Streamlining the image-guided radiotherapy process for proton beam therapy

2021 ◽  
pp. 20210764
Author(s):  
Lucy Siew Chen Davies ◽  
Louise McHugh ◽  
Marianne Aznar ◽  
Josh Lindsay ◽  
Cynthia Eccles
Keyword(s):  
Proton Beam ◽  
Proton Beam Therapy ◽  
Altman Analysis ◽  
Initial Image ◽  
Imaging Protocol ◽  
Image Guided Radiotherapy ◽  
Bland Altman Analysis ◽  
Image Guided ◽  
Imaging Dose ◽  
The Uk

Objectives: This work evaluated the on-treatment imaging workflow in the UK’s first proton beam therapy (PBT) centre, with a view to reducing times and unnecessary imaging doses to patients. Methods: Imaging dose and timing data from the first 20 patients (70% paediatrics, 30% TYA/adult) treated with PBT using the initial image-guided PBT (IGPBT) workflow of a 2-dimensional kilo-voltage (2DkV), followed by cone-beam computed-tomography (CBCT) and repeat 2DkV was included. Pearson correlations and Bland-Altman analysis were used to describe correlations between 2DkV and CBCT images to determine if any images were superfluous. Results: 229 treatment sessions were evaluated. Patient repositioning following the initial 2DkV (i2DkV) was required on 19 (8.3%) fractions. This three-step process resulted in an additional mean imaging dose of 3.4 mGy per patient, and 5.1 minutes on the treatment bed for the patient, over a whole course of PBT, compared to a two-step workflow (removing the i2DkV image). Correspondence between the mean displacements from i2DkV and CBCT was high, with R = 0.94, 0.94 and 0.80 in the anteroposterior, superiorinferior and right-left directions, respectively. Bland-Altman analysis showed very little bias and narrow limits of agreement. Conclusions: Removing the i2DkV, streamlining to a two-step workflow, would reduce treatment times and imaging dose, and has been implemented as standard verification protocol. For challenging cases (e.g. paediatric patients under GA), further investigations are required before the three-step workflow can be modified. Advances in knowledge: This is the first report assessing a preliminary imaging protocol in PBT in the UK and determining a way to reduce dose and time, which ultimately benefits the patient.

PD-0068: Streamlining the image-guided radiotherapy process for proton beam therapy: a service evaluation

2020 ◽  
Vol 152 ◽  
pp. S28-S29
Author(s):  
L. Davies ◽  
L. McHugh ◽  
M.C. Aznar ◽  
J. Lindsay ◽  
C.L. Eccles
Keyword(s):  
Proton Beam ◽  
Proton Beam Therapy ◽  
Service Evaluation ◽  
Image Guided Radiotherapy ◽  
Image Guided

scholarly journals Proton beam therapy: perspectives on the National Health Service England clinical service and research programme

2020 ◽  
Vol 93 (1107) ◽  
pp. 20190873 ◽  
Author(s):  
Neil G Burnet ◽  
Ranald I Mackay ◽  
Ed Smith ◽  
Amy L Chadwick ◽  
Gillian A Whitfield ◽  
...  
Keyword(s):  
Dna Damage ◽  
National Health Service ◽  
Health Service ◽  
Proton Beam ◽  
National Health ◽  
Proton Beam Therapy ◽  
Systematic Evaluation ◽  
High Dose ◽  
X Rays ◽  
The Uk

The UK has an important role in the evaluation of proton beam therapy (PBT) and takes its place on the world stage with the opening of the first National Health Service (NHS) PBT centre in Manchester in 2018, and the second in London coming in 2020. Systematic evaluation of the role of PBT is a key objective. By September 2019, 108 patients had started treatment, 60 paediatric, 19 teenagers and young adults and 29 adults. Obtaining robust outcome data is vital, if we are to understand the strengths and weaknesses of current treatment approaches. This is important in demonstrating when PBT will provide an advantage and when it will not, and in quantifying the magnitude of benefit. The UK also has an important part to play in translational PBT research, and building a research capability has always been the vision. We are perfectly placed to perform translational pre-clinical biological and physical experiments in the dedicated research room in Manchester. The nature of DNA damage from proton irradiation is considerably different from X-rays and this needs to be more fully explored. A better understanding is needed of the relative biological effectiveness (RBE) of protons, especially at the end of the Bragg peak, and of the effects on tumour and normal tissue of PBT combined with conventional chemotherapy, targeted drugs and immunomodulatory agents. These experiments can be enhanced by deterministic mathematical models of the molecular and cellular processes of DNA damage response. The fashion of ultra-high dose rate FLASH irradiation also needs to be explored.

A phase II trial of S-1 plus cisplatin with concurrent proton-beam therapy for locally advanced non-small cell lung cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20070-e20070
Author(s):  
Kenji Akita ◽  
Hiromitsu Iwata ◽  
Hiroyuki Ogino ◽  
Yusuke Yamaba ◽  
Eiji Kunii ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Proton Beam ◽  
Phase Ii ◽  
Phase Ii Trial ◽  
Locally Advanced ◽  
Proton Beam Therapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Image Guided

e20070 Background: Concurrent chemo-radiotherapy is the standard treatment for locally advanced (LA) non-small cell lung cancer (NSCLC). Recent phase II studies have demonstrated that S-1 plus cisplatin (CDDP) with concurrent radiotherapy yields promising results against LA NSCLC. Proton-beam therapy (PBT) is an alternative modality that is expected to reduce toxic effects against normal tissues compared with X-ray radiotherapy. We conducted a phase II trial of S-1 plus CDDP combined with concurrent PBT for patients (pts) with LA NSCLC. Methods: The eligibility criteria included unresectable stage III NSCLC, chemo-naïve status, PS 0 or 1, and age < 75 years. Pts received CDDP (80 mg/m2) on day 1 and S-1 (30-40 mg/m2 twice daily) on days 1 to 14, q4w, up to 4 cycles, plus concurrent PBT at a total dose of 70 GyE in 35 fractions for primary lesion and 66 GyE in 33 fractions for lymph node metastasis. PBT was performed using respiratory-gated and image-guided techniques, and adaptive plans were implemented according to a verification plan at 10, 20, and 30 days. Results: Thirty-two pts were enrolled between August 2013 and December 2016. The patient characteristics were as follows: median age, 66 (31-74); male/female, 24/8; PS 0, 26 pts; stage IIIA/IIIB, 19/13; non-squamous histology, 17 (53%). Twenty pts were out of indication for radical chemo-radiation with X rays. All 4 cycles of S-1 plus CDDP could be completed in 24 pts and the median number of cycles was 3.3 (range: 2 to 4). Grade 3/4 toxicities per pt were: neutropenia 28%, anemia 13%, thrombocytopenia 9.4%, fatigue, anorexia, esophagitis, mucositis and enteritis 3.1%, and radiation pneumonitis 0%. One case of febrile neutropenia was observed. PR + CR was achieved in 24 of 28 evaluable pts. The median PFS was 12.5 months, and 2-year OS was 63%, with a median follow-up period of 19.5 (range: 1.5-40.0) months. Conclusions: Concurrent chemo-PBT using S-1 plus CDDP with image-guided and adaptive techniques is considered to be effective and well tolerated for LA NSCLC. Further evaluations in a large randomized controlled trial are warranted.

Rhabdomyosarcoma of the trachea: first reported case treated with proton beam therapy

2012 ◽  
Vol 126 (9) ◽  
pp. 966-969 ◽  
Author(s):  
R Exley ◽  
J M Bernstein ◽  
B Brennan ◽  
M P Rothera
Keyword(s):  
Proton Beam ◽  
World Literature ◽  
Proton Beam Therapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Conventional Radiotherapy ◽  
The Usa ◽  
History Of ◽  
The Uk

AbstractObjective:We report a case of rhabdomyosarcoma of the trachea in a 14-month-old child, and we present the first reported use of proton beam therapy for this tumour.Case report:A 14-month-old girl presented acutely with a seven-day history of biphasic stridor. Emergency endoscopic debulking of a posterior tracheal mass was undertaken. Histological examination revealed an embryonal rhabdomyosarcoma with anaplasia. Multimodality therapy with surgery and chemotherapy was administered in the UK, and proton beam therapy in the USA.Conclusion:Only three cases of rhabdomyosarcoma of the trachea have previously been reported in the world literature. This is the first reported case of treatment of this tumour with proton beam therapy. Compared with conventional radiotherapy, proton beam therapy may confer improved long-term outcome in children, with benefits including reduced irradiation of the spinal cord.

PO-1460 Adaptive re-planning with image guided pencil beam scanning proton beam therapy

2021 ◽  
Vol 161 ◽  
pp. S1197-S1198
Author(s):  
S. Chilukuri ◽  
U. Gaikwad ◽  
S. Nangia ◽  
K. Patro ◽  
R. Thiagarajan ◽  
...  
Keyword(s):  
Proton Beam ◽  
Proton Beam Therapy ◽  
Pencil Beam ◽  
Beam Scanning ◽  
Image Guided ◽  
Pencil Beam Scanning
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