International Journal of Particle Therapy最新文献

Mechanism of action: External beam, whether with photons or particles, remains as the most common type of radiation therapy. The main drawback is that radiation deposits dose in healthy tissue before reaching its target. Boron neutron capture therapy (BNCT) is based on the nuclear capture and fission reactions that occur when ¹⁰B is irradiated with low-energy (0.0025 eV) thermal neutrons. The resulting ¹⁰B(n,α)⁷Li capture reaction produces high linear energy transfer (LET) α particles, helium nuclei (⁴He), and recoiling lithium-7 (⁷Li) atoms. The short range (5-9 μm) of the α particles limits the destructive effects within the boron-containing cells. In theory, BNCT can selectively destroy malignant cells while sparing adjacent normal tissue at the cellular levels by delivering a single fraction of radiation with high LET particles.

History: BNCT has been around for many decades. Early studies were promising for patients with malignant brain tumors, recurrent tumors of the head and neck, and cutaneous melanomas; however, there were certain limitations to its widespread adoption and use.

Current limitations and prospects: Recently, BNCT re-emerged owing to several developments: (1) small footprint accelerator-based neutron sources; (2) high specificity third-generation boron carriers based on monoclonal antibodies, nanoparticles, among others; and (3) treatment planning software and patient positioning devices that optimize treatment delivery and consistency.

Purpose: This study aimed to determine the integral depth-dose curves and assess the geometric collection efficiency of different detector diameters in proton pencil beam scanning.

Materials and methods: The Varian ProBeam Compact spot scanning system was used for this study. The integral depth-dose curves with a proton energy range of 130 to 220 MeV were acquired with 2 types of Bragg peak chambers: 34070 with 8-cm diameter and 34089 with 15-cm diameter (PTW), multi-layer ionization chamber with 12-cm diameter (Giraffe, IBA Dosimetry), and PeakFinder with 8-cm diameter (PTW). To assess geometric collection efficiency, the integral depth-dose curves of 8- and 12-cm chamber diameters were compared to a 15-cm chamber diameter as the largest detector.

Results: At intermediate depths of 130, 150, 190, and 220 MeV, PTW Bragg peak chamber type 34089 provided the highest integral depth-dose curves followed by IBA Giraffe, PTW Bragg peak chamber type 34070, and PTW PeakFinder. Moreover, PTW Bragg peak chamber type 34089 had increased geometric collection efficiency up to 3.8%, 6.1%, and 3.1% when compared to PTW Bragg peak chamber type 34070, PTW PeakFinder, and IBA Giraffe, respectively.

Conclusion: A larger plane-parallel ionization chamber could increase the geometric collection efficiency of the detector, especially at intermediate depths and high-energy proton beams.

Purpose: Cranial radiation therapy remains an integral component of curative treatment for pediatric patients with brain tumors. Proton beam radiation therapy (PBT) can limit collateral radiation dose to surrounding normal tissue, thus reducing off-target exposure while maintaining appropriate tumor coverage. While PBT offers significant advantages over photon therapy for pediatric patients with intracranial malignancies, cases of brainstem necrosis after PBT have raised concerns that PBT may pose an increased risk of necrosis over photon therapy. We investigated the incidence of brainstem necrosis at our institution in children treated with PBT for intracranial malignancies.

Patients and methods: Patients with pediatric brain tumor treated with passively scattered PBT, using a gantry-mounted, synchrocyclotron single-vault system between 2013 and 2018, were retrospectively reviewed. Inclusion criteria included patients 21 years of age or younger who received a minimum 0.1 cm³ maximum brainstem dose of 50 Gray relative biological effectiveness (GyRBE). Patients were assessed for "central nervous system necrosis" in the brainstem per the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0 (US National Cancer Institute, Bethesda, Maryland) criteria.

Results: Fifty-eight patients were included for analysis. The median age was 10.3 years. Twenty-one (36.2%) patients received craniospinal irradiation. Thirty-four (58.6%) patients received chemotherapy. The median prescription radiation dose was 54 GyRBE. Regarding published dosimetric constraints used at 3 separate proton centers, the goal brainstem D50% <52 GyRBE was exceeded in 23 (40%) patients, but the brainstem Dmax <58 GyRBE was not exceeded in any patients. No patient experienced grade ≥2 brainstem injury. One patient demonstrated radiographic changes consistent with grade 1 toxicity. This patient had myeloablative chemotherapy with tandem stem cell rescue before PBT.

Conclusion: Our data demonstrates a low risk of any brainstem injury in children treated with passively scattered PBT using a single-vault synchrocyclotron.

Purpose: Proton beam therapy (PBT) may provide an advantage when planning well-selected patients with extremity soft tissue sarcoma (eSTS), specifically for large, anatomically challenging cases. We analyzed our early experience with PBT on toxicity and outcomes.

Materials and methods: A retrospective study was performed for eSTS treated between June 2016 and October 2020 with pencil beam scanning PBT at 2 institutions. Diagnostic, treatment, and toxicity characteristics were gathered from baseline to last follow-up or death. Wound complications were defined as secondary operations for wound repair (debridement, drainage, skin graft, and muscle flap) or nonoperative management requiring hospitalization. Statistical analysis was performed with R software.

Results: Twenty consecutive patients with a median age 51.5 years (range, 19-78 years) were included. Median follow-up was 13.7 months (range, 1.7-48.1 months). Tumor presentation was primary (n = 17) or recurrent after prior combined modality therapy (n = 3). Tumor location was either lower extremity (n = 16) or upper extremity (n = 4). Radiation was delivered preoperatively in most patients (n = 18). Median pretreatment tumor size was 7.9 cm (range, 1.3 -30.0 cm). The 1-year locoregional control was 100%. Four patients (20%) had developed metastatic disease by end of follow-up. Maximum toxicity for acute dermatitis was grade 2 in 8 patients (40%) and grade 3 in 3 patients (15%). After preoperative radiation and surgical resection, acute wound complications occurred in 6 patients (35%). Tumor size was larger in patients with acute wound complications compared with those without (medians 16 cm, range [12-30.0 cm] vs 6.3 cm, [1.3-14.4 cm], P = .003).

Conclusion: PBT for well selected eSTS cases demonstrated excellent local control and similar acute wound complication rate comparable to historic controls. Long-term follow-up and further dosimetric analyses will provide further insight into potential advantages of PBT in this patient population.

We introduce a custom-made silicone-filled vaginal spacer for use during treatment of female patients receiving pelvic proton radiation therapy. Commercially available vaginal dilators can be purchased as hollow objects; when filled with a media, they can act as a beam stopper and/or tissue spacer while pushing uninvolved vaginal wall away from a high-dose region. Dosimetric advantages of these specifically constructed silicone-filled vaginal spacers were investigated when compared to the unaltered commercially available product or no vaginal spacer in pediatric proton therapy.

Sexual dysfunction is a common toxicity and detrimental for the quality of life of women treated with chemoradiotherapy for anal cancer. Sexual dysfunction occurs because the vagina is closely approximated to the anal canal and typically receives substantial doses of radiation. Strategies for mitigation have largely been focused on posttreatment therapy and symptom management. The use of daily vaginal dilator placement during radiotherapy to mitigate dose to the vagina has been previously explored with modest gains, while proton therapy is under active investigation for the treatment of anal cancer. Use of proton therapy for anal cancer reduces dose to some organs at risk but may inadvertently increase vaginal toxicity if the proton beam terminates in the vaginal tissue. Herein, we present the case histories of 2 women treated for squamous cell carcinoma of the anal canal with the novel combination of intensity-modulated proton therapy and daily vaginal dilator placement to maximally reduce dose to the vagina and protect it from areas of increased energy deposition at the end of the proton range.

Purpose: The purpose of this work is to study the feasibility of using an XRV-124 scintillation detector in measuring the collinearity of the x-ray system and uniform scanning proton beam.

Methods: A brass aperture for Snout 10 was manufactured. The center of the aperture had an opening of 1 cm in diameter (4 cm for the film measurements). The 2D kV x-ray images of the XRV-124 were acquired such that the marker inside the detector is aligned to the imaging isocenter. After obtaining the optimal camera settings, a uniform scanning proton beam was delivered for various ranges (12 g/cm² to 28 g/cm² in step size of 2 g/cm²). For each range, 10 monitor units (MU) of the first layer were delivered to the XRV-124 detector. Collinearity tests were repeated by using EDR2 and EBT3 films following our current quality assurance protocol in practice. The results from the XRV-124 measurements were compared against the collinearity results from EDR2 and EBT3 films.

Results and discussion: The collinearity results were evaluated in the horizontal (x) and vertical (y) directions. The average deviation in collinearity in the x-direction was -0.24 ± 0.30 mm, 0.57 ± 0.39 mm, and -0.27 ± 0.14 mm for EDR2, EBT3, and XRV-124, respectively. In the y-direction, the average deviation was 0.39 ± 0.07 mm, 0.29 ± 0.14 mm, and 0.39 ± 0.03 mm for EDR2, EBT3, and XRV-124, respectively.

Conclusion: The measurement results from the XRV-124 and films are in good agreement. Compared to film, the use of the XRV-124 detector for collinearity measurements in uniform scanning protons is more efficient and provides results in real time.

Purpose: Proton beam radiotherapy (PBT) has been used for the definitive treatment of localized prostate cancer with low rates of high-grade toxicity and excellent patient-reported quality-of-life metrics. Technological advances such as pencil beam scanning (PBS), Monte Carlo dose calculations, and polyethylene glycol gel rectal spacers have optimized prostate proton therapy. Here, we report the early clinical outcomes of patients treated for localized prostate cancer using modern PBS-PBT with hydrogel rectal spacing and fiducial tracking without the use of endorectal balloons.

Materials and methods: This is a single institutional review of consecutive patients treated with histologically confirmed localized prostate cancer. Prior to treatment, all patients underwent placement of fiducials into the prostate and insertion of a hydrogel rectal spacer. Patients were typically given a prescription dose of 7920 cGy at 180 cGy per fraction using a Monte Carlo dose calculation algorithm. Acute and late toxicity were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE), version 5. Biochemical failure was defined using the Phoenix definition.

Results: From July 2018 to April 2020, 33 patients were treated (median age, 75 years). No severe acute toxicities were observed. The most common acute toxicity was urinary frequency. With a median follow-up of 18 months, there were no high-grade genitourinary late toxicities; however, one grade 3 gastrointestinal toxicity was observed. Late erectile dysfunction was common. One treatment failure was observed at 21 months in a patient treated for high-risk prostate cancer.

Conclusion: Early clinical outcomes of patients treated with PBS-PBT using Monte Carlo-based planning, fiducial placement, and rectal spacers sans endorectal balloons demonstrate minimal treatment-related toxicity with good oncologic outcomes. Rectal spacer stabilization without the use of endorectal balloons is feasible for the use of PBS-PBT.

Purpose: To present quantitative dosimetric evaluations of five proton pencil beam spot placement techniques.

Materials and methods: The spot placement techniques that were investigated include two grid-based (rectilinear grid and hexagonal grid, both commonly available in commercial planning systems) and three boundary-contoured (concentric contours, hybrid, and optimized) techniques. Treatment plans were created for two different target volumes, one spherical and one conical. An optimal set of planning parameters was defined for all treatment plans and the impact of spot placement techniques on the plan quality was evaluated in terms of lateral/distal dose falloff, normal tissue sparing, conformity and homogeneity of dose distributions, as well as total number of spots used.

Results: The results of this work highlight that for grid-based spot placement techniques, the dose conformity is dependent on target cross-sectional shape perpendicular to beam direction, which changes for each energy layer. This variable conformity problem is mitigated by using boundary contoured spot placement techniques. However, in the case of concentric contours, the conformity is improved but at the cost of decreased homogeneity inside the target. Hybrid and optimized spot placement techniques, which use contoured spots at the boundary and gridlike interior spot patterns, provide more uniform dose distributions inside the target volume while maintaining the improved dose conformity. The optimized spot placement technique improved target coverage, homogeneity of dose, and minimal number of spots. The dependence of these results on spot size is also presented for both target shapes.

Conclusion: This work illustrates that boundary-contoured spot placement techniques offer marked improvement in dosimetry metrics when compared to commercially available grid-based techniques for a range of proton scanned beam spot sizes.