Motion‐robust intensity‐modulated proton therapy for distal esophageal cancer

Yu, Jen; Zhang, Xiaodong; Liao, Li; Li, Heng; Zhu, Ronald X.; Park, Peter Chul; Sahoo, Narayan; Gillin, Michael; Li, Yupeng; Chang, Joe Y.; Komaki, Ritsuko; Lin, Steven H.

doi:10.1118/1.4940789

Cited by 70 publications

(87 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several methods are available to mitigate these uncertainties: robust beam angle selection utilizing waterequivalent thickness optimization, 4DCT-based robust optimization, layer or volumetric "repainting" delivery, spotsequence delivery optimization, increased fractionation, spot-size modulation, mini-ridge filter utilization, and respiratory gating or breath-hold-based treatment, to name a few (105,(110)(111)(112)(113)(114). Unfortunately, most of these methods require additional treatment planning software and devices or increase time and logistical burden on planning, quality assurance, and treatment delivery.…”

Section: Modalitiesmentioning

confidence: 99%

Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy

Diwanji¹,

Mohindra²,

Vyfhuis³

et al. 2017

Transl. Lung Cancer Res.

Self Cite

View full text Add to dashboard Cite

Abstract:The 21st century has seen several paradigm shifts in the treatment of non-small cell lung cancer (NSCLC) in early-stage inoperable disease, definitive locally advanced disease, and the postoperative setting.A key driver in improvement of local disease control has been the significant evolution of radiation therapy techniques in the last three decades, allowing for delivery of definitive radiation doses while limiting exposure of normal tissues. For patients with locally-advanced NSCLC, the advent of volumetric imaging techniques has allowed a shift from 2-dimensional approaches to 3-dimensional conformal radiation therapy (3DCRT).The next generation of 3DCRT, intensity-modulated radiation therapy and volumetric-modulated arc therapy (VMAT), have enabled even more conformal radiation delivery. Clinical evidence has shown that this can improve the quality of life for patients undergoing definitive management of lung cancer. In the earlystage setting, conventional fractionation led to poor outcomes. Evaluation of altered dose fractionation with the previously noted technology advances led to advent of stereotactic body radiation therapy (SBRT). This technique has dramatically improved local control and expanded treatment options for inoperable, earlystage patients. The recent development of proton therapy has opened new avenues for improving conformity and the therapeutic ratio. Evolution of newer proton therapy techniques, such as pencil-beam scanning (PBS), could improve tolerability and possibly allow reexamination of dose escalation. These new progresses, along with significant advances in systemic therapies, have improved survival for lung cancer patients across the spectrum of non-metastatic disease. They have also brought to light new challenges and avenues for further research and improvement.

show abstract

Section: Modalitiesmentioning

confidence: 99%

Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy

Diwanji¹,

Mohindra²,

Vyfhuis³

et al. 2017

Transl. Lung Cancer Res.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Differences in beam arrangements can mean substantial dosimetric differences (83). Optimally accounting for bowel gas and respiratory motion, which if unaccounted for may result in range errors and misdosing of the tumor, is another realm that is increasingly being explored (83,84). Finally, dosimetric and clinical differences in proton pencil beam scanning versus passive scattering have only begun to be investigated (85).…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: a systematic review

Verma

Lin

Simone

et al. 2016

J. Gastrointest. Oncol.

Self Cite

View full text Add to dashboard Cite

Background: Proton beam radiotherapy (PBT) is frequently shown to be dosimetrically superior to photon radiotherapy (RT), though supporting data for clinical benefit are severely limited. Because of the potential for toxicity reduction in gastrointestinal (GI) malignancies, we systematically reviewed the literature on clinical outcomes (survival/toxicity) of PBT. Methods: A systematic search of PubMed, EMBASE, abstracts from meetings of the American Society for Radiation Oncology, Particle Therapy Co-Operative Group, and American Society of Clinical Oncology was conducted for publications from 2000-2015. Thirty-eight original investigations were analyzed. Results: Although results of PBT are not directly comparable to historical data, outcomes roughly mirror previous data, generally with reduced toxicities for PBT in some neoplasms. For esophageal cancer, PBT is associated with reduced toxicities, postoperative complications, and hospital stay as compared to photon radiation, while achieving comparable local control (LC) and overall survival (OS). In pancreatic cancer, numerical survival for resected/unresected cases is also similar to existing photon data, whereas grade ≥3 nausea/emesis and post-operative complications are numerically lower than those reported with photon RT.The strongest data in support of PBT for HCC comes from phase II trials demonstrating very low toxicities, and a phase III trial of PBT versus transarterial chemoembolization demonstrating trends towards improved LC and progression-free survival (PFS) with PBT, along with fewer post-treatment hospitalizations. Survival and toxicity data for cholangiocarcinoma, liver metastases, and retroperitoneal sarcoma are also roughly equivalent to historical photon controls. There are two small reports for gastric cancer and three for anorectal cancer; these are not addressed further. Conclusions: Limited quality (and quantity) of data hamper direct comparisons and conclusions. However, the available data, despite the inherent caveats and limitations, suggest that PBT offers the potential to achieve significant reduction in treatment-related toxicities without compromising survival or LC for multiple GI malignancies. Several randomized comparative trials are underway that will provide more definitive answers.

show abstract

“…Typically, RU from ±3% to ±3.5% of HU is taken into consideration for routine clinical practice [7]. Uncertainties related to motion should be considered as well when evaluating proton therapy plans, especially for PBS treatments due to interplay effect [8]. As all of these uncertainties may result in significant deviations between planned and delivered dose distributions [9], it is very important to evaluate the robustness of proton therapy plans, especially for newly developed clinical protocols.…”

Section: Range Uncertainties (Ru) Arise From Conversion Of Computed Tmentioning

confidence: 99%

Robustness Evaluation of a Novel Proton Beam Geometry for Head and Neck Patients Treated with Pencil Beam Scanning Therapy

Huang¹,

Liu²,

Shen³

et al. 2018

IJMPCERO

View full text Add to dashboard Cite

Background: To evaluate the robustness of head and neck treatment using proton pencil beam scanning (PBS) technique with respect to range uncertainty (RU) and setup errors (SE), and to establish a robust PBS planning strategy for future treatment. Methods and Materials: Ten consecutive patients were planned with a novel proton field geometry (combination of two posterior oblique fields and one anterior field with gradient dose match) using single-field uniform dose (SFUD) planning technique and the proton plans were dosimetrically compared to two coplanar arc VMAT plans. Robustness of the plans, with respect to range uncertainties (RU = ± 3% for proton) and setup errors (SE = 2.25 mm for proton and VMAT), in terms of deviations to target coverage (CTV D98%) and OAR doses (max/mean), were evaluated and compared for each patient under worst case scenarios. Results: Dosimetrically, PBS plans provided better sparing to larynx (p = 0.005), oral cavity (p < 0.001) and contralateral parotid (p = 0.004) when compared to VMAT. CTV D98% variations were higher from SE than from RU for proton plans (−1.1% ± 1.3 % vs −0.4% ± 0.7% for nodal CTV and −1.4% ± 1.2 vs −0.4% ± 0.5% % for boost CTV). Overall, the magnitudes of variation of CTV D98% to combined SE and RU were found to be similar to the impact of the SE on the VMAT plans (−1.6% ± 1.9% vs −1.7% ± 1.4% for nodal CTV and −1.9% ± 1.6% vs −1.3% ± 1.5% for boost CTV). Compared to VMAT, a larger range of relative dose deviations were found for OARs in proton plans, but safe doses were maintained for cord (41.8 ± 3.6 Gy for PBS and 41.7 ± 3.9 Gy for VMAT) and brainstem (35.2 ± 8.4 Gy for PBS and 36.2 ± 5.

show abstract

Motion‐robust intensity‐modulated proton therapy for distal esophageal cancer

Cited by 70 publications

References 33 publications

Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy

Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy

Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: a systematic review

Robustness Evaluation of a Novel Proton Beam Geometry for Head and Neck Patients Treated with Pencil Beam Scanning Therapy

Contact Info

Product

Resources

About