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Range uncertainty is a much discussed topic in proton therapy. Although a very real aspect of proton therapy, its magnitude and consequences are sometimes misunderstood or over estimated. In this article, the sources and consequences of range uncertainty are reviewed, a number of myths associated with the effect discussed and the effects of range uncertainty put into clinical context. The aim is to put range uncertainty into clinical context and attempt to de-bunk some of the more exaggerated claims made as...
Proton radiation therapy offers advantages over photon therapy, assisting with severe side effect avoidance. Pediatric patients with medulloblastoma have demonstrated benefit from this technology in recently published cohort studies.
Although the number of proton therapy centres is growing worldwide, proton therapy is still a limited resource. The primary reasons are gantry size and cost. Therefore, we investigate the potential of a new design for proton therapy, which may facilitate proton treatments in conventional bunkers and allow the widespread use of protons.
Craniospinal irradiation (CSI) is an important component of therapy for many pediatric central nervous system (CNS) malignancies. Proton therapy is increasingly available and utilized for minimizing radiation exposure to normal tissues. The absence of exit dose with proton therapy mandates decisions regarding coverage of the vertebral bodies (VB) in non-skeletally mature patients. While the contents within thecal sac represent the true CTV, some physicians target the entire VB in growing children due to con...
This study recruited two centers with expertise in treating pediatric brain tumors with robotic radiation delivery system photon therapy and proton therapy, respectively, to study the plan quality and the dose deposition characteristics of robotic radiation delivery system photon and intensity modulated proton therapy (IMPT) plans.
In vivo range verification in proton therapy is a critical step to help minimize range and dose uncertainty. We propose to employ a time reversal (TR)-based approach using proton-induced acoustics (protoacoustics) to reconstruct pressure/dose distribution in heterogeneous tissues.
In this work, we investigated the effect on the workflow and setup accuracy of using surface guided radiation therapy (SGRT) for patient setup, megavoltage cone beam CT (MVCBCT) or kilovoltage cone beam CT (kVCBCT) for imaging and fixed IMRT or volumetric-modulated arc therapy (VMAT) for treatment delivery with the Halcyon linac.
Proton arc therapy (PAT) has been proposed as a possible evolution for proton therapy. This Commentary uses dosimetric and cancer risk evaluations from earlier studies to compare PAT with Intensity Modulated Proton Therapy (IMPT). It is concluded that, although PAT may not produce better physical dose distributions than IMPT, the radiobiological considerations associated with particular PAT techniques could offer the possibility of an increased Therapeutic Index.
To investigate the role of intensity-modulated proton therapy (IMPT) for regional nodal irradiation in patients with breast carcinoma in comparison with volumetric-modulated arc therapy (VMAT).
Robust optimization is becoming the gold standard for generating robust plans against various kinds of treatment uncertainties. Today, most robust optimization strategies use a pragmatic set of treatment scenarios (so-called uncertainty set) consisting of combinations of maximum errors, of each considered uncertainty source (such as tumor motion, setup and image-conversion errors). This approach presents two key issues. First, a subset of considered scenarios are unnecessarily improbable which could potenti...
To investigate the effects of interfractional variation, such as anatomical changes and setup errors, on dose delivery during treatment for prostate cancer (PC) and head and neck cancer (HNC) by courses of volumetric modulated arc therapy (VMAT) aided by on-treatment electronic portal imaging device (EPID) images.
Classical robust optimization (cRO) in intensity-modulated proton therapy (IMPT) considers isocenter position and particle range uncertainties; anatomical robust optimization (aRO) aims to consider additional non-rigid positioning variations. This work compares the influence of different uncertainty sources on the robustness of cRO and aRO IMPT plans for head and neck squamous cell carcinoma (HNSCC).
Clinicians deciding whether to refer a patient or family to specialty palliative care report facing high levels of uncertainty. Most research on medical uncertainty has focused on prognostic uncertainty. As part of a pediatric palliative referral intervention for oncology teams we explored how uncertainty might influence palliative care referrals.
To evaluate the incidence of imaging changes in our pediatric brain tumor population treated with spot scanning proton therapy, and analyze the spatial correlation of imaging changes with a novel biologic dose model.
Proton therapy is very sensitive to treatment uncertainties. These uncertainties can induce proton range variations and may lead to severe dose distortions. However, most commercial tools only offer a limited integration of these uncertainties during treatment planning. In order to verify the robustness of a treatment plan, this study aims at developing a comprehensive Monte Carlo simulation of the treatment delivery, including the simulation of setup and range errors, variation of the breathing motion, and...
Proton therapy is affected by range uncertainty, which is partly caused by an ambiguous conversion from x-ray attenuation to proton stopping power. CT calibration curves, or Hounsfield look-up tables (HLUTs), are institution-specific and may be a source of systematic errors in treatment planning. A range probing method to verify, optimize and validate HLUTs for proton treatment is proposed.
Postmastectomy radiation therapy is technically difficult and can be considered one of the most complex techniques concerning patient setup reproducibility. Slight patient setup variations - particularly when high-conformal treatment techniques are used - can adversely affect the accuracy of the delivered dose and the patient outcome. This research aims to investigate the inter-fraction setup variations occurring in two different scenarios of clinical practice: at the reference and at the current patient s...
High-dose fractionated radiotherapy is often necessary to achieve long-term tumor control in several types of tumors involving or within close proximity to the brain. There is limited data to guide on optimal constraints to the adjacent nontarget brain. This investigation explored the significance of the three-dimensional (3D) dose distribution of passive scattering proton therapy to the brain with other clinicopathological factors on the development of symptomatic radiation necrosis.
Radiosensitizer enhanced radiotherapy provides the possibility of improved treatment outcomes by preferentially increasing the effectiveness of radiation within the tumor. Proton therapy offers improved sparing of tissue distal of the tumor along the beam path and reduced integral dose compared to conventional photon therapy. The combination of proton therapy with radiosensitizers offers the potential for an enhanced therapy with increased effect within the tumor and low integral dose. The simulations perfo...
To report the outcomes of sinonasal tumors treated with proton beam therapy (PBT) on the Proton Collaborative Group registry study.
The Pediatric Proton/Photon Consortium Registry (PPCR) is a comprehensive data registry composed of pediatric patients treated with radiation. It was established to expedite outcomes-based research. The attributes which allow the PPCR to be a successful collaboration are reviewed.
For the past 20 years, Paul Scherrer Institut (PSI) has treated more than 1500 patients with deep-seated tumors using PSI-Plan, an in-house developed TPS used for PBS proton therapy, in combination with its home-built gantries. The goal of the present work is to benchmark the performance of a new TPS/Gantry system for proton therapy centers which have established already a baseline standard of care.
To evaluate the clinical impact of biological uncertainties in small field proton therapy due to the assumption of using a constant relative biological effectiveness (RBE) value of 1.1 (RBE-fixed) compared to a variable RBE (RBE-weighted). In this context the impact of the applied range margin was investigated. Eight patients with arteriovenous malformation (AVM) treated with proton radiosurgery were selected due to the small target volume. Dose distributions were compared for RBE-weighte...
Proton pump inhibitors (PPIs) are an effective treatment for eosinophilic esophagitis (EoE); however, only 30% to 60% of patients respond. Common genetic variants in CYP2C19 and STAT6 associate with PPI plasma concentration and magnitude of inflammatory response, respectively. Our objective was to determine if genetic variation in the genes for CYP2C19 and STAT6 influence differentiation between PPI responsive esophageal eosinophilia versus PPI nonresponsive EoE (PPI-REE, PPI-nonresponsive EoE).
Proton therapy is an evolving radiotherapy modality with indication for numerous cancer types. With the benefits of reducing dose and sparing normal tissue, protons offer a clear physical and dosimetric advantage over photon radiotherapy for many patients. However, its impact on one type of disease, non-small cell lung cancer (NSCLC), is still not fully understood. Our review aims to highlight the data for using proton therapy in NSCLC, with a focus on the clinical data-or lack thereof-supporting proton tre...