A Novel Proton Pencil Beam Scanning FLASH RT Delivery Method Enables Optimal OAR Sparing and Ultra-High Dose Rate Delivery: A Comprehensive Dosimetry Study for Lung Tumors

Purpose: While transmission proton beams have been demonstrated to achieve ultra-high dose rate FLASH therapy delivery, they are unable to spare normal tissues distal to the target. This study aims to compare FLASH treatment planning using single energy Bragg peak proton beams versus transmission pr...

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Autores principales:	Shouyi Wei, Haibo Lin, J. Isabelle Choi, Charles B. Simone, Minglei Kang
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	proton therapy pencil beam scanning transmission beam proton Bragg peak FLASH ultra-high dose rate FLASH radiotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/c400439927ef46d083dc3680bb09aa40
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spelling	oai:doaj.org-article:c400439927ef46d083dc3680bb09aa402021-11-25T17:04:01ZA Novel Proton Pencil Beam Scanning FLASH RT Delivery Method Enables Optimal OAR Sparing and Ultra-High Dose Rate Delivery: A Comprehensive Dosimetry Study for Lung Tumors10.3390/cancers132257902072-6694https://doaj.org/article/c400439927ef46d083dc3680bb09aa402021-11-01T00:00:00Zhttps://www.mdpi.com/2072-6694/13/22/5790https://doaj.org/toc/2072-6694Purpose: While transmission proton beams have been demonstrated to achieve ultra-high dose rate FLASH therapy delivery, they are unable to spare normal tissues distal to the target. This study aims to compare FLASH treatment planning using single energy Bragg peak proton beams versus transmission proton beams in lung tumors and to evaluate Bragg peak plan optimization, characterize plan quality, and quantify organ-at-risk (OAR) sparing. Materials and Methods: Both Bragg peak and transmission plans were optimized using an in-house platform for 10 consecutive lung patients previously treated with proton stereotactic body radiation therapy (SBRT). To bring the dose rate up to the FLASH-RT threshold, Bragg peak plans with a minimum MU/spot of 1200 and transmission plans with a minimum MU/spot of 400 were developed. Two common prescriptions, 34 Gy in 1 fraction and 54 Gy in 3 fractions, were studied with the same beam arrangement for both Bragg peak and transmission plans (<i>n</i> = 40 plans). RTOG 0915 dosimetry metrics and dose rate metrics based on different dose rate calculations, including average dose rate (ADR), dose-averaged dose rate (DADR), and dose threshold dose rate (DTDR), were investigated. We then evaluated the effect of beam angular optimization on the Bragg peak plans to explore the potential for superior OAR sparing. Results: Bragg peak plans significantly reduced doses to several OAR dose parameters, including lung V<sub>7.4Gy</sub> and V<sub>7Gy</sub> by 32.0% (<i>p</i> < 0.01) and 30.4% (<i>p</i> < 0.01) for 34Gy/fx plans, respectively; and by 40.8% (<i>p</i> < 0.01) and 41.2% (<i>p</i> < 0.01) for 18Gy/fx plans, respectively, compared with transmission plans. Bragg peak plans have ~3% less in DADR and ~10% differences in mean OARs in DTDR and DADR relative to transmission plans due to the larger portion of lower dose regions of Bragg peak plans. With angular optimization, optimized Bragg peak plans can further reduce the lung V<sub>7Gy</sub> by 20.7% (<i>p</i> < 0.01) and V<sub>7.4Gy</sub> by 19.7% (<i>p</i> < 0.01) compared with Bragg peak plans without angular optimization while achieving a similar 3D dose rate distribution. Conclusion: The single-energy Bragg peak plans achieve superior dosimetry performances in OARs to transmission plans with comparable dose rate performances for lung cancer FLASH therapy. Beam angle optimization can further improve the OAR dosimetry parameters with similar 3D FLASH dose rate coverage.Shouyi WeiHaibo LinJ. Isabelle ChoiCharles B. SimoneMinglei KangMDPI AGarticleproton therapypencil beam scanningtransmission beamproton Bragg peak FLASHultra-high dose rateFLASH radiotherapyNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancers, Vol 13, Iss 5790, p 5790 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	proton therapy pencil beam scanning transmission beam proton Bragg peak FLASH ultra-high dose rate FLASH radiotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	proton therapy pencil beam scanning transmission beam proton Bragg peak FLASH ultra-high dose rate FLASH radiotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Shouyi Wei Haibo Lin J. Isabelle Choi Charles B. Simone Minglei Kang A Novel Proton Pencil Beam Scanning FLASH RT Delivery Method Enables Optimal OAR Sparing and Ultra-High Dose Rate Delivery: A Comprehensive Dosimetry Study for Lung Tumors
description	Purpose: While transmission proton beams have been demonstrated to achieve ultra-high dose rate FLASH therapy delivery, they are unable to spare normal tissues distal to the target. This study aims to compare FLASH treatment planning using single energy Bragg peak proton beams versus transmission proton beams in lung tumors and to evaluate Bragg peak plan optimization, characterize plan quality, and quantify organ-at-risk (OAR) sparing. Materials and Methods: Both Bragg peak and transmission plans were optimized using an in-house platform for 10 consecutive lung patients previously treated with proton stereotactic body radiation therapy (SBRT). To bring the dose rate up to the FLASH-RT threshold, Bragg peak plans with a minimum MU/spot of 1200 and transmission plans with a minimum MU/spot of 400 were developed. Two common prescriptions, 34 Gy in 1 fraction and 54 Gy in 3 fractions, were studied with the same beam arrangement for both Bragg peak and transmission plans (<i>n</i> = 40 plans). RTOG 0915 dosimetry metrics and dose rate metrics based on different dose rate calculations, including average dose rate (ADR), dose-averaged dose rate (DADR), and dose threshold dose rate (DTDR), were investigated. We then evaluated the effect of beam angular optimization on the Bragg peak plans to explore the potential for superior OAR sparing. Results: Bragg peak plans significantly reduced doses to several OAR dose parameters, including lung V<sub>7.4Gy</sub> and V<sub>7Gy</sub> by 32.0% (<i>p</i> < 0.01) and 30.4% (<i>p</i> < 0.01) for 34Gy/fx plans, respectively; and by 40.8% (<i>p</i> < 0.01) and 41.2% (<i>p</i> < 0.01) for 18Gy/fx plans, respectively, compared with transmission plans. Bragg peak plans have ~3% less in DADR and ~10% differences in mean OARs in DTDR and DADR relative to transmission plans due to the larger portion of lower dose regions of Bragg peak plans. With angular optimization, optimized Bragg peak plans can further reduce the lung V<sub>7Gy</sub> by 20.7% (<i>p</i> < 0.01) and V<sub>7.4Gy</sub> by 19.7% (<i>p</i> < 0.01) compared with Bragg peak plans without angular optimization while achieving a similar 3D dose rate distribution. Conclusion: The single-energy Bragg peak plans achieve superior dosimetry performances in OARs to transmission plans with comparable dose rate performances for lung cancer FLASH therapy. Beam angle optimization can further improve the OAR dosimetry parameters with similar 3D FLASH dose rate coverage.
format	article
author	Shouyi Wei Haibo Lin J. Isabelle Choi Charles B. Simone Minglei Kang
author_facet	Shouyi Wei Haibo Lin J. Isabelle Choi Charles B. Simone Minglei Kang
author_sort	Shouyi Wei
title	A Novel Proton Pencil Beam Scanning FLASH RT Delivery Method Enables Optimal OAR Sparing and Ultra-High Dose Rate Delivery: A Comprehensive Dosimetry Study for Lung Tumors
title_short	A Novel Proton Pencil Beam Scanning FLASH RT Delivery Method Enables Optimal OAR Sparing and Ultra-High Dose Rate Delivery: A Comprehensive Dosimetry Study for Lung Tumors
title_full	A Novel Proton Pencil Beam Scanning FLASH RT Delivery Method Enables Optimal OAR Sparing and Ultra-High Dose Rate Delivery: A Comprehensive Dosimetry Study for Lung Tumors
title_fullStr	A Novel Proton Pencil Beam Scanning FLASH RT Delivery Method Enables Optimal OAR Sparing and Ultra-High Dose Rate Delivery: A Comprehensive Dosimetry Study for Lung Tumors
title_full_unstemmed	A Novel Proton Pencil Beam Scanning FLASH RT Delivery Method Enables Optimal OAR Sparing and Ultra-High Dose Rate Delivery: A Comprehensive Dosimetry Study for Lung Tumors
title_sort	novel proton pencil beam scanning flash rt delivery method enables optimal oar sparing and ultra-high dose rate delivery: a comprehensive dosimetry study for lung tumors
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/c400439927ef46d083dc3680bb09aa40
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A Novel Proton Pencil Beam Scanning FLASH RT Delivery Method Enables Optimal OAR Sparing and Ultra-High Dose Rate Delivery: A Comprehensive Dosimetry Study for Lung Tumors

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