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Simulation study using the spots deletion technique in spot scanning proton beam therapy for prostate cancers

  • Authors:
    • Nobuyoshi Fukumitsu
    • Tomokatsu Hayakawa
    • Tomohiro Yamashita
    • Masayuki Mima
    • Yusuke Demizu
    • Takeshi Suzuki
    • Toshinori Soejima
  • View Affiliations / Copyright

    Affiliations: Department of Radiation Oncology, Kobe Proton Center, Kobe, Hyogo 650‑0047, Japan, Division of Radiation Therapy, Radiation and Proton Therapy Center, Shizuoka Cancer Center, Shizuoka, Shizuoka 411‑8777, Japan, Division of Medical Physics, Kobe Proton Center, Kobe, Hyogo 650‑0047, Japan, Department of Anesthesiology, Kobe Proton Center, Kobe, Hyogo 650‑0047, Japan
    Copyright: © Fukumitsu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 25
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    Published online on: December 1, 2021
       https://doi.org/10.3892/mco.2021.2458
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Abstract

The aim of the present study was to investigate the effects on the dose distribution and beam delivery time in spot scanning proton beam therapy (PBT) incorporating the spot deletion technique. A spot scanning plan was created for 30 patients with prostate cancer. The plan was then modified via two processes: Spots with lower weighting depositions were deleted (process A) and spots that were distant from the clinical target volume (CTV) were deleted (process B). The dose distribution to the organs at risk (OAR), the expanded CTV (exCTV), which was defined by a uniform expansion of the CTV by a radius of 5 mm, and the beam delivery time were compared among initial and modified plans. The V50 Gy [relative biological effectiveness (RBE)] to the rectum and bladder, and V60 Gy(RBE) to the urethral bulb, inhomogeneity index (INH) of the exCTV showed a difference (P=1.1x10‑14, P=6.4x10‑14, P=2.7x10‑7, P=3.2x10‑17), although only changes by process B were significant. Modified plan by process B showed the V50 Gy(RBE) to the rectum and bladder decreased by ‑2.4±1.6 and ‑2.3±1.4%, and the V60 Gy (RBE) to the urethral bulb decreased by ‑15.9±19.4%. The INH of the exCTV increased by 0.05±0.03%. On the other hand, modification of the initial plan by process A did not affect the dose of the OAR, exCTV or beam delivery time. In spot scanning PBT, modification of the initial radiotherapy plan by systemic deletion of spots distant from the CTV could result in a dose reduction to the OAR.
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1 

Lawrence JH, Tobias CA, Born JL, Linfoot JA, Kling RP and Gottschalk A: Alpha and proton heavy particles and the bragg peak in therapy. Trans Am Clin Climatol Assoc. 75:111–116. 1964.PubMed/NCBI

2 

Bortfeld T and Schlegel W: An analytical approximation of depth-dose distributions for therapeutic proton beams. Phys Med Biol. 41:1331–1339. 1996.PubMed/NCBI View Article : Google Scholar

3 

Schulte RW, Slater JD, Rossi CJ Jr and Slater JM: Value and perspectives of proton radiation therapy for limited stage prostate cancer. Strahlenther Onkol. 176:3–8. 2000.PubMed/NCBI View Article : Google Scholar

4 

Nihei K, Ogino T, Onozawa M, Onozawa M, Murayama S, Fuji H, Murakami M and Hishikawa Y: Multi-institutional phase II study of proton beam therapy for organ-confined prostate cancer focusing on the incidence of late rectal toxicities. Int J Radiat Oncol Biol Phys. 81:390–396. 2011.PubMed/NCBI View Article : Google Scholar

5 

Royce TJ and Efstathiou JA: Proton therapy for prostate cancer: A review of the rationale, evidence, and current state. Urol Oncol. 37:628–636. 2019.PubMed/NCBI View Article : Google Scholar

6 

Hyer DE, Hill PM, Wang D, Smith BR and Flynn RT: A dynamic collimation system for penumbra reduction in spot-scanning proton therapy: Proof of concept. Med Phys. 41(091701)2014.PubMed/NCBI View Article : Google Scholar

7 

DeLaney TF: Proton therapy in the clinic. Front Radiat Ther Oncol. 43:465–485. 2011.PubMed/NCBI View Article : Google Scholar

8 

Bert C and Durante M: Motion in radiotherapy: Particle therapy. Phys Med Biol. 56:R113–R144. 2011.PubMed/NCBI View Article : Google Scholar

9 

Pugh TJ, Munsell MF, Choi S, Nguyen QN, Mathai B, Zhu XR, Sahoo N, Gillin M, Johnson JL, Amos RA, et al: Quality of life and toxicity from passively scattered and spot-scanning proton beam therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 87:946–953. 2013.PubMed/NCBI View Article : Google Scholar

10 

Widesott L, Pierelli A, Fiorino C, Lomax AJ, Amichetti M, Cozzarini C, Soukup M, Schneider R, Hug E, Di Muzio N, et al: Helical tomotherapy vs. intensity-modulated proton therapy for whole pelvis irradiation in high-risk prostate cancer patients: Dosimetric, normal tissue complication probability, and generalized equivalent uniform dose analysis. Int J Radiat Oncol Biol Phys. 80:1589–1600. 2011.PubMed/NCBI View Article : Google Scholar

11 

van de Water S, Kraan AC, Breedveld S, Schillemans W, Teguh DN, Kooy HM, Madden TM, Heijmen BJ and Hoogeman MS: Improved efficiency of multi-criteria IMPT treatment planning using iterative resampling of randomly placed pencil beams. Phys Med Biol. 58:6969–6983. 2013.PubMed/NCBI View Article : Google Scholar

12 

van de Water S, Safai S, Schippers JM, Weber DC and Lomax AJ: Towards FLASH proton therapy: The impact of treatment planning and machine characteristics on achievable dose rates. Acta Oncol. 58:1463–1469. 2019.PubMed/NCBI View Article : Google Scholar

13 

Wang D, Smith BR, Gelover E, Flynn RT and Hyer DE: A method to select aperture margin in collimated spot scanning proton therapy. Phys Med Biol. 60:N109–N119. 2015.PubMed/NCBI View Article : Google Scholar

14 

Meier G, Leiser D, Besson R, Mayor A, Safai S, Weber DC and Lomax AJ: Contour scanning for penumbra improvement in pencil beam scanned proton therapy. Phys Med Biol. 62:2398–2416. 2017.PubMed/NCBI View Article : Google Scholar

15 

Winterhalter C, Meier G, Oxley D, Weber DC, Lomax AJ and Safai S: Contour scanning, multi-leaf collimation and the combination thereof for proton pencil beam scanning. Phys Med Biol. 64(015002)2018.PubMed/NCBI View Article : Google Scholar

16 

Bues M, Newhauser WD, Titt U and Smith AR: Therapeutic step and shoot proton beam spot-scanning with a multi-leaf collimator: A Monte Carlo study. Radiat Prot Dosimetry. 115:164–169. 2005.PubMed/NCBI View Article : Google Scholar

17 

Dowdell SJ, Clasie B, Depauw N, Metcalfe P, Rosenfeld AB, Kooy HM, Flanz JB and Paganetti H: Monte Carlo study of the potential reduction in out-of-field dose using a patient-specific aperture in pencil beam scanning proton therapy. Phys Med Biol. 57:2829–2842. 2012.PubMed/NCBI View Article : Google Scholar

18 

Younkin JE, Bues M, Sio TT, Liu W, Ding X, Keole SR, Stoker JB and Shen J: Multiple energy extraction reduces beam delivery time for a synchrotron-based proton spot-scanning system. Adv Radiat Oncol. 3:412–420. 2018.PubMed/NCBI View Article : Google Scholar

19 

Zhang X, Penagaricano J, Narayanasamy G, Corry P, Liu T, Sanjay M, Paudel N and Morrill S: Helical tomotherapy to LINAC plan conversion utilizing RayStation Fallback planning. J Appl Clin Med Phys. 18:178–185. 2017.PubMed/NCBI View Article : Google Scholar

20 

International Commission on Radiation Units & Measurements (ICRU): Prescribing, recording, and reporting proton-beam therapy. ICRU 7: Report 78. ICRU, Bethesda, MD, 2007.

21 

Zhu XR, Poenisch F, Li H, Zhang X, Sahoo N, Wu RY, Li X, Lee AK, Chang EL, Choi S, et al: A single-field integrated boost treatment planning technique for spot scanning proton therapy. Radiat Oncol. 9(202)2014.PubMed/NCBI View Article : Google Scholar

22 

Kirk ML, Tang S, Zhai H, Vapiwala N, Deville C, James P, Bekelman JE, Christodouleas JP, Tochner Z and Both S: Comparison of prostate proton treatment planning technique, interfraction robustness, and analysis of single-field treatment feasibility. Pract Radiat Oncol. 5:99–105. 2015.PubMed/NCBI View Article : Google Scholar

23 

Hou Z, Li G and Bai S: High dose versus conventional dose in external beam radiotherapy of prostate cancer: A meta-analysis of long-term follow-up. J Cancer Res Clin Oncol. 141:1063–1071. 2015.PubMed/NCBI View Article : Google Scholar

24 

Jolnerovski M, Salleron J, Beckendorf V, Peiffert D, Baumann AS, Bernier V, Huger S, Marchesi V and Chira C: Intensity-modulated radiation therapy from 70 to 80Gy in prostate cancer: Six-year outcomes and predictors of late toxicity. Radiat Oncol. 12(99)2017.PubMed/NCBI View Article : Google Scholar

25 

Thor M, Deasy JO, Paulus R, Robert Lee W, Amin MB, Bruner DW, Low DA, Shah AB, Malone SC, Michalski JM, et al: Tolerance doses for late adverse events after hypofractionated radiotherapy for prostate cancer on trial NRG oncology/RTOG 0415. Radiother Oncol. 135:19–24. 2019.PubMed/NCBI View Article : Google Scholar

26 

Colaco RJ, Hoppe BS, Flampouri S, McKibben BT, Henderson RH, Bryant C, Nichols RC, Mendenhall WM, Li Z, Su Z, et al: Rectal toxicity after proton therapy for prostate cancer: An analysis of outcomes of prospective studies conducted at the university of Florida proton therapy institute. Int J Radiat Oncol Biol Phys. 91:172–181. 2015.PubMed/NCBI View Article : Google Scholar

27 

Boladeras A, Ferrer F, Navarro V, De Blas R, Cunillera O, Mateo D, Gutierrez C, Martinez E, Villà S, Pera J, et al: Association between EBRT dose volume histograms and quality of life in prostate cancer patients. Rep Pract Oncol Radiother. 23:360–368. 2018.PubMed/NCBI View Article : Google Scholar

28 

Shen J, Tryggestad E, Younkin JE, Keole SR, Furutani KM, Kang Y, Herman MG and Bues M: Technical note: Using experimentally determined proton spot scanning timing parameters to accurately model beam delivery time. Med Phys. 44:5081–5088. 2017.PubMed/NCBI View Article : Google Scholar

29 

Rosas S, Belosi FM, Bizzocchi N, Böhlen T, Zepter S, Morach P, Lomax AJ, Weber DC and Hrbacek J: Benchmarking a commercial proton therapy solution: The paul scherrer institut experience. Br J Radiol. 93(20190920)2020.PubMed/NCBI View Article : Google Scholar

30 

Schippers JM and Lomax AJ: Emerging technologies in proton therapy. Acta Oncol. 50:838–850. 2011.PubMed/NCBI View Article : Google Scholar

31 

Engelsman M, Schwarz M and Dong L: Physics controversies in proton therapy. Semin Radiat Oncol. 23:88–96. 2013.PubMed/NCBI View Article : Google Scholar

32 

Mizushima K, Katagiri K, Iwata Y, Furukawa T, Fujimoto T, Sato S, Hara Y, Shirai T and Noda K: Experimental studies of systematic multiple-energy operation at HIMAC synchrotron. Nucl Instrum Methods Phys Res Sec B. 331:243–247. 2014.

33 

Hamstra DA, Mariados N, Sylvester J, Shah D, Karsh L, Hudes R, Beyer D, Kurtzman S, Bogart J, His RA, et al: Continued benefit to rectal separation for prostate radiation therapy: Final results of a phase III trial. Int J Radiat Oncol Biol Phys. 97:976–985. 2017.PubMed/NCBI View Article : Google Scholar

34 

Karsh LI, Gross ET, Pieczonka CM, Aliotta PJ, Skomra CJ, Ponsky LE, Nieh PT, Han M, Hamstra DA and Shore ND: Absorbable hydrogel spacer use in prostate radiotherapy: A comprehensive review of phase 3 clinical trial published data. Urology. 115:39–44. 2018.PubMed/NCBI View Article : Google Scholar

35 

Wei JT, Dunn RL, Litwin MS, Sandler HM and Sanda MG: Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology. 56:899–905. 2000.PubMed/NCBI View Article : Google Scholar

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Copy and paste a formatted citation
Spandidos Publications style
Fukumitsu N, Hayakawa T, Yamashita T, Mima M, Demizu Y, Suzuki T and Soejima T: Simulation study using the spots deletion technique in spot scanning proton beam therapy for prostate cancers. Mol Clin Oncol 16: 25, 2022.
APA
Fukumitsu, N., Hayakawa, T., Yamashita, T., Mima, M., Demizu, Y., Suzuki, T., & Soejima, T. (2022). Simulation study using the spots deletion technique in spot scanning proton beam therapy for prostate cancers. Molecular and Clinical Oncology, 16, 25. https://doi.org/10.3892/mco.2021.2458
MLA
Fukumitsu, N., Hayakawa, T., Yamashita, T., Mima, M., Demizu, Y., Suzuki, T., Soejima, T."Simulation study using the spots deletion technique in spot scanning proton beam therapy for prostate cancers". Molecular and Clinical Oncology 16.1 (2022): 25.
Chicago
Fukumitsu, N., Hayakawa, T., Yamashita, T., Mima, M., Demizu, Y., Suzuki, T., Soejima, T."Simulation study using the spots deletion technique in spot scanning proton beam therapy for prostate cancers". Molecular and Clinical Oncology 16, no. 1 (2022): 25. https://doi.org/10.3892/mco.2021.2458
Copy and paste a formatted citation
x
Spandidos Publications style
Fukumitsu N, Hayakawa T, Yamashita T, Mima M, Demizu Y, Suzuki T and Soejima T: Simulation study using the spots deletion technique in spot scanning proton beam therapy for prostate cancers. Mol Clin Oncol 16: 25, 2022.
APA
Fukumitsu, N., Hayakawa, T., Yamashita, T., Mima, M., Demizu, Y., Suzuki, T., & Soejima, T. (2022). Simulation study using the spots deletion technique in spot scanning proton beam therapy for prostate cancers. Molecular and Clinical Oncology, 16, 25. https://doi.org/10.3892/mco.2021.2458
MLA
Fukumitsu, N., Hayakawa, T., Yamashita, T., Mima, M., Demizu, Y., Suzuki, T., Soejima, T."Simulation study using the spots deletion technique in spot scanning proton beam therapy for prostate cancers". Molecular and Clinical Oncology 16.1 (2022): 25.
Chicago
Fukumitsu, N., Hayakawa, T., Yamashita, T., Mima, M., Demizu, Y., Suzuki, T., Soejima, T."Simulation study using the spots deletion technique in spot scanning proton beam therapy for prostate cancers". Molecular and Clinical Oncology 16, no. 1 (2022): 25. https://doi.org/10.3892/mco.2021.2458
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