Radiation oncology (London, England) · 2025
Gantry-based pencil beam scanning proton therapy for uveal melanoma: IMPT versus proton arc therapy.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Qi Hang, Hu Lei, Huang Sheng, Lee Yen-Po, Yu Francis, Chen Qing, Yang Yunjie, Kang Minglei, Zhai Huifang, Vermeulen Milo, Shim Andy, Park Peter, Ding Xuanfeng, Zhou Jun, Abramson David H, Francis Jasmine H, Simone Charles B, Barker Christopher A, Lin Haibo
Аннотация
BACKGROUND: This study reports the single-institution clinical experience of multifield pencil beam scanning (PBS) intensity-modulated proton therapy (IMPT) and dosimetric comparison to proton arc for uveal melanoma (UM) in a regular PBS gantry room.
METHODS: Eleven consecutive UM patients were treated with IMPT to 50 Gy in 5 fractions. A customized gaze-fixation device attached to the thermoplastic mask was used to reproduce the globe position for each patient. IMPT plans were robustly optimized with perturbations of 3 mm setup and 3.5% range uncertainties using 3-4 fields without apertures. Each plan was robustly reoptimized (using the same perturbation parameters) using two non-coplanar arc fields in the RayStation treatment planning system. Treatment quality for both plans was evaluated daily using CBCT-generated synthetic CT. Target coverage, conformity, and mean/maximum doses to adjacent organs were assessed.
RESULTS: Proton arc plans provided comparable plan quality compared to IMPT plans. Similar target coverage was achieved, with an average GTV D95% equal to 101.1% [Formula: see text] 1.0% and 101.4% [Formula: see text] 0.4% for IMPT and proton arc plans, respectively. Proton arc improves the conformity index (RTOG) compared to IMPT plans (average 0.96 [Formula: see text] 0.23 vs. 0.88 [Formula: see text] 0.18, p = 0.11). Both modalities met all the clinical goals for organs-at-risk (OARs), while proton arc significantly reduced the maximum dose for the retina from, on average, 54.5 [Formula: see text] 0.7 to 53.2 [Formula: see text] 0.3 Gy (p < 0.01). Treatment evaluation on synthetic CT showed that the doses received by patients were highly consistent with the planned doses, with a relative target coverage (D95%) difference within 3.5% for IMPT and 3.1% for proton arc, and the D95% of actual delivery exceeding 98.7% and 98.2%, respectively. The doses delivered to OARs did not exceed clinical constraints.
CONCLUSIONS: This is a novel report on proton arc for ocular tumors and gantry-based multifield PBS proton treatment for these tumors. This study demonstrated that both modalities can meet the clinical goals. The IMPT is currently clinically implanted, and 2-field non-coplanar proton arc plans can achieve comparable dosimetric metrics to those of IMPT plans when the deliver technique is matured.
METHODS: Eleven consecutive UM patients were treated with IMPT to 50 Gy in 5 fractions. A customized gaze-fixation device attached to the thermoplastic mask was used to reproduce the globe position for each patient. IMPT plans were robustly optimized with perturbations of 3 mm setup and 3.5% range uncertainties using 3-4 fields without apertures. Each plan was robustly reoptimized (using the same perturbation parameters) using two non-coplanar arc fields in the RayStation treatment planning system. Treatment quality for both plans was evaluated daily using CBCT-generated synthetic CT. Target coverage, conformity, and mean/maximum doses to adjacent organs were assessed.
RESULTS: Proton arc plans provided comparable plan quality compared to IMPT plans. Similar target coverage was achieved, with an average GTV D95% equal to 101.1% [Formula: see text] 1.0% and 101.4% [Formula: see text] 0.4% for IMPT and proton arc plans, respectively. Proton arc improves the conformity index (RTOG) compared to IMPT plans (average 0.96 [Formula: see text] 0.23 vs. 0.88 [Formula: see text] 0.18, p = 0.11). Both modalities met all the clinical goals for organs-at-risk (OARs), while proton arc significantly reduced the maximum dose for the retina from, on average, 54.5 [Formula: see text] 0.7 to 53.2 [Formula: see text] 0.3 Gy (p < 0.01). Treatment evaluation on synthetic CT showed that the doses received by patients were highly consistent with the planned doses, with a relative target coverage (D95%) difference within 3.5% for IMPT and 3.1% for proton arc, and the D95% of actual delivery exceeding 98.7% and 98.2%, respectively. The doses delivered to OARs did not exceed clinical constraints.
CONCLUSIONS: This is a novel report on proton arc for ocular tumors and gantry-based multifield PBS proton treatment for these tumors. This study demonstrated that both modalities can meet the clinical goals. The IMPT is currently clinically implanted, and 2-field non-coplanar proton arc plans can achieve comparable dosimetric metrics to those of IMPT plans when the deliver technique is matured.