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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Scripted spot removal in PBS proton therapy planning.

Samantha G Hedrick1, Bryant Walker1, Bart Morris1

  • 1Provision CARES Proton Therapy Center, Knoxville, Tennessee, USA.

Journal of Applied Clinical Medical Physics
|December 10, 2021
PubMed
Summary
This summary is machine-generated.

Proton therapy spot deletion in critical structures can reduce side effects. This method, using a simple script, shows excellent clinical results, including fewer skin reactions in head and neck and breast patients.

Keywords:
PBSoutcomesscripting

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Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Proton therapy exhibits variable relative biological effectiveness (RBE) across the Bragg peak, with increased RBE at the distal end due to higher linear energy transfer (LET).
  • Current proton therapy treatment planning systems are evolving towards LET optimization to manage the biological impact at the Bragg peak's end.
  • A script-based approach allows for the simulation of spot deletion in critical structures during optimization, potentially mitigating these effects.

Purpose of the Study:

  • To develop and implement a script for deleting proton therapy beam spots within organs at risk (OARs).
  • To investigate the potential for reducing treatment-related side effects by eliminating Bragg peaks in OARs.
  • To evaluate the clinical efficacy of this spot deletion strategy in various patient populations.

Main Methods:

  • A custom script was developed to enable users to delete treatment beam spots from selected OARs.
  • The script was initially applied to prostate cancer patients, removing spots from the rectum and sigmoid outside the planning target volume.
  • The method was subsequently extended to head and neck (H&N) and breast/chestwall patients, targeting a 0.5-cm skin rind to minimize acute skin toxicity.

Main Results:

  • The implementation of the spot deletion script has yielded positive clinical outcomes.
  • A notable reduction in acute skin reactions was observed in H&N and breast cancer patients treated with this method.
  • Nominal target coverage and plan robustness were generally maintained satisfactorily despite spot deletions.

Conclusions:

  • A straightforward script for deleting spots in critical structures during proton therapy planning is clinically effective.
  • This technique has demonstrated success in reducing side effects, particularly skin reactions, in H&N and breast cancer patients.
  • The spot deletion strategy offers a practical approach to enhance patient safety and treatment tolerance in proton therapy.