Intensity Modulated Proton Therapy Treatment Planning for Postmastectomy Patients with Metallic Port Tissue Expanders

Purpose: Proton beam therapy can significantly reduce cardiopulmonary radiation exposure compared with photon-based techniques in the postmastectomy setting for locally advanced breast cancer. For patients with metallic port tissue expanders, which are commonly placed in patients undergoing a staged...

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Autores principales:	Mingyao Zhu, PhD, Katja Langen, PhD, Elizabeth M. Nichols, MD, Yuting Lin, PhD, Stella Flampouri, PhD, Karen D. Godette, MD, Sunil W. Dutta, MD, Mark W. McDonald, MD, Sagar A. Patel, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/a6352d3f909c43e0a6da1e895b36484a
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spelling	oai:doaj.org-article:a6352d3f909c43e0a6da1e895b36484a2021-11-10T04:30:22ZIntensity Modulated Proton Therapy Treatment Planning for Postmastectomy Patients with Metallic Port Tissue Expanders2452-109410.1016/j.adro.2021.100825https://doaj.org/article/a6352d3f909c43e0a6da1e895b36484a2022-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2452109421001834https://doaj.org/toc/2452-1094Purpose: Proton beam therapy can significantly reduce cardiopulmonary radiation exposure compared with photon-based techniques in the postmastectomy setting for locally advanced breast cancer. For patients with metallic port tissue expanders, which are commonly placed in patients undergoing a staged breast reconstruction, dose uncertainties introduced by the high-density material pose challenges for proton therapy. In this report, we describe an intensity modulated proton therapy planning technique for port avoidance through a hybrid single-field optimization/multifield optimization approach. Methods and Materials: In this planning technique, 3 beams are utilized. For each beam, no proton spot is placed within or distal to the metal port plus a 5 mm margin. Therefore, precise modeling of the metal port is not required, and various tissue expander manufacturers/models are eligible. The blocked area of 1 beam is dosimetrically covered by 1 or 2 of the remaining beams. Multifield optimization is used in the chest wall target region with blockage of any beam, while single-field optimization is used for remainder of chest wall superior/inferior to the port. Results: Using this technique, clinical plans were created for 6 patients. Satisfactory plans were achieved in the 5 patients with port-to-posterior chest wall separations of 1.5 cm or greater, but not in the sixth patient with a 0.7 cm separation. Conclusions: We described a planning technique and the results suggest that the metallic port-to-chest wall distance may be a key parameter for optimal plan design.Mingyao Zhu, PhDKatja Langen, PhDElizabeth M. Nichols, MDYuting Lin, PhDStella Flampouri, PhDKaren D. Godette, MDSunil W. Dutta, MDMark W. McDonald, MDSagar A. Patel, MDElsevierarticleMedical physics. Medical radiology. Nuclear medicineR895-920Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENAdvances in Radiation Oncology, Vol 7, Iss 1, Pp 100825- (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Mingyao Zhu, PhD Katja Langen, PhD Elizabeth M. Nichols, MD Yuting Lin, PhD Stella Flampouri, PhD Karen D. Godette, MD Sunil W. Dutta, MD Mark W. McDonald, MD Sagar A. Patel, MD Intensity Modulated Proton Therapy Treatment Planning for Postmastectomy Patients with Metallic Port Tissue Expanders
description	Purpose: Proton beam therapy can significantly reduce cardiopulmonary radiation exposure compared with photon-based techniques in the postmastectomy setting for locally advanced breast cancer. For patients with metallic port tissue expanders, which are commonly placed in patients undergoing a staged breast reconstruction, dose uncertainties introduced by the high-density material pose challenges for proton therapy. In this report, we describe an intensity modulated proton therapy planning technique for port avoidance through a hybrid single-field optimization/multifield optimization approach. Methods and Materials: In this planning technique, 3 beams are utilized. For each beam, no proton spot is placed within or distal to the metal port plus a 5 mm margin. Therefore, precise modeling of the metal port is not required, and various tissue expander manufacturers/models are eligible. The blocked area of 1 beam is dosimetrically covered by 1 or 2 of the remaining beams. Multifield optimization is used in the chest wall target region with blockage of any beam, while single-field optimization is used for remainder of chest wall superior/inferior to the port. Results: Using this technique, clinical plans were created for 6 patients. Satisfactory plans were achieved in the 5 patients with port-to-posterior chest wall separations of 1.5 cm or greater, but not in the sixth patient with a 0.7 cm separation. Conclusions: We described a planning technique and the results suggest that the metallic port-to-chest wall distance may be a key parameter for optimal plan design.
format	article
author	Mingyao Zhu, PhD Katja Langen, PhD Elizabeth M. Nichols, MD Yuting Lin, PhD Stella Flampouri, PhD Karen D. Godette, MD Sunil W. Dutta, MD Mark W. McDonald, MD Sagar A. Patel, MD
author_facet	Mingyao Zhu, PhD Katja Langen, PhD Elizabeth M. Nichols, MD Yuting Lin, PhD Stella Flampouri, PhD Karen D. Godette, MD Sunil W. Dutta, MD Mark W. McDonald, MD Sagar A. Patel, MD
author_sort	Mingyao Zhu, PhD
title	Intensity Modulated Proton Therapy Treatment Planning for Postmastectomy Patients with Metallic Port Tissue Expanders
title_short	Intensity Modulated Proton Therapy Treatment Planning for Postmastectomy Patients with Metallic Port Tissue Expanders
title_full	Intensity Modulated Proton Therapy Treatment Planning for Postmastectomy Patients with Metallic Port Tissue Expanders
title_fullStr	Intensity Modulated Proton Therapy Treatment Planning for Postmastectomy Patients with Metallic Port Tissue Expanders
title_full_unstemmed	Intensity Modulated Proton Therapy Treatment Planning for Postmastectomy Patients with Metallic Port Tissue Expanders
title_sort	intensity modulated proton therapy treatment planning for postmastectomy patients with metallic port tissue expanders
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/a6352d3f909c43e0a6da1e895b36484a
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Intensity Modulated Proton Therapy Treatment Planning for Postmastectomy Patients with Metallic Port Tissue Expanders

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