Dosimetric Evaluation and Reproducibility of Breath-hold Plans in Intensity Modulated Proton Therapy: An Initial Clinical Experience
Purpose: Breath-hold (BH) technique can mitigate target motion, minimize target margins, reduce normal tissue doses, and lower the effect of interplay effects with intensity-modulated proton therapy (IMPT). This study presents dosimetric comparisons between BH and nonbreath-hold (non-BH) IMPT plans...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109423002208 |
| _version_ | 1797355196492283904 |
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| author | Pouya Sabouri, PhD Jason Molitoris, MD, PhD Maida Ranjbar, PhD Julie Moreau, BS Charles B. Simone, II, MD Pranshu Mohindra, MD, MBBS Katja Langen, PhD Sina Mossahebi, PhD |
| author_facet | Pouya Sabouri, PhD Jason Molitoris, MD, PhD Maida Ranjbar, PhD Julie Moreau, BS Charles B. Simone, II, MD Pranshu Mohindra, MD, MBBS Katja Langen, PhD Sina Mossahebi, PhD |
| author_sort | Pouya Sabouri, PhD |
| collection | DOAJ |
| description | Purpose: Breath-hold (BH) technique can mitigate target motion, minimize target margins, reduce normal tissue doses, and lower the effect of interplay effects with intensity-modulated proton therapy (IMPT). This study presents dosimetric comparisons between BH and nonbreath-hold (non-BH) IMPT plans and investigates the reproducibility of BH plans using frequent quality assurance (QA) computed tomography scans (CT). Methods and Materials: Data from 77 consecutive patients with liver (n = 32), mediastinal/lung (n = 21), nonliver upper abdomen (n = 20), and malignancies in the gastroesophageal junction (n = 4), that were treated with a BH spirometry system (SDX) were evaluated. All patients underwent both BH CT and 4-dimensional CT simulations. Clinically acceptable BH and non-BH plans were generated on each scan, and dose-volume histograms of the 2 plans were compared. Reproducibility of the BH plans for 30 consecutive patients was assessed using 1 to 3 QA CTs per patient and variations in dose-volume histograms for deformed target and organs at risk (OARs) volumes were compared with the initial CT plan. Results: Use of BH scans reduced initial and boost target volumes to 72% ± 20% and 70% ± 17% of non-BH volumes, respectively. Additionally, mean dose to liver, stomach, kidney, esophagus, heart, and lung V20 were each reduced to 71% to 79% with the BH technique. Similarly, small and large bowels, heart, and spinal cord maximum doses were each lowered to 68% to 84%. Analysis of 62 QA CT scans demonstrated that mean target and OAR doses using BH scans were reproducible to within 5% of their nominal plan values. Conclusions: The BH technique reduces the irradiated volume, leading to clinically significant reductions in OAR doses. By mitigating tumor motion, the BH technique leads to reproducible target coverage and OAR doses. Its use can reduce motion-related uncertainties that are normally associated with the treatment of thoracic and abdominal tumors and, therefore, optimize IMPT delivery. |
| first_indexed | 2024-03-08T14:08:44Z |
| format | Article |
| id | doaj.art-256db647f92543d3a22d429bc8ec1fb9 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-03-08T14:08:44Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-256db647f92543d3a22d429bc8ec1fb92024-01-15T04:23:44ZengElsevierAdvances in Radiation Oncology2452-10942024-03-0193101392Dosimetric Evaluation and Reproducibility of Breath-hold Plans in Intensity Modulated Proton Therapy: An Initial Clinical ExperiencePouya Sabouri, PhD0Jason Molitoris, MD, PhD1Maida Ranjbar, PhD2Julie Moreau, BS3Charles B. Simone, II, MD4Pranshu Mohindra, MD, MBBS5Katja Langen, PhD6Sina Mossahebi, PhD7Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, ArkansasDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland; Maryland Proton Treatment Center, Baltimore, MarylandDepartment of Radiation Oncology, University of California San Diego, La Jolla, CaliforniaNew York Proton Center, New York, New YorkNew York Proton Center, New York, New YorkDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland; Maryland Proton Treatment Center, Baltimore, MarylandDepartment of Radiation Oncology, Emory University, Atlanta, GeorgiaDepartment of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland; Maryland Proton Treatment Center, Baltimore, Maryland; Corresponding author: Sina Mossahebi, PhDPurpose: Breath-hold (BH) technique can mitigate target motion, minimize target margins, reduce normal tissue doses, and lower the effect of interplay effects with intensity-modulated proton therapy (IMPT). This study presents dosimetric comparisons between BH and nonbreath-hold (non-BH) IMPT plans and investigates the reproducibility of BH plans using frequent quality assurance (QA) computed tomography scans (CT). Methods and Materials: Data from 77 consecutive patients with liver (n = 32), mediastinal/lung (n = 21), nonliver upper abdomen (n = 20), and malignancies in the gastroesophageal junction (n = 4), that were treated with a BH spirometry system (SDX) were evaluated. All patients underwent both BH CT and 4-dimensional CT simulations. Clinically acceptable BH and non-BH plans were generated on each scan, and dose-volume histograms of the 2 plans were compared. Reproducibility of the BH plans for 30 consecutive patients was assessed using 1 to 3 QA CTs per patient and variations in dose-volume histograms for deformed target and organs at risk (OARs) volumes were compared with the initial CT plan. Results: Use of BH scans reduced initial and boost target volumes to 72% ± 20% and 70% ± 17% of non-BH volumes, respectively. Additionally, mean dose to liver, stomach, kidney, esophagus, heart, and lung V20 were each reduced to 71% to 79% with the BH technique. Similarly, small and large bowels, heart, and spinal cord maximum doses were each lowered to 68% to 84%. Analysis of 62 QA CT scans demonstrated that mean target and OAR doses using BH scans were reproducible to within 5% of their nominal plan values. Conclusions: The BH technique reduces the irradiated volume, leading to clinically significant reductions in OAR doses. By mitigating tumor motion, the BH technique leads to reproducible target coverage and OAR doses. Its use can reduce motion-related uncertainties that are normally associated with the treatment of thoracic and abdominal tumors and, therefore, optimize IMPT delivery.http://www.sciencedirect.com/science/article/pii/S2452109423002208 |
| spellingShingle | Pouya Sabouri, PhD Jason Molitoris, MD, PhD Maida Ranjbar, PhD Julie Moreau, BS Charles B. Simone, II, MD Pranshu Mohindra, MD, MBBS Katja Langen, PhD Sina Mossahebi, PhD Dosimetric Evaluation and Reproducibility of Breath-hold Plans in Intensity Modulated Proton Therapy: An Initial Clinical Experience Advances in Radiation Oncology |
| title | Dosimetric Evaluation and Reproducibility of Breath-hold Plans in Intensity Modulated Proton Therapy: An Initial Clinical Experience |
| title_full | Dosimetric Evaluation and Reproducibility of Breath-hold Plans in Intensity Modulated Proton Therapy: An Initial Clinical Experience |
| title_fullStr | Dosimetric Evaluation and Reproducibility of Breath-hold Plans in Intensity Modulated Proton Therapy: An Initial Clinical Experience |
| title_full_unstemmed | Dosimetric Evaluation and Reproducibility of Breath-hold Plans in Intensity Modulated Proton Therapy: An Initial Clinical Experience |
| title_short | Dosimetric Evaluation and Reproducibility of Breath-hold Plans in Intensity Modulated Proton Therapy: An Initial Clinical Experience |
| title_sort | dosimetric evaluation and reproducibility of breath hold plans in intensity modulated proton therapy an initial clinical experience |
| url | http://www.sciencedirect.com/science/article/pii/S2452109423002208 |
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