Pencil Beam Scanning Bragg Peak FLASH Technique for Ultra-High Dose Rate Intensity-Modulated Proton Therapy in Early-Stage Breast Cancer Treatment.

Autor: Lattery G; Department of Physics and Astronomy, Hofstra University, 1000 Hempstead Turnpike, Hempstead, NY 11549, USA., Kaulfers T; Department of Physics and Astronomy, Hofstra University, 1000 Hempstead Turnpike, Hempstead, NY 11549, USA., Cheng C; Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, USA., Zhao X; Beijing Key Laboratory of Medical Physics and Engineering, Peking University, Beijing 100871, China.; New York Proton Center, 225 E 126th Street, New York, NY 10035, USA., Selvaraj B; New York Proton Center, 225 E 126th Street, New York, NY 10035, USA., Lin H; New York Proton Center, 225 E 126th Street, New York, NY 10035, USA., Simone CB 2nd; New York Proton Center, 225 E 126th Street, New York, NY 10035, USA., Choi JI; New York Proton Center, 225 E 126th Street, New York, NY 10035, USA., Chang J; Department of Physics and Astronomy, Hofstra University, 1000 Hempstead Turnpike, Hempstead, NY 11549, USA.; Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY 11042, USA., Kang M; New York Proton Center, 225 E 126th Street, New York, NY 10035, USA.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2023 Sep 14; Vol. 15 (18). Date of Electronic Publication: 2023 Sep 14.
DOI: 10.3390/cancers15184560
Abstrakt: Bragg peak FLASH-RT can deliver highly conformal treatment and potentially offer improved normal tissue protection for radiotherapy patients. This study focused on developing ultra-high dose rate (≥40 Gy × RBE/s) intensity-modulated proton therapy (IMPT) for hypofractionated treatment of early-stage breast cancer. A novel tracking technique was developed to enable pencil beaming scanning (PBS) of single-energy protons to adapt the Bragg peak (BP) to the target distally. Standard-of-care PBS treatment plans of consecutively treated early-stage breast cancer patients using multiple energy layers were reoptimized using this technique, and dose metrics were compared between single-energy layer BP FLASH and conventional IMPT plans. FLASH dose rate coverage by volume (V 40Gy/s ) was also evaluated for the FLASH sparing effect. Distal tracking can precisely stop BP at the target distal edge. All plans ( n = 10) achieved conformal IMPT-like dose distributions under clinical machine parameters. No statistically significant differences were observed in any dose metrics for heart, ipsilateral lung, most ipsilateral breast, and CTV metrics ( p > 0.05 for all). Conventional plans yielded slightly superior target and skin dose uniformities with 4.5% and 12.9% lower dose maxes, respectively. FLASH-RT plans reached 46.7% and 61.9% average-dose rate FLASH coverage for tissues receiving more than 1 and 5 Gy plan dose total under the 250 minimum MU condition. Bragg peak FLASH-RT techniques achieved comparable plan quality to conventional IMPT while reaching adequate dose rate ratios, demonstrating the feasibility of early-stage breast cancer clinical applications.
Databáze: MEDLINE
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