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Robustness of the Voluntary Breath-Hold Approach for the Treatment of Peripheral Lung Tumors Using Hypofractionated Pencil Beam Scanning Proton Therapy

Dueck, Jenny LU ; Knopf, Antje Christin ; Lomax, Antony ; Albertini, Francesca ; Persson, Gitte F. ; Josipovic, Mirjana ; Aznar, Marianne ; Weber, Damien C. and Munck Af Rosenschöld, Per LU orcid (2016) In International Journal of Radiation Oncology Biology Physics 95(1). p.534-541
Abstract

Purpose The safe clinical implementation of pencil beam scanning (PBS) proton therapy for lung tumors is complicated by the delivery uncertainties caused by breathing motion. The purpose of this feasibility study was to investigate whether a voluntary breath-hold technique could limit the delivery uncertainties resulting from interfractional motion. Methods and Materials Data from 15 patients with peripheral lung tumors previously treated with stereotactic radiation therapy were included in this study. The patients had 1 computed tomographic (CT) scan in voluntary breath-hold acquired before treatment and 3 scans during the treatment course. PBS proton treatment plans with 2 fields (2F) and 3 fields (3F), respectively, were calculated... (More)

Purpose The safe clinical implementation of pencil beam scanning (PBS) proton therapy for lung tumors is complicated by the delivery uncertainties caused by breathing motion. The purpose of this feasibility study was to investigate whether a voluntary breath-hold technique could limit the delivery uncertainties resulting from interfractional motion. Methods and Materials Data from 15 patients with peripheral lung tumors previously treated with stereotactic radiation therapy were included in this study. The patients had 1 computed tomographic (CT) scan in voluntary breath-hold acquired before treatment and 3 scans during the treatment course. PBS proton treatment plans with 2 fields (2F) and 3 fields (3F), respectively, were calculated based on the planning CT scan and subsequently recalculated on the 3 repeated CT scans. Recalculated plans were considered robust if the V95% (volume receiving ≥95% of the prescribed dose) of the gross target volume (GTV) was within 5% of what was expected from the planning CT data throughout the simulated treatment. Results A total of 14/15 simulated treatments for both 2F and 3F met the robustness criteria. Reduced V95% was associated with baseline shifts (2F, P=.056; 3F, P=.008) and tumor size (2F, P=.025; 3F, P=.025). Smaller tumors with large baseline shifts were also at risk for reduced V95% (interaction term baseline/size: 2F, P=.005; 3F, P=.002). Conclusions The breath-hold approach is a realistic clinical option for treating lung tumors with PBS proton therapy. Potential risk factors for reduced V95% are small targets in combination with large baseline shifts. On the basis of these results, the baseline shift of the tumor should be monitored (eg, through image guided therapy), and appropriate measures should be taken accordingly. The intrafractional motion needs to be investigated to confirm that the breath-hold approach is robust.

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author
; ; ; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
in
International Journal of Radiation Oncology Biology Physics
volume
95
issue
1
pages
8 pages
publisher
Elsevier
external identifiers
  • scopus:84983528622
  • pmid:26797540
ISSN
0360-3016
DOI
10.1016/j.ijrobp.2015.11.015
language
English
LU publication?
no
id
6a776ebd-763c-4117-a3f8-94dc91a09149
date added to LUP
2020-07-28 09:03:44
date last changed
2024-03-05 01:38:45
@article{6a776ebd-763c-4117-a3f8-94dc91a09149,
  abstract     = {{<p>Purpose The safe clinical implementation of pencil beam scanning (PBS) proton therapy for lung tumors is complicated by the delivery uncertainties caused by breathing motion. The purpose of this feasibility study was to investigate whether a voluntary breath-hold technique could limit the delivery uncertainties resulting from interfractional motion. Methods and Materials Data from 15 patients with peripheral lung tumors previously treated with stereotactic radiation therapy were included in this study. The patients had 1 computed tomographic (CT) scan in voluntary breath-hold acquired before treatment and 3 scans during the treatment course. PBS proton treatment plans with 2 fields (2F) and 3 fields (3F), respectively, were calculated based on the planning CT scan and subsequently recalculated on the 3 repeated CT scans. Recalculated plans were considered robust if the V<sub>95%</sub> (volume receiving ≥95% of the prescribed dose) of the gross target volume (GTV) was within 5% of what was expected from the planning CT data throughout the simulated treatment. Results A total of 14/15 simulated treatments for both 2F and 3F met the robustness criteria. Reduced V<sub>95%</sub> was associated with baseline shifts (2F, P=.056; 3F, P=.008) and tumor size (2F, P=.025; 3F, P=.025). Smaller tumors with large baseline shifts were also at risk for reduced V<sub>95%</sub> (interaction term baseline/size: 2F, P=.005; 3F, P=.002). Conclusions The breath-hold approach is a realistic clinical option for treating lung tumors with PBS proton therapy. Potential risk factors for reduced V<sub>95%</sub> are small targets in combination with large baseline shifts. On the basis of these results, the baseline shift of the tumor should be monitored (eg, through image guided therapy), and appropriate measures should be taken accordingly. The intrafractional motion needs to be investigated to confirm that the breath-hold approach is robust.</p>}},
  author       = {{Dueck, Jenny and Knopf, Antje Christin and Lomax, Antony and Albertini, Francesca and Persson, Gitte F. and Josipovic, Mirjana and Aznar, Marianne and Weber, Damien C. and Munck Af Rosenschöld, Per}},
  issn         = {{0360-3016}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{1}},
  pages        = {{534--541}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Radiation Oncology Biology Physics}},
  title        = {{Robustness of the Voluntary Breath-Hold Approach for the Treatment of Peripheral Lung Tumors Using Hypofractionated Pencil Beam Scanning Proton Therapy}},
  url          = {{http://dx.doi.org/10.1016/j.ijrobp.2015.11.015}},
  doi          = {{10.1016/j.ijrobp.2015.11.015}},
  volume       = {{95}},
  year         = {{2016}},
}