SU‐E‐T‐359: Patients Could (and Should) Be Treated in An Upright Position

Court, Laurence Edward; Yang, Jinzhong; Fullen, D; Han, Na Mi; Ko, Jong-Hyun; Mason, Sarah A.; Nguyen, Khoi D.; Stein, Scott; Fave, Xenia; Hsieh, M. Ani; Kuruvila, Shirly J; Hillebrandt, E.; Palmer, Jacob; Beadle, Beth M.; Dabaja, Bouthaina S.; Skinner, Heath; Balter, Peter A

doi:10.1118/1.4814793

Cited by 6 publications

(5 citation statements)

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“…Aside from the economical arguments, there have been a small, but growing number of studies indicating a possible therapeutic benefit of upright treatment as well. Upright positioning could provide greater comfort for head&neck patients suffering from increased saliva production (25), and patients suffering orthopnea, dyspnea or dysphagia in supine position (26).…”

Section: Clinical Argumentsmentioning

confidence: 99%

“…Using an upright MRI scanner, Yang et al ( 28) also demonstrated increased lung volume in upright positioning compared to supine, as well as showing a reduced motion amplitude from respiration. The greater lung volume implies greater distance between target and organs at risk, as well as lower mean lung dose, which has been used to argue for better healthy tissue sparing possibility (25). For particle therapy, the important quantity is the water equivalent thickness, which would not change relevantly with greater air volume in the lungs.…”

Section: Clinical Argumentsmentioning

confidence: 99%

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Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

et al. 2022

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Particle therapy is a rapidly growing field in cancer therapy. Worldwide, over 100 centers are in operation, and more are currently in construction phase. The interest in particle therapy is founded in the superior target dose conformity and healthy tissue sparing achievable through the particles’ inverse depth dose profile. This physical advantage is, however, opposed by increased complexity and cost of particle therapy facilities. Particle therapy, especially with heavier ions, requires large and costly equipment to accelerate the particles to the desired treatment energy and steer the beam to the patient. A significant portion of the cost for a treatment facility is attributed to the gantry, used to enable different beam angles around the patient for optimal healthy tissue sparing. Instead of a gantry, a rotating chair positioning system paired with a fixed horizontal beam line presents a suitable cost-efficient alternative. Chair systems have been used already at the advent of particle therapy, but were soon dismissed due to increased setup uncertainty associated with the upright position stemming from the lack of dedicated image guidance systems. Recently, treatment chairs gained renewed interest due to the improvement in beam delivery, commercial availability of vertical patient CT imaging and improved image guidance systems to mitigate the problem of anatomical motion in seated treatments. In this review, economical and clinical reasons for an upright patient positioning system are discussed. Existing designs targeted for particle therapy are reviewed, and conclusions are drawn on the design and construction of chair systems and associated image guidance. Finally, the different aspects from literature are channeled into recommendations for potential upright treatment layouts, both for retrofitting and new facilities.

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Section: Clinical Argumentsmentioning

confidence: 99%

Section: Clinical Argumentsmentioning

confidence: 99%

Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

et al. 2022

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“…Another option which could increase the flexibility of a fixed horizontal beam line substantially is an upright positioning of the patient, which lately gained interest again in the community and by vendors. [39][40][41][42]…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, an inclined beam line might increase the cost of the treatment compared to a horizontal beam line. Another option which could increase the flexibility of a fixed horizontal beam line substantially is an upright positioning of the patient, which lately gained interest again in the community and by vendors 39–42 …”

Section: Discussionmentioning

confidence: 99%

Combined proton–photon therapy for non‐small cell lung cancer

et al. 2022

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Purpose Advanced non‐small cell lung cancer (NSCLC) is still a challenging indication for conventional photon radiotherapy. Proton therapy has the potential to improve outcomes, but proton treatment slots remain a limited resource despite an increasing number of proton therapy facilities. This work investigates the potential benefits of optimally combined proton–photon therapy delivered using a fixed horizontal proton beam line in combination with a photon Linac, which could increase accessibility to proton therapy for such a patient cohort. Materials and methods A treatment planning study has been conducted on a patient cohort of seven advanced NSCLC patients. Each patient had a planning computed tomography scan (CT) and multiple repeated CTs from three different days and for different breath‐holds on each day. Treatment plans for combined proton–photon therapy (CPPT) were calculated for individual patients by optimizing the combined cumulative dose on the initial planning CT only (non‐adapted) as well as on each daily CT respectively (adapted). The impact of inter‐fractional changes and/or breath‐hold variability was then assessed on the repeat breath‐hold CTs. Results were compared to plans for IMRT or IMPT alone, as well as against combined treatments assuming a proton gantry. Plan quality was assessed in terms of dosimetric, robustness and NTCP metrics. Results Combined treatment plans improved plan quality compared to IMRT treatments, especially in regard to reductions of low and medium doses to organs at risk (OARs), which translated into lower NTCP estimates for three side effects. For most patients, combined treatments achieved results close to IMPT‐only plans. Inter‐fractional changes impact mainly the target coverage of combined and IMPT treatments, while OARs doses were less affected by these changes. With plan adaptation however, target coverage of combined treatments remained high even when taking variability between breath‐holds into account. Conclusions Optimally combined proton‐photon plans improve treatment plan quality compared to IMRT only, potentially reducing the risk of toxicity while also allowing to potentially increase accessibility to proton therapy for NSCLC patients.

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“…Research is ongoing to develop a specialized treatment chair for this technique. 40,41 In contrast to previous chairs used for upright treatments, this one is being developed with patient comfort in mind to help minimize motion. Interfraction and intrafraction motions tests using this chair, and other chair designs, are planned to assess patient positioning, reproducibility, and detect any necessary modifications.…”

Section: Discussionmentioning

confidence: 99%