Treatment planning comparison of IMPT, VMAT and 4π radiotherapy for prostate cases

Tran, A.; Zhang, Jingjing; Woods, Kaley; Yu, Victoria; Nguyen, Dan; Gustafson, Gary; Rosen, L; Sheng, Ke

doi:10.1186/s13014-016-0761-0

Cited by 76 publications

(74 citation statements)

References 20 publications

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“…Proton beam therapy (PBT) has been used to treat prostate cancer for more than 25 years. Protons have better dosimetric results for organs at risk, especially in the area of maximum and also middle, and low doses . Recent papers describe very good long‐term PSA disease‐free survival and low late toxicity, including a low rate of erectile dysfunction after treatment …”

Section: Introductionmentioning

confidence: 99%

“…Protons have better dosimetric results for organs at risk, especially in the area of maximum and also middle, and low doses. 1 Recent papers describe very good long-term PSA disease-free survival and low late toxicity, 2,3 including a low rate of erectile dysfunction after treatment. 4 Stereotactic photon radiotherapy is an established modality with high effectivity and low toxicity.…”

Section: Introductionmentioning

confidence: 99%

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Extreme hypofractionated proton radiotherapy for prostate cancer using pencil beam scanning: Dosimetry, acute toxicity and preliminary results

et al. 2019

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Introduction Extreme hypofractionated radiotherapy for prostate cancer is a common modality in photon therapy. Pencil beam scanning (PBS) in similar fractionation allows better dose distribution and makes proton therapy more available for such patients. The purpose of this study is the feasibility of extreme proton hypofractionated radiotherapy and publication of early clinical results. Methods Two hundred patients with early‐stage prostate cancer were treated with IMPT (intensity‐modulated proton therapy), extreme hypofractionated schedule (36.25 GyE in five fractions) between February 2013 and December 2015. Mean age of the patients was 64.3 years, and the mean value of prostate‐specific antigen (PSA) before treatment was 6.83 μg/L (0.6–17.3 μg/L). Ninety‐three patients (46.5%) were in the low‐risk group. One hundred and seven patients (53.5%) were in the intermediate‐risk group. Twenty‐nine patients (14.5%) had neoadjuvant hormonal therapy, and no patients had adjuvant hormonal therapy. Acute toxicity, late toxicity and short‐term results were evaluated. Results All patients finished radiotherapy without interruptions. The median follow‐up time was 36 months. The mean treatment time was 9.5 days (median 9 days). Acute toxicity according to Common Terminology Criteria for Adverse Events (CTCAE) v 4.0 was (gastrointestinal toxicity) GI (grade) G1‐17%, G2‐3.5%; (genitourinary toxicity) GU G1‐40%, G2‐19%; and no G3 toxicity was observed. Late toxicity was GI G1‐19%, G2‐5.5%; GU G1‐17%, G2‐4%; and no G3 toxicity was observed. PSA relapse was observed in one patient (1.08%) in the low‐risk group (pelvic lymph node involvement was detected) and in seven patients (6.5%) in the intermediate‐risk group (three lymph node metastases, two lymph node and bone metastases, two PSA relapses). No patient died of prostate cancer, and three patients died from other reasons. No local recurrence of cancer in the prostate was observed. Conclusions Proton beam radiotherapy for prostate cancer is feasible with a low rate of acute toxicity and promising late toxicity and effectivity.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Extreme hypofractionated proton radiotherapy for prostate cancer using pencil beam scanning: Dosimetry, acute toxicity and preliminary results

et al. 2019

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“…, left) modeled from mouse CT data was used to demonstrate a realistic application for the SOC, as described in Part I. Mouse liver and kidney structures were transferred from a contrast‐enhanced mouse CT, and the liver was targeted with a dose of 10 Gy using five beam angles optimized with the 4π algorithm . Film was inserted between the two phantom halves for dose measurement.…”

Section: Methodsmentioning

confidence: 99%

A sparse orthogonal collimator for small animal intensity‐modulated radiation therapy. Part II: hardware development and commissioning

et al. 2019

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Purpose A dose‐modulation device for small animal radiotherapy is required to use clinically analogous treatment techniques, which will likely increase the translatability of preclinical research results. Because the clinically used multileaf collimator (MLC) is impractical for miniaturization, we have developed a simpler, better‐suited sparse orthogonal collimator (SOC) for delivering small animal intensity‐modulated radiation therapy (IMRT) using a rectangular aperture optimization (RAO) treatment planning system. Methods The SOC system was modeled in computer‐aided design software and fabricated with machined tungsten leaves and three‐dimensional (3D) printed leaf housing. A graphical user interface was developed for controlling and calibrating the SOC leaves, which are driven by Arduino‐controlled stepper motors. A Winston‐Lutz test was performed to assess mechanical alignment, and abutting field and grid dose patterns were created to analyze intra‐ and intercalibration leaf positioning error. Leaf transmission and penumbra were measured over the full range of gantry angles and leaf positions, respectively. Three SOC test plans were delivered, and film measurements were compared to the intended dose distributions. The differences in maximum, mean, and minimum, as well as pixelwise absolute dose differences, were compared for each structure, and a gamma analysis was performed for the target structures using criteria of 4% dose difference and 0.3 mm distance to agreement. Results The Winston‐Lutz test revealed maximum directional offsets between the SOC and primary collimator axes of 0.53 mm at 0° and 0.68 mm over the full 360°. Upper and lower abutting field patterns had maximum dose deviations of 18.8 ± 3.1% and 15.5 ± 2.9%, respectively, and grid patterns showed intra‐ and intercalibration repeatability of 93% and 91%, respectively. Extremely low midleaf (0.15 ± 0.05%) and interleaf (0.27 ± 0.22%) transmission was measured, with no significant rotational variation. The average penumbra was ~0.8 mm for all leaves at field center, with a range of 0.17 mm for all leaf positions. A highly concave test plan was delivered with a ~ 95% gamma analysis pass rate, and a realistic mouse phantom liver irradiation plan achieved a pass rate of ~98%. A highly complex dose distribution was also created with 551 SOC apertures averaging 2.4 mm in size. Conclusions A sparse orthogonal collimator was developed and commissioned, with promising preliminary dosimetry results. The SOC design, with its limited moving components and high dose‐modulation resolution, is ideal for delivering high‐quality small animal IMRT with our RAO‐based treatment planning system.

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“…In particular, image‐guided intensity‐modulated particle beam RT using a new beam delivering method, known as pencil beam scanning, provides more highly conformal and precise treatments beyond what were available previously (Fig. ) . By further decreasing the irradiated volumes and doses in the rectum and bladder, the incidence of GI and GU toxicities is expected to decrease.…”

Section: Future Prospectsmentioning

confidence: 99%

Particle therapy for prostate cancer: The past, present and future

et al. 2019

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Although prostate cancer control using radiotherapy is dose‐dependent, dose–volume effects on late toxicities in organs at risk, such as the rectum and bladder, have been observed. Both protons and carbon ions offer advantageous physical properties for radiotherapy, and create favorable dose distributions using fewer portals compared with photon‐based radiotherapy. Thus, particle beam therapy using protons and carbon ions theoretically seems suitable for dose escalation and reduced risk of toxicity. However, it is difficult to evaluate the superiority of particle beam radiotherapy over photon beam radiotherapy for prostate cancer, as no clinical trials have directly compared the outcomes between the two types of therapy due to the limited number of facilities using particle beam therapy. The Japanese Society for Radiation Oncology organized a joint effort among research groups to establish standardized treatment policies and indications for particle beam therapy according to disease, and multicenter prospective studies have been planned for several common cancers. Clinical trials of proton beam therapy for intermediate‐risk prostate cancer and carbon‐ion therapy for high‐risk prostate cancer have already begun. As particle beam therapy for prostate cancer is covered by the Japanese national health insurance system as of April 2018, and the number of facilities practicing particle beam therapy has increased recently, the number of prostate cancer patients treated with particle beam therapy in Japan is expected to increase drastically. Here, we review the results from studies of particle beam therapy for prostate cancer and discuss future developments in this field.

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Treatment planning comparison of IMPT, VMAT and 4π radiotherapy for prostate cases

Cited by 76 publications

References 20 publications

Extreme hypofractionated proton radiotherapy for prostate cancer using pencil beam scanning: Dosimetry, acute toxicity and preliminary results

Extreme hypofractionated proton radiotherapy for prostate cancer using pencil beam scanning: Dosimetry, acute toxicity and preliminary results

A sparse orthogonal collimator for small animal intensity‐modulated radiation therapy. Part II: hardware development and commissioning

Particle therapy for prostate cancer: The past, present and future

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