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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Adaptive fractionation therapy: I. Basic concept and strategy.

Weiguo Lu1, Mingli Chen, Quan Chen

  • 1TomoTherapy Inc, 1240 Deming Way, Madison, WI 53717, USA. wlu@tomotherapy.com

Physics in Medicine and Biology
|September 11, 2008
PubMed
Summary
This summary is machine-generated.

Adaptive fractionation therapy (AFT) adjusts radiation fraction size daily based on tumor and organ proximity, optimizing dose delivery. This technique significantly reduces organ at risk (OAR) dose while ensuring the prescribed tumor dose is met.

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Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Conventional radiotherapy uses fixed fraction sizes, potentially leading to suboptimal therapeutic ratios due to daily variations in patient anatomy.
  • Variations in the distance between tumors and organs at risk (OAR) present challenges for precise dose delivery in radiotherapy.

Purpose of the Study:

  • To introduce and evaluate the concept and strategies of adaptive fractionation therapy (AFT) for optimizing OAR sparing.
  • To demonstrate that AFT can achieve a better therapeutic ratio by adapting fraction sizes based on real-time anatomical changes.

Main Methods:

  • AFT utilizes on-line adaptive techniques, identifying daily anatomical configurations via image guidance.
  • Fraction sizes are optimized using dynamic linear programming to maximize OAR sparing while maintaining the planned tumor dose.
  • Extensive simulations of thousands of treatment courses were performed to assess AFT's efficiency and robustness.

Main Results:

  • Simulations showed that AFT can significantly reduce cumulative OAR dose compared to conventional fractionation.
  • For a 20% variation and fraction size bounds of [1 Gy, 3 Gy], AFT reduced OAR dose by 7-20% (3-8 Gy).
  • The effectiveness of AFT in sparing OARs is directly related to the magnitude of anatomical variations and the flexibility of fraction size bounds.

Conclusions:

  • Adaptive fractionation therapy offers a promising approach to improve therapeutic ratios in radiotherapy.
  • AFT allows for personalized dose delivery by adapting to intra-fractional anatomical changes, leading to enhanced OAR protection.