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Feasibility of Pencil Beam Scanned Intensity Modulated Proton Therapy in Breath-hold for Locally Advanced Non-Small Cell Lung Cancer

Gorgisyan, Jenny LU ; Munck af Rosenschold, Per LU orcid ; Perrin, Rosalind ; Persson, Gitte F. ; Josipovic, Mirjana ; Belosi, Maria Francesca ; Engelholm, Svend Aage ; Weber, Damien C. and Lomax, Antony J. (2017) In International Journal of Radiation Oncology Biology Physics 99(5). p.1121-1128
Abstract

Purpose We evaluated the feasibility of treating patients with locally advanced non-small cell lung cancer (NSCLC) with pencil beam scanned intensity modulated proton therapy (IMPT) in breath-hold. Methods and Materials Fifteen NSCLC patients who had previously received 66 Gy in 33 fractions with image guided photon radiation therapy were included in the present simulation study. In addition to a planning breath-hold computed tomography (CT) scan before the treatment start, a median of 6 (range 3-9) breath-hold CT scans per patient were acquired prospectively throughout the radiation therapy course. Three-field IMPT plans were constructed using the planning breath-hold CT scan, and the four-dimensional dose distributions were simulated,... (More)

Purpose We evaluated the feasibility of treating patients with locally advanced non-small cell lung cancer (NSCLC) with pencil beam scanned intensity modulated proton therapy (IMPT) in breath-hold. Methods and Materials Fifteen NSCLC patients who had previously received 66 Gy in 33 fractions with image guided photon radiation therapy were included in the present simulation study. In addition to a planning breath-hold computed tomography (CT) scan before the treatment start, a median of 6 (range 3-9) breath-hold CT scans per patient were acquired prospectively throughout the radiation therapy course. Three-field IMPT plans were constructed using the planning breath-hold CT scan, and the four-dimensional dose distributions were simulated, with consideration of both patient intra- and interfraction motion, in addition to dynamic treatment delivery. Results The median clinical target volume receiving 95% of the prescribed dose was 99.8% and 99.7% for the planned and simulated dose distributions, respectively. For 3 patients (20%), the dose degradation was >5%, and plan adjustment was needed. Dose degradation correlated significantly with the change in water-equivalent path lengths (P<.01) in terms of the percentage of voxels with 3-mm or more undershoot on repeat CT scans. The dose to the organs at risk was similar for the planned and simulated dose distributions. Three or fewer breath-holds per field would be required for 12 of the 15 patients, which was clinically feasible. Conclusions For 9 of 15 NSCLC patients, IMPT in breath-hold was both dosimetrically robust and feasible to deliver regarding the treatment time. Three patients would have required plan adaption to meet the dosimetric criteria. The change in water-equivalent path length is an indicator of plan robustness and should be considered for the selection of patients for whom the plan would require adaptation.

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author
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publishing date
type
Contribution to journal
publication status
published
in
International Journal of Radiation Oncology Biology Physics
volume
99
issue
5
pages
8 pages
publisher
Elsevier
external identifiers
  • pmid:28964587
  • scopus:85030154324
ISSN
0360-3016
DOI
10.1016/j.ijrobp.2017.08.023
language
English
LU publication?
no
id
70299b5d-3e9f-4253-a5c2-98eda983971a
date added to LUP
2020-07-28 08:59:10
date last changed
2024-03-05 01:38:44
@article{70299b5d-3e9f-4253-a5c2-98eda983971a,
  abstract     = {{<p>Purpose We evaluated the feasibility of treating patients with locally advanced non-small cell lung cancer (NSCLC) with pencil beam scanned intensity modulated proton therapy (IMPT) in breath-hold. Methods and Materials Fifteen NSCLC patients who had previously received 66 Gy in 33 fractions with image guided photon radiation therapy were included in the present simulation study. In addition to a planning breath-hold computed tomography (CT) scan before the treatment start, a median of 6 (range 3-9) breath-hold CT scans per patient were acquired prospectively throughout the radiation therapy course. Three-field IMPT plans were constructed using the planning breath-hold CT scan, and the four-dimensional dose distributions were simulated, with consideration of both patient intra- and interfraction motion, in addition to dynamic treatment delivery. Results The median clinical target volume receiving 95% of the prescribed dose was 99.8% and 99.7% for the planned and simulated dose distributions, respectively. For 3 patients (20%), the dose degradation was &gt;5%, and plan adjustment was needed. Dose degradation correlated significantly with the change in water-equivalent path lengths (P&lt;.01) in terms of the percentage of voxels with 3-mm or more undershoot on repeat CT scans. The dose to the organs at risk was similar for the planned and simulated dose distributions. Three or fewer breath-holds per field would be required for 12 of the 15 patients, which was clinically feasible. Conclusions For 9 of 15 NSCLC patients, IMPT in breath-hold was both dosimetrically robust and feasible to deliver regarding the treatment time. Three patients would have required plan adaption to meet the dosimetric criteria. The change in water-equivalent path length is an indicator of plan robustness and should be considered for the selection of patients for whom the plan would require adaptation.</p>}},
  author       = {{Gorgisyan, Jenny and Munck af Rosenschold, Per and Perrin, Rosalind and Persson, Gitte F. and Josipovic, Mirjana and Belosi, Maria Francesca and Engelholm, Svend Aage and Weber, Damien C. and Lomax, Antony J.}},
  issn         = {{0360-3016}},
  language     = {{eng}},
  month        = {{12}},
  number       = {{5}},
  pages        = {{1121--1128}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Radiation Oncology Biology Physics}},
  title        = {{Feasibility of Pencil Beam Scanned Intensity Modulated Proton Therapy in Breath-hold for Locally Advanced Non-Small Cell Lung Cancer}},
  url          = {{http://dx.doi.org/10.1016/j.ijrobp.2017.08.023}},
  doi          = {{10.1016/j.ijrobp.2017.08.023}},
  volume       = {{99}},
  year         = {{2017}},
}