Dataset Information

In-vivo range verification analysis with in-beam PET data for patients treated with proton therapy at CNAO.

ABSTRACT: Morphological changes that may arise through a treatment course are probably one of the most significant sources of range uncertainty in proton therapy. Non-invasive in-vivo treatment monitoring is useful to increase treatment quality. The INSIDE in-beam Positron Emission Tomography (PET) scanner performs in-vivo range monitoring in proton and carbon therapy treatments at the National Center of Oncological Hadrontherapy (CNAO). It is currently in a clinical trial (ID: NCT03662373) and has acquired in-beam PET data during the treatment of various patients. In this work we analyze the in-beam PET (IB-PET) data of eight patients treated with proton therapy at CNAO. The goal of the analysis is twofold. First, we assess the level of experimental fluctuations in inter-fractional range differences (sensitivity) of the INSIDE PET system by studying patients without morphological changes. Second, we use the obtained results to see whether we can observe anomalously large range variations in patients where morphological changes have occurred. The sensitivity of the INSIDE IB-PET scanner was quantified as the standard deviation of the range difference distributions observed for six patients that did not show morphological changes. Inter-fractional range variations with respect to a reference distribution were estimated using the Most-Likely-Shift (MLS) method. To establish the efficacy of this method, we made a comparison with the Beam's Eye View (BEV) method. For patients showing no morphological changes in the control CT the average range variation standard deviation was found to be 2.5 mm with the MLS method and 2.3 mm with the BEV method. On the other hand, for patients where some small anatomical changes occurred, we found larger standard deviation values. In these patients we evaluated where anomalous range differences were found and compared them with the CT. We found that the identified regions were mostly in agreement with the morphological changes seen in the CT scan.

SUBMITTER: Moglioni M

PROVIDER: S-EPMC9549776 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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In-vivo range verification analysis with in-beam PET data for patients treated with proton therapy at CNAO.

Moglioni Martina M Kraan Aafke Christine AC Baroni Guido G Battistoni Giuseppe G Belcari Nicola N Berti Andrea A Carra Pietro P Cerello Piergiorgio P Ciocca Mario M De Gregorio Angelica A De Simoni Micol M Del Sarto Damiano D Donetti Marco M Dong Yunsheng Y Embriaco Alessia A Fantacci Maria Evelina ME Ferrero Veronica V Fiorina Elisa E Fischetti Marta M Franciosini Gaia G Giraudo Giuseppe G Laruina Francesco F Maestri Davide D Magi Marco M Magro Giuseppe G Malekzadeh Etesam E Marafini Michela M Mattei Ilaria I Mazzoni Enrico E Mereu Paolo P Mirandola Alfredo A Morrocchi Matteo M Muraro Silvia S Orlandi Ester E Patera Vincenzo V Pennazio Francesco F Pullia Marco M Retico Alessandra A Rivetti Angelo A Da Rocha Rolo Manuel Dionisio MD Rosso Valeria V Sarti Alessio A Schiavi Angelo A Sciubba Adalberto A Sportelli Giancarlo G Tampellini Sara S Toppi Marco M Traini Giacomo G Trigilio Antonio A Valle Serena Marta SM Valvo Francesca F Vischioni Barbara B Vitolo Viviana V Wheadon Richard R Bisogni Maria Giuseppina MG

Frontiers in oncology 20220926

Morphological changes that may arise through a treatment course are probably one of the most significant sources of range uncertainty in proton therapy. Non-invasive in-vivo treatment monitoring is useful to increase treatment quality. The INSIDE in-beam Positron Emission Tomography (PET) scanner performs in-vivo range monitoring in proton and carbon therapy treatments at the National Center of Oncological Hadrontherapy (CNAO). It is currently in a clinical trial (ID: NCT03662373) ...[more]

PMID: 36226070

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Project description:PurposeTo compare the dosimetric performances of intensity-modulated proton therapy (IMPT) plans generated with two different beam angle configurations (the Right-Left oblique posterior beams and the Superior-Inferior oblique posterior beams) for the treatment of distal esophageal carcinoma in the presence of uncertainties and interplay effect.Methods and materialsTwenty patients' IMPT plans were retrospectively selected, with 10 patients treated with the R-L oblique posterior beams (Group R-L) and the other 10 patients treated with the S-I oblique posterior beams (Group S-I). Patients in both groups were matched by their clinical target volumes (CTVs-high and low dose levels) and respiratory motion amplitudes. Dose-volume-histogram (DVH) indices were used to assess plan quality. DVH bandwidth was calculated to evaluate plan robustness. Interplay effect was quantified using four-dimensional (4D) dynamic dose calculation with random respiratory starting phase of each fraction. Normal tissue complication probability (NTCP) for heart, liver, and lung was calculated, respectively, to estimate the clinical outcomes. Wilcoxon signed-rank test was used for statistical comparison between the two groups.ResultsCompared with plans in Group R-L, plans in Group S-I resulted in significantly lower liver Dmean and lung V30Gy[RBE] with slightly higher but clinically acceptable spinal cord Dmax . Similar plan robustness was observed between the two groups. When interplay effect was considered, plans in Group S-I performed statistically better for heart Dmean and V30Gy[RBE] , lung Dmean and V5Gy[RBE] , and liver Dmean , with slightly increased but clinically acceptable spinal cord Dmax . NTCP for liver was significantly better in Group S-I.ConclusionsIMPT plans in Group S-I have better sparing of liver, heart, and lungs at the slight cost of spinal cord maximum dose protection, and are more interplay-effect resilient compared to IMPT plans in Group R-L. Our study supports the routine use of the S-I oblique posterior beams for the treatments of distal esophageal carcinoma.

Dataset Information

In-vivo range verification analysis with in-beam PET data for patients treated with proton therapy at CNAO.

Publications

<i>In-vivo</i> range verification analysis with in-beam PET data for patients treated with proton therapy at CNAO.

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