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Title: SU-E-CAMPUS-T-02: Can Pre-Treatment 4DCT-Based Motion Margins Estimates Be Trusted for Proton Radiotherapy?

Purpose: Radiotherapy motion margins are generated using pre-treatment 4DCT data. The purpose of this study is to assess if pre-treatment 4DCT is sufficient in proton therapy to provide accurate estimate of motion margins. A dosimetric assessment is performed comparing pre-treatment margins with daily-customized margins. Methods: Gold fiducial markers implanted in lung tumors of patients were used to track the tumor. A spherical tumor of diameter 20 mm is inserted into a realistic digital respiratory phantom, where the tumor motion is based on real patient lung tumor trajectories recorded over multiple days. Using “Day 1” patient data, 100 ITVs were generated with 1 s interval between consecutive scan start times. Each ITV was made up by the union of 10 tumor positions obtained from 6 s scan time. Two ITV volumes were chosen for treatment planning: ITVmean-σ and ITVmean+σ. The delivered dose was computed on i) 10 phases forming the planning ITV (“10-phase” - simulating dose calculation based on 4DCT) and ii) 50 phantoms produced from 100 s of data from any other day with tumor positions sampled every 2 s (“dynamic” - simulating the dose that would actually be delivered). Results: For similar breathing patterns between “Day 1” and anymore » other “Day N(>1)”, the 95% volume coverage (D95) for “dynamic” case was 8.13% lower than the “10-phase” case for ITVmean+σ. For breathing patterns that were very different between “Day 1” and any other “Day N(>1)”, this difference was as high as 24.5% for ITVmean-σ. Conclusion: Proton treatment planning based on pre-treatment 4DCT can lead to under-dosage of the tumor and over-dosage of the surrounding tissues, because of inadequate estimate of the range of motion of the tumor. This is due to the shift of the Bragg peak compared to photon therapy in which the tumor is surrounded by an electron bath.« less
Authors:
;  [1] ;  [2] ; ;  [3]
  1. Mass General Hospital, Harvard Medical, Boston, MA (United States)
  2. Varian Medical Systems, Palo Alto, CA (United States)
  3. Brigham and Women's Hospital, Harvard Medial School, Boston, MA (United States)
Publication Date:
OSTI Identifier:
22402269
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 41; Journal Issue: 6; Other Information: (c) 2014 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; BRAGG CURVE; COMPARATIVE EVALUATIONS; FIDUCIAL MARKERS; GOLD; LUNGS; NEOPLASMS; PATIENTS; PHANTOMS; PLANNING; PROTON BEAMS; RADIOTHERAPY