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Title: SU-E-T-547: Modeling Biological Response to Proton Irradiation and Evaluating Its Potential Clinical Consequences

Abstract

Purpose: In addition to physical uncertainties, proton therapy may also be associated with biologic uncertainties. Currently a generic RBE value of 1.1 is used for treatment planning. In this work the effects of variable RBE, in comparison to a fixed RBE, were evaluated by calculating the effective dose for proton treatments. Methods: The repair misrepair fixation (RMF) model was used to calculate variable proton RBEs. The RBE weighted spread-out Bragg peak (SOBP) dose in water phantom was calculated using Monte Carlo simulation and compared to 1.1 weighted SOBP dose. A head and neck proton treatment was used to evaluate the potential effects, by comparing the head and neck treatment plan computed with a commercial treatment planning system that incorporates fixed RBE of 1.1 and a Monte Carlo treatment planning system that incorporates variable RBE. Results: RBE calculations along the depth of SOBP showed that the RBE at the entrance is approximately 1 and reaches 1.1 near the center of the SOBP. However, in distal regions the RBE rises to higher values (up to 3.5 depending on the cell type). Comparison of commercial treatment plans using a fixed RBE of 1.1 and Monte Carlo using variable RBE showed noticeable differences inmore » the effective dose distributions. Conclusion: The comparison of the treatment planning with fixed and variable RBE shows that using commercial treatment planning systems that incorporate fixed RBE (1.1) could Result in overestimation of the effective dose to part of head and neck target volumes, while underestimating the effective dose to the normal tissue beyond the tumor. The accurate variable RBE as a function of proton beam energy in patient should be incorporated in treatment planning to improve the accuracy of effective dose calculation.« less

Authors:
; ; ; ; ; ; ;  [1]
  1. Departments of Radiation Physics and Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX (United States)
Publication Date:
OSTI Identifier:
22496263
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 42; Journal Issue: 6; Other Information: (c) 2015 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRAGG CURVE; COMPUTERIZED SIMULATION; DOSE-RESPONSE RELATIONSHIPS; HEAD; IRRADIATION; MONTE CARLO METHOD; NECK; NEOPLASMS; PROTON BEAMS; RADIATION DOSE DISTRIBUTIONS; RADIOTHERAPY; RBE; THERAPEUTIC USES

Citation Formats

Taleei, R, Peeler, C, Guan, F, Patel, D, Titt, U, Mirkovic, D, Grosshans, D, and Mohan, R. SU-E-T-547: Modeling Biological Response to Proton Irradiation and Evaluating Its Potential Clinical Consequences. United States: N. p., 2015. Web. doi:10.1118/1.4924909.
Taleei, R, Peeler, C, Guan, F, Patel, D, Titt, U, Mirkovic, D, Grosshans, D, & Mohan, R. SU-E-T-547: Modeling Biological Response to Proton Irradiation and Evaluating Its Potential Clinical Consequences. United States. doi:10.1118/1.4924909.
Taleei, R, Peeler, C, Guan, F, Patel, D, Titt, U, Mirkovic, D, Grosshans, D, and Mohan, R. Mon . "SU-E-T-547: Modeling Biological Response to Proton Irradiation and Evaluating Its Potential Clinical Consequences". United States. doi:10.1118/1.4924909.
@article{osti_22496263,
title = {SU-E-T-547: Modeling Biological Response to Proton Irradiation and Evaluating Its Potential Clinical Consequences},
author = {Taleei, R and Peeler, C and Guan, F and Patel, D and Titt, U and Mirkovic, D and Grosshans, D and Mohan, R},
abstractNote = {Purpose: In addition to physical uncertainties, proton therapy may also be associated with biologic uncertainties. Currently a generic RBE value of 1.1 is used for treatment planning. In this work the effects of variable RBE, in comparison to a fixed RBE, were evaluated by calculating the effective dose for proton treatments. Methods: The repair misrepair fixation (RMF) model was used to calculate variable proton RBEs. The RBE weighted spread-out Bragg peak (SOBP) dose in water phantom was calculated using Monte Carlo simulation and compared to 1.1 weighted SOBP dose. A head and neck proton treatment was used to evaluate the potential effects, by comparing the head and neck treatment plan computed with a commercial treatment planning system that incorporates fixed RBE of 1.1 and a Monte Carlo treatment planning system that incorporates variable RBE. Results: RBE calculations along the depth of SOBP showed that the RBE at the entrance is approximately 1 and reaches 1.1 near the center of the SOBP. However, in distal regions the RBE rises to higher values (up to 3.5 depending on the cell type). Comparison of commercial treatment plans using a fixed RBE of 1.1 and Monte Carlo using variable RBE showed noticeable differences in the effective dose distributions. Conclusion: The comparison of the treatment planning with fixed and variable RBE shows that using commercial treatment planning systems that incorporate fixed RBE (1.1) could Result in overestimation of the effective dose to part of head and neck target volumes, while underestimating the effective dose to the normal tissue beyond the tumor. The accurate variable RBE as a function of proton beam energy in patient should be incorporated in treatment planning to improve the accuracy of effective dose calculation.},
doi = {10.1118/1.4924909},
journal = {Medical Physics},
number = 6,
volume = 42,
place = {United States},
year = {Mon Jun 15 00:00:00 EDT 2015},
month = {Mon Jun 15 00:00:00 EDT 2015}
}
  • Purpose: In this study, the algorithms and calculation setting effect and contribution weighing on prostate Volumetric Modulated Arc Therapy (VMAT) based SBRT were evaluated for clinical analysis. Methods: A low risk prostate patient under SBRT was selected for the treatment planning evaluation. The treatment target was divided into low dose prescription target volume (PTV) and high Dose PTV. Normal tissue constraints include urethra and femur head, and rectum was separated into anterior, lateral and posterior parts. By varying the constraint limit of treatment plan calculation setting and algorithms, the effect on dose coverage and normal tissue dose constraint parameter carriedmore » effective comparison for the nominal prescription and constraint. For each setting, their percentage differences to the nominal value were calculated with geometric mean and harmonic mean. Results: In the arbitrary prostate SBRT case, 14 variables were selected for this evaluation by using nominal prescription and constraint. Six VMAT planning settings were anisotropic analytic algorithm stereotactic beam with and without couch structure in grid size of 1mm and 2mm, non stereotactic beam, Acuros algorithm . Their geometry means of the variable sets for these plans were 112.3%, 111.9%, 112.09%, 111.75%, 111.28%, and 112.05%. And the corresponding harmonic means were 2.02%, 2.16%, 3.15%, 4.74%, 5.47% and 5.55%. Conclusions: In this study, the algorithm difference shows relatively larger harmonic mean between prostate SBRT VMAT plans. This study provides a methodology to find sensitive combined variables related to clinical analysis, and similar approach could be applied to the whole treatment procedure from simulation to treatment in radiotherapy for big clinical data analysis.« less
  • Purpose: We present a study of dosimetric consequences on doses in water in modeling in-air proton fluence independently along principle axes for rotated elliptical spots. Methods: Phase-space parameters for modeling in-air fluence are the position sigma for the spatial distribution, the angle sigma for the angular distribution, and the correlation between position and angle distributions. Proton spots of the McLaren proton therapy system were measured at five locations near the isocenter for the energies of 180 MeV and 250 MeV. An elongated elliptical spot rotated with respect to the principle axes was observed for the 180 MeV, while a circular-likemore » spot was observed for the 250 MeV. In the first approach, the phase-space parameters were derived in the principle axes without rotation. In the second approach, the phase space parameters were derived in the reference frame with axes rotated to coincide with the major axes of the elliptical spot. Monte-Carlo simulations with derived phase-space parameters using both approaches to tally doses in water were performed and analyzed. Results: For the rotated elliptical 180 MeV spots, the position sigmas were 3.6 mm and 3.2 mm in principle axes, but were 4.3 mm and 2.0 mm when the reference frame was rotated. Measured spots fitted poorly the uncorrelated 2D Gaussian, but the quality of fit was significantly improved after the reference frame was rotated. As a Result, phase space parameters in the rotated frame were more appropriate for modeling in-air proton fluence of 180 MeV protons. Considerable differences were observed in Monte Carlo simulated dose distributions in water with phase-space parameters obtained with the two approaches. Conclusion: For rotated elliptical proton spots, phase-space parameters obtained in the rotated reference frame are better for modeling in-air proton fluence, and can be introduced into treatment planning systems.« less
  • Purpose: To investigate the trade-off between vertebral column sparing and thecal-sac target coverage in craniospinal irradiation (CSI) of pediatric patients treated with passive-scattering (PS) and intensity modulated (IMPT) proton therapy. Methods: We selected 2 pediatric patients treated with PS CSI for medulloblastoma. Spinal irradiation was re-planned with IMPT. For all cases, we assumed prescription dose of 23.4 Gy(RBE), with the spinal canal receiving at least 95% of 23.4 Gy(RBE). PS planning was performed using the commercial system XiO. IMPT planning was done using the Astroid planning system. Beam arrangements consisted of (a) PS posterior-anterior (PA) field, PS-PA, (b) IMPT PAmore » field, IMPT-PA, and (c) two posterior oblique IMPT fields, IMPT2 (-35°, 35°). Dose distributions were re-calculated using TOPAS Monte Carlo, along with LET distributions, to investigate LET variations within the target and vertebra anatomy. Variable RBE-weighed dose distributions were also calculated based on a dose and LET-dependent biophysical model. Dosimetric data were compared among the plans for the target volume, spinal cord and adjacent critical organs (thecal-sac and cauda equina). Results: IMPT2 resulted in better sparing of the posterior vertebral column (entrance region posterior to thecal-sac), where planned dose was approximately 6–8Gy(RBE). For IMPT-PA and PS-PA the MC-calculated dose to the posterior vertebral column was, on average, 20Gy and 18Gy respectively. For IMPT2 higher mean-LET (5keV/µm/(g/cm3)) values were observed in anterior vertebral column (beyond the thecal-sac) relative to IMPT-PA and PS-PA, where mean-LET was 3.5keV/µm/(g/cm3) and 2.5keV/µm/(g/cm3) respectively. The higher LET region observed for both IMPT plans was in the distal end of treatment fields, where dose delivered was less 5Gy(RBE). Conclusion: The two-oblique proton beams IMPT2 best spared the spinal column, while reducing the dose to the posterior spinal column from 18–20 to 6–8 Gy(RBE). The best LET distribution was obtained with the PS-PA fields.« less
  • Purpose: The spatially fractionated radiation therapy (Grid therapy) is a novel technique that has been recently introduced for treatments of the patients with advanced bulky tumors. The purpose of this study is to investigate the effect of the radiation sensitivity of tumor and Grid block design on the clinical response of the Grid therapy. Methods: The Geant4 toolkit is used to simulate a Varian2100C linear accelerator with the block-based Grid. The dose profile has been utilized to calculate the Therapeutic Ratio (TR) and Equivalent Uniform Dose (EUD) for different types of tumors. These calculations were performed with respect to theirmore » radiation sensitivities using Linear Quadratic model (LQ). Clinical responses of few hundred patients from different publications that were treated with Grid therapy, have been used to validate correlation between tumor radiation sensitivity and clinical response of Grid therapy. Moreover, the influence of Grid design on clinical response of this radiation technique was investigated with using Monte Carlo simulation of a Grid block with different hole-diameters of 0.5 cm, 0.75 cm, 1.25 cm, and 1.5 cm. The Geometrical Sparing Factor (GSF) was considered to compare the results from different Grid designs. Results: The higher clinical response of Grid therapy for more radio-resistant tumors was confirmed in both theoretical assumptions and clinical outcomes. In addition, the results indicate that the Grid hole diameter have more effect on increasing the TR in comparison with the hole center-to-center distance effect. From this Monte Carlo study, a Grid design with the hole diameter between 1.25 cm and 1.5 cm with GSF value of 0.90 is recommended. Conclusion: Grid Therapy is more effective for more radio-resistant tumors.The optimum results of the Grid therapy depend on selection of the appropriate Grid design.This study is a first step toward clarifying some important aspects in a clinical response of spatially fractionated radiation therapy.« less
  • Purpose: To investigate causes of isocenter shifts in treatment planning and its clinical impact on patient treatment efficiency and safety. Methods/Materials: Treatment planning data of 340 patients under treatment over 8 weeks period were gathered to identify isocenter shifts according to site of the treatment, types of treatment plan or types of the machine used. Treatment plans included inversed and forward IMRT, as well as 3D plans. Treatment sites included pelvis, chest, abdomen, breasts, head and necks and extremities. Re-planning were performed without the isocenter shift for pelvis and chest plans, the dosimetric parameters such as PTV coverage, and dosemore » sparing of OARs of these plans were analyzed and compared. Results/Discussions: Results showed that the isocenter shift was always necessary for some of sites such as breasts, two or more distinctive PTVs, or special cases such as large PTV treated with enhanced dynamic wedge. Many other cases, the re-planning results indicated 53% of the plans that the same quality of the plan can be achieved without the shift of the isocenter. Repositioning patients on a daily basis demanded unambiguous instructions for therapists for patient setups, and additional time to perform the shifts before treatment. Opportunities for error propagation exist during the communication and hand-over of such plans. Conclusion: Isocenter shifts demanded unambiguous instructions and times for therapists for daily patient setups, therefore it impacted both safety and efficiency of the patient treatment. Based on the analysis, the isocenter shifts were unavoidable for cases such as treatment of multiple sites, overcoming limitations of treatment machines, and/or sometime better dosimetry. However, we found many initially proposed shifts may have been eliminated either by careful planning or by improved CT simulation process such as detailed review of the images and localization of the PTV during simulation.« less