Proton beam therapy is an advanced form of external radiotherapy that uses high-energy proton beams instead of photon x-ray beams or electrons. Carefully measured doses of protons are delivered to the precise area needing treatment, using the latest IBA ProteusONE technology. This ensures that the delivery of proton beam therapy is highly accurate and prevents the risk of radiation reaching surrounding healthy tissue.
Radiotherapy is used to kill and destroy cancer cells. It utilises radiation in the form of high-energy x-rays, known as photons, to kill and damage the cancerous cells and prevent their growth and reproduction. It can be used as a non-surgical option to treat cancer, and it can also be used to shrink a tumour or in combination with other treatments.
The Rutherford Cancer Centres and Elekta are bringing the next generation of personalised adaptive radiotherapy technology to oncology centres across the UK, with the new MR-linac Elekta Unity now available at the Rutherford Cancer Centre North West in Liverpool.
External Research Paper
31 / 05 / 21
Objective: To establish optimal robust optimization uncertainty settings for clinical head and neck cancer (HNC) patients undergoing 3D image-guided pencil beam scanning (PBS) proton therapy.
Methods: We analyzed ten consecutive HNC patients treated with 70 and 54.25 GyRBE to the primary and prophylactic clinical target volumes (CTV) respectively using intensity-modulated proton therapy (IMPT). Clinical plans were generated using robust optimization with 5 mm/3% setup/range uncertainties (RayStation v6.1). Additional plans were created for 4, 3, 2 and 1 mm setup and 3% range uncertainty and for 3 mm setup and 3%, 2% and 1% range uncertainty. Systematic and random error distributions were determined for setup and range uncertainties based on our quality assurance program. From these, 25 treatment scenarios were sampled for each plan, each consisting of a systematic setup and range error and daily random setup errors. Fraction doses were calculated on the weekly verification CT closest to the date of treatment as this was considered representative of the daily patient anatomy.
Results: Plans with a 2 mm/3% setup/range uncertainty setting adequately covered the primary and prophylactic CTV (V95 ≥ 99% in 98.8% and 90.8% of the treatment scenarios respectively). The average organ-at-risk dose decreased with 1.1 GyRBE/mm setup uncertainty reduction and 0.5 GyRBE/1% range uncertainty reduction. Normal tissue complication probabilities decreased by 2.0%/mm setup uncertainty reduction and by 0.9%/1% range uncertainty reduction.
Conclusion: The results of this study indicate that margin reduction below 3 mm/3% is possible but requires a larger cohort to substantiate clinical introduction.
Wagenaar D, Kierkels RGJ, van der Schaaf A, Meijers A, Scandurra D, Sijtsema NM, Korevaar EW, Steenbakkers RJHM, Knopf AC, Langendijk JA, Both S. Head and neck IMPT probabilistic dose accumulation: Feasibility of a 2 mm setup uncertainty setting. Radiother Oncol. 2021 Jan;154:45-52. doi: 10.1016/j.radonc.2020.09.001. Epub 2020 Sep 6. PMID: 32898561.
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