Comparison of clinical outcomes between passive scattering versus pencil-beam scanning proton beam therapy for hepatocellular carcinoma

Yoo, Gyu Sang; Yu, Jeong Il; Cho, Sungkoo; Jung, Sang Hoon; Han, Youngyih; Park, Seyjoon; Oh, Yun; Lee, Boram; Park, Hee Chul; Lim, Do Hoon; Choi, Moon Seok; Won, Hojeong

doi:10.1016/j.radonc.2020.02.019

Cited by 32 publications

(35 citation statements)

References 27 publications

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“…The use of a pencil-beam scanning (PBS) module was considered under the following conditions: (1) the need for dose conformality at the proximal edge where PBS was required rather than passive scattering and (2) large tumor size for which PBS had benefits due to dosimetry homogeneity. The detailed processes for the preparation of PBT were as described previously [ 10 , 11 ]. We retrospectively reviewed 177 patients who were treated with PBT to the primary HCC from January 2016 to December 2017.…”

Section: Methodsmentioning

confidence: 99%

“…The protocol of PBT planning for primary HCC was described in the previous literature [ 10 , 11 ]. For the breath-hold technique, the gross tumor volumes (GTV) were delineated on the six sets of computed tomography (CT) images obtained with repetitive breath hold at the same level and summed to cover the deviation of each breath hold.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, the use of RT has been increased as a combined or alternative modality to standard therapy [ 4 , 5 , 6 ]. Furthermore, with advances in RT technologies, including stereotactic body RT and proton beam therapy (PBT), the highly accurate delivery of high-dose radiation to primary HCC has resulted in excellent local control after RT without an increased risk of radiation-induced liver disease, which had previously been the main concern of liver-directed RT [ 7 , 8 , 9 , 10 , 11 ]. Among the complications of treatments for primary HCC, biliary complications including bile duct stricture or biloma are important issues.…”

Section: Introductionmentioning

confidence: 99%

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Do Biliary Complications after Proton Beam Therapy for Perihilar Hepatocellular Carcinoma Matter?

Yoo

Park

et al. 2020

Cancers

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We aimed to evaluate the biliary complications and efficacy of proton beam therapy (PBT) for hepatocellular carcinoma (HCC). We retrospectively analyzed 167 patients who received PBT with ≥ 75 GyRBE of biological effective dose with ?/β = 10 for primary HCC. The perihilar region was defined as a 1-cm area extending from the right, left, and common hepatic ducts, including the gallbladder and cystic duct. PBT-related biliary complications were defined as follows: significant elevation in bilirubin level to > 3.0 mg/dL; elevation to more than twice of the baseline level after the completion of PBT; or newly developed radiological biliary abnormalities, which were not caused by HCC progression, comorbidities, or other treatments. Eighty (47.9%) had perihilar HCC. PBT-related events occurred in seven (4.2%), three of whom had perihilar HCC. Radiologic biliary abnormalities developed in 12 patients (7.2%); however, no events were PBT-related. All patients who experienced PBT-related biliary complications had underlying liver cirrhosis. The albumin-bilirubin grade was identified as an independent factor associated with PBT-related biliary complications. PBT at the current dose showed a low rate of PBT-related biliary complications even for patients with perihilar HCC. PBT for HCC patients with risk factors requires attention to reduce PBT-related biliary complications.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Do Biliary Complications after Proton Beam Therapy for Perihilar Hepatocellular Carcinoma Matter?

Yoo

Park

et al. 2020

Cancers

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“…Although there is a merit that the conformity on the proximal side can be improved compared to PSPT, there are also problems such as the risk that an interplay effect may occur for moving targets. Despite a retrospective analysis, Yoo et al analyzed the outcomes of both methods and reported that they were comparable 21 . The problem of positioning in HCC is a common issue for both PSPT and PBS, and the results of this study are expected to be a useful data for PBS, which will become mainstream in the future.…”

Section: Discussionmentioning

confidence: 75%

“…20 These results are considered to be consistent with our result in this study. 21 The problem of positioning in HCC is a common issue for both PSPT and PBS, and the results of this study are expected to be a useful data for PBS, which will become mainstream in the future.…”

Section: Discussionmentioning

confidence: 87%

The impact of different setup methods on the dose distribution in proton therapy for hepatocellular carcinoma

Takemasa

Katō

Narita

et al. 2021

J Applied Clin Med Phys

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To investigate the impact of different setup methods, vertebral body matching (VM), diaphragm matching (DM), and marker matching (MM), on the dose distribution in proton therapy (PT) for hepatocellular carcinoma (HCC). Materials and Methods: Thirty-eight HCC lesions were studied retrospectively to assess changes in the dose distribution on two computed tomography (CT) scans. One was for treatment planning (1st-CT), and the other was for dose confirmation acquired during the course of PT (2nd-CT). The dose coverage of the clinical target volume (CTV-D 98) and normal liver volume that received 30 Gy relative biological effectiveness (RBE) (liver-V 30) were evaluated under each condition. Initial treatment planning on the 1st-CT was defined as reference, and three dose distributions recalculated using VM, DM, and MM on the 2nd-CT, were compared to it, respectively. In addition, the relationship between the CTV-D 98 of each method and the distance between the center of mass (COM) of the CTV and the right diaphragm top was evaluated. Results: For CTV-D 98 , significant differences were observed between the reference and VM and DM, respectively (P = 0.013, P = 0.015). There were also significant differences between MM and VM and DM, respectively (P = 0.018, P = 0.036). Regarding liver-V 30 , there was no significant difference in any of the methods, and there were no discernable difference due to the different setup methods. In DM, only two out of 34 cases with a distance from right diaphragm top to COM of CTV of 90 mm or less that CTV-D 98 difference was 5% or more and CTV-D 98 was worse than VM were confirmed. Conclusion: Although MM is obviously the most effective method, it is suggested that DM may be particularly effective in cases where the distance from right diaphragm top to COM of CTV of 90 mm or less.

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Utilizing collimated aperture with proton pencil beam scanning (PBS) for stereotactic radiotherapy

Chou,

Tsai,

Huang

et al. 2024

J Applied Clin Med Phys

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PurposeProton stereotactic radiosurgery (PSRS) has emerged as an innovative proton therapy modality aimed at achieving precise dose delivery with minimal impact on healthy tissues. This study explores the dosimetric outcomes of PSRS in comparison to traditional intensity‐modulated proton therapy (IMPT) by focusing on cases with small target volumes. A custom‐made aperture system designed for proton therapy, specifically tailored to small target volumes, was developed and implemented for this investigation.MethodsA prerequisite mechanical validation through an isocentricity test precedes dosimetric assessments, ensuring the seamless integration of mechanical and dosimetry analyses. Five patients were enrolled in the study, including two with choroid melanoma and three with arteriovenous malformations (AVM). Two treatment plans were meticulously executed for each patient, one utilizing a collimated aperture and the other without. Both plans were subjected to robust optimization, maintaining identical beam arrangements and consistent optimization parameters to account for setup errors of 2 mm and range uncertainties of 3.5%. Plan evaluation metrics encompassing the Heterogeneity Index (HI), Paddick Conformity Index (CIPaddick), Gradient Index (GI), and the R50% index to evaluate alterations in low‐dose volume distribution.ResultsThe comparative analysis between PSRS and traditional PBS treatment revealed no significant differences in plan outcomes, with both modalities demonstrating comparable target coverage. However, collimated apertures resulted in discernible improvements in dose conformity, dose fall‐off, and reduced low‐dose volume.ConclusionsThis study underscores the advantageous impact of the aperture system on proton therapy, particularly in cases involving small target volumes.

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Comparison of clinical outcomes between passive scattering versus pencil-beam scanning proton beam therapy for hepatocellular carcinoma

Cited by 32 publications

References 27 publications

Do Biliary Complications after Proton Beam Therapy for Perihilar Hepatocellular Carcinoma Matter?

Do Biliary Complications after Proton Beam Therapy for Perihilar Hepatocellular Carcinoma Matter?

The impact of different setup methods on the dose distribution in proton therapy for hepatocellular carcinoma

Utilizing collimated aperture with proton pencil beam scanning (PBS) for stereotactic radiotherapy

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