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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Intensity modulated proton arc therapy via geometry-based energy selection for ependymoma.

Wenhua Cao1, Yupeng Li1, Xiaodong Zhang1

  • 1Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Journal of Applied Clinical Medical Physics
|March 13, 2023
PubMed
Summary

A new intensity modulated proton arc therapy (IMPAT) planning method offers dosimetric benefits for ependymoma patients. IMPAT plans showed improved homogeneity, conformity, and biological effectiveness compared to intensity-modulated proton therapy (IMPT).

Keywords:
Proton Arc Geometry-based Ependymoma

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Cancer Treatment

Background:

  • Intensity-modulated proton therapy (IMPT) is a precise radiation technique.
  • Optimizing treatment plans for complex tumor geometries, like ependymoma, remains a challenge.
  • Novel planning strategies are needed to enhance dosimetric outcomes and biological effectiveness.

Purpose of the Study:

  • To develop and evaluate a novel method for intensity modulated proton arc therapy (IMPAT) planning.
  • To assess if IMPAT planning offers dosimetric advantages over conventional IMPT for ependymoma.
  • To compare the computational resources required for IMPAT and IMPT planning.

Main Methods:

  • A geometry-based energy selection module was developed, utilizing ray-tracing and Gaussian approximation for spot contributions.
  • The module identifies a minimal set of energy layers per gantry angle to ensure target coverage.
  • IMPAT plans were generated using robust optimization in a commercial treatment planning system and compared to reference IMPT plans for four ependymoma patients.

Main Results:

  • IMPAT plans achieved comparable plan robustness and similar maximum doses to the brainstem as IMPT plans.
  • IMPAT plans demonstrated superior homogeneity and conformity of the dose distribution within the clinical target volume (CTV).
  • IMPAT plans showed increased relative biological effectiveness (RBE) enhancement in the CTV and, in most cases, the brainstem.

Conclusions:

  • The proposed IMPAT planning method is efficient and shows potential for treating ependymoma and tumors near critical organs.
  • IMPAT planning can provide dosimetric benefits, including enhanced RBE, due to increased linear energy transfer (LET).
  • This technique may improve treatment efficacy and reduce toxicity for specific patient populations.