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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

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Robust mixed electron-photon radiation therapy planning for soft tissue sarcoma.

Veng Jean Heng¹, Monica Serban^2,3, Marc-André Renaud⁴

¹Department of Physics and Medical Physics Unit, McGill University, Montreal, Canada.

Medical Physics

|September 8, 2023

Summary

Mixed electron-photon beam radiation therapy (MBRT) spares organs at risk for soft tissue sarcoma patients. This advanced technique offers dosimetric benefits without compromising target coverage compared to VMAT.

Keywords:

mixed beam radiation therapy planning study soft tissue sarcoma

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Area of Science:

Radiation Oncology
Medical Physics

Background:

Mixed electron-photon beam radiation therapy (MBRT) combines electron and photon beams for optimized radiation treatment plans.
MBRT leverages the dose falloff of electrons and the sharp penumbra of photons.

Purpose of the Study:

To investigate the dosimetric advantages of MBRT for soft tissue sarcoma (STS) patients.
Compare MBRT plans against conventional photon-based Volumetric Modulated Arc Therapy (VMAT).

Main Methods:

Retrospective replanning of 22 lower extremity STS cases from VMAT to MBRT.
MBRT plans utilized 6 MV photons and electron energies (6-20 MeV) on a Varian TrueBeam linac.
Compared dose to clinical target volume (CTV), bone, and organs at risk (OARs) using Wilcoxon signed-rank test.

Main Results:

MBRT eliminated the need for bolus in 10/22 patients due to higher electron entrance dose.
Clinical target volume (CTV) coverage was equivalent: 97.9% (MBRT) vs. 98.1% (VMAT).
MBRT significantly reduced dose to normal tissue (14.9%) and bone (8.2%) compared to VMAT.

Conclusions:

MBRT provides significant sparing of organs at risk for STS patients with subcutaneous involvement.
MBRT achieves this without sacrificing target coverage compared to VMAT.
MBRT is a logistically feasible technique deliverable on conventional linacs with clear dosimetric benefits.