).…”

Section: Discussionmentioning

confidence: 99%

“…Proton therapy has superior normal tissue sparing for most H&N treatments, and more patients are being treated in proton facilities (H&N cancer accounts for about 40% of the population at our proton center). However, compared to photon therapy, the highly modulated IMPT plans are significantly more sensitive to patient anatomy changes, such as tumor and normal‐tissue shrinkage due to treatment and weight loss 1,24 . As a result, more than 30% of H&N cases need to be replanned at least once during their treatments.…”

Section: Discussionmentioning

confidence: 99%

“…Intensity‐modulated proton therapy (IMPT) can spare more critical normal tissue than intensity‐modulated photon therapy for head and neck (H&N) cancer and hence the use of proton therapy is increasing 1–3 …”

Section: Introductionmentioning

confidence: 99%

“…The highly modulated proton plans are sensitive to changes in patient anatomy such as tumor growth or shrinkage, weight loss, and cavity filling 1–3 making a robust quality assurance (QA) process essential to the accurate treatment of the patient. Anatomical changes are particularly important in the treatment of H&N cancer patient as anatomical changes due to weight loss and tumor shrinkage or growth dramatically affect contours 4–6 .…”

Section: Introductionmentioning

confidence: 99%

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Onboard cone‐beam CT‐based replan evaluation for head and neck proton therapy

Stanforth

Lin

Beitler

et al. 2022

J Applied Clin Med Phys

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Quality assurance computed tomography (QACT) is the current clinical practice in proton therapy to evaluate the needs for replan. QACT could falsely indicate replan because of setup issues that would be solved on the treatment machine. Deforming the treatment planning CT (TPCT) to the pretreatment CBCT may eliminate this issue. We investigated the performance of replan evaluation based on deformed TPCT (TPCTdir) for proton head and neck (H&N) therapy. Methods and materials: Twenty-eight H&N datasets along with pretreatment CBCT and QACT were used to validate the method. The changes in body volume were analyzed between the no-replan and replan groups. The dose on the TPCTdir, the deformed QACT (QACTdir), and the QACT were calculated by applying the clinical plans to these image sets. Dosimetric parameters' changes, including ΔD95, ΔDmean, and ΔD1 for the clinical target volumes (CTVs) were calculated. Receiver operating characteristic curves for replan evaluation based on ΔD95 on QACT and TPCTdir were calculated, using ΔD95 on QACTdir as the reference. A threshold for replan based on ΔD95 on TPCTdir is proposed. The specificities for the proposed method were calculated. Results: The changes in the body contour were 95.8 ± 83.8 cc versus 305.0 ± 235.0 cc (p < 0.01) for the no-replan and replan groups, respectively. The ΔD95, ΔDmean, and ΔD1 are all comparable for all the evaluations. The differences between TPCTdir and QACTdir evaluations were 0.30% ± 0.86%, 0.00 ± 0.22 Gy, and −0.17 ± 0.61 Gy for CTV ΔD95, ΔDmean, and ΔD1, respectively. The corresponding differences between the QACT and QACTdir were 0.12% ± 1.1%, 0.02 ± 0.32 Gy, and −0.01 ± 0.71 Gy. CTV ΔD95 > 2.6% in TPCTdir was chosen as the threshold to trigger QACT/replan. The corresponding specificity was 94% and 98% for the clinical practice and the proposed method, respectively. Conclusions:The replan evaluation based on TPCTdir provides better specificity than that based on the QACT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Onboard cone‐beam CT‐based replan evaluation for head and neck proton therapy

Stanforth

Lin

Beitler

et al. 2022

J Applied Clin Med Phys

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“…The current strategy for handling systematic variations is adaptation [36,37], while for random variations a plan library strategy may be used. Adaptation procedures can be costly and inconvenient, as it implies the patient showing up for an additional CT scan [38], plus time spent on additional treatment planning and potentially on patient-specific QA.…”

Section: Discussionmentioning

confidence: 99%

Dose and robustness comparison of nominal, daily and accumulated doses for photon and proton treatment of sinonasal cancer

Perez

Sharma

Elstrøm

et al. 2022

Radiotherapy and Oncology

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Proton Therapy for Head and Neck Cancer

Kim

Leeman

Riaz

et al. 2018

Curr. Treat. Options in Oncol.

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The application of proton beam radiation therapy in the treatment of head and neck cancer has grown tremendously in the past few years. Globally, widespread interest in proton beam therapy has led to multiple research efforts regarding its therapeutic value and cost-effectiveness. The current standard of care using modern photon radiation technology has demonstrated excellent treatment outcomes, yet there are some situations where disease control remains suboptimal with the potential for detrimental acute and chronic toxicities. Due to the advantageous physical properties of the proton beam, proton beam therapy may be superior to photon therapy in some patient subsets for both disease control and patient quality of life. As enthusiasm and excitement for proton beam therapy continue to increase, clinical research and widespread adoption will elucidate the true value of proton beam therapy and give a greater understanding of the full risks and benefits of proton therapy in head and neck cancer.

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Adaptive Replanning is Required During Intensity Modulated Proton Therapy For Head-and-Neck Cancers

Cited by 4 publications

References 0 publications

Onboard cone‐beam CT‐based replan evaluation for head and neck proton therapy

Onboard cone‐beam CT‐based replan evaluation for head and neck proton therapy

Dose and robustness comparison of nominal, daily and accumulated doses for photon and proton treatment of sinonasal cancer

Proton Therapy for Head and Neck Cancer

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