Proton beam therapy: neuroradiology considerations and challenges

Area of Science:

• Neuroradiology
• Radiation Oncology
• Paediatric Neuro-oncology

Background:

• Proton beam therapy (PBT) is gaining traction in paediatric neuro-oncology due to its superior dose distribution and reduced toxicity potential.
• Neuroradiologists are crucial for identifying PBT-induced changes and guiding long-term patient surveillance.

Purpose of the Study:

• This review details essential neuroradiological considerations throughout the PBT process.
• It aims to equip neuroradiologists with knowledge of PBT-specific imaging findings and management strategies.

Main Methods:

• Discusses MRI integration challenges, including workflow modifications, specialized immobilization, and tailored sequence design for PBT planning.
• Highlights the role of ongoing sequence optimization, high-resolution imaging, and advanced reconstructions for improved target and organ delineation.
• Addresses the need for interval imaging and adaptive replanning due to anatomical changes during treatment.

Main Results:

• PBT can lead to distinct post-treatment radiological appearances compared to photon therapy, including unique patterns of pseudoprogression, white matter injury, and vascular complications.
• Accurate interpretation is vital to differentiate treatment effects from tumor recurrence.
• Advances in MRI-only workflows, synthetic CT, ultra-high-field imaging, and computational modeling promise enhanced treatment precision and characterization of effects.

Conclusions:

• Familiarity with PBT-specific imaging patterns is essential for neuroradiologists, particularly those at referring centers.
• Standardizing post-treatment imaging protocols is crucial as PBT use expands.
• This review supports neuroradiologists in managing patients undergoing PBT, improving diagnostic accuracy and patient care.