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Pencil-beam Delivery Pattern Optimization Increases Dose Rate for Stereotactic FLASH Proton Therapy.

Rodrigo José Santo1, Steven J M Habraken2, Sebastiaan Breedveld3

  • 1Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, The Netherlands; Instituto Superior Técnico, Department of Physics, Universidade de Lisboa, Lisbon, Portugal; Holland Proton Therapy Center, Department of Medical Physics & Informatics, Delft, The Netherlands.

International Journal of Radiation Oncology, Biology, Physics
|September 3, 2022
PubMed
Summary

Optimizing proton therapy scan patterns significantly increases FLASH coverage for lung cancer treatment. This novel approach enhances dose rates, potentially improving healthy tissue sparing in FLASH-PT.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Cancer Treatment

Background:

  • Proton therapy (PT) offers high dose rates (>40 Gy/s) with pencil-beam scanning (PBS).
  • The PBS delivery pattern critically influences local dose rates (PBS-DR) in FLASH-PT.
  • Optimizing scan patterns is crucial for maximizing FLASH coverage in PBS-based FLASH-PT.

Purpose of the Study:

  • To optimize patient-specific scan patterns for stereotactic FLASH-PT of early-stage lung cancer and lung metastases.
  • To maximize the volume of organs at risk irradiated to >8 Gy with a PBS-DR >40 Gy/s (FLASH coverage).
  • To evaluate the impact of scan pattern optimization on PBS-DR distribution and FLASH coverage.

Main Methods:

  • Developed in-house software for optimizing 54 Gy/3 fractions PT plans using 244 MeV proton beams.
  • Employed a Genetic Algorithm with parallel populations and migration for scan pattern optimization.
  • Evaluated optimized patterns against standard line-by-line scanning for FLASH coverage and PBS-DR robustness.

Main Results:

  • Optimized patterns exhibited a snowflake-like structure, significantly increasing median FLASH coverage from 6.9% to 29.0%.
  • Optimized patterns demonstrated robustness against beam current variations, with minimal impact on FLASH coverage.
  • The study quantified PBS-DR distribution and evaluated population PBS-DR-volume histograms.

Conclusions:

  • Sequential scan-pattern optimization significantly improves PBS-DR, FLASH coverage, and potential healthy-tissue sparing.
  • The developed optimizer is flexible and adaptable to specific FLASH conditions.
  • This approach holds promise for enhancing the efficacy and safety of FLASH-PT.