Proton pencil beam scanning for mediastinal lymphoma: treatment planning and robustness assessment

Modern radiotherapy (RT) for lymphoma is highly personalized. While advanced imaging is largely employed to define limited treatment volumes, the use of proton pencil beam scanning (PBS) for highly conformal lymphoma RT is still in its infancy. Here, we assess the dosimetric benefits and feasibility...

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Bibliographic Details
Published in:Acta oncologica 2016-10, Vol.55 (9-10), p.1132-1138
Main Authors: Zeng, Chuan, Plastaras, John P, James, Paul, Tochner, Zelig A, Hill-Kayser, Christine E, Hahn, Stephen M, Both, Stefan
Format: Article
Language:English
Subjects:
Feasibility Studies
Female
Four-Dimensional Computed Tomography
Humans
Lymphoma - radiotherapy
Male
Mediastinal Neoplasms - radiotherapy
Patient Selection
Precision Medicine - methods
Proton Therapy - instrumentation
Proton Therapy - methods
Radiation Dosage
Radiation Monitoring - methods
Radiotherapy Planning, Computer-Assisted - methods
Radiotherapy, Conformal
Radiotherapy, Intensity-Modulated
Scattering, Radiation
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Summary:Modern radiotherapy (RT) for lymphoma is highly personalized. While advanced imaging is largely employed to define limited treatment volumes, the use of proton pencil beam scanning (PBS) for highly conformal lymphoma RT is still in its infancy. Here, we assess the dosimetric benefits and feasibility of PBS for mediastinal lymphoma (ML). Ten patients were planned using PBS for involved-site RT. The initial plans were calculated on the average four-dimensional computed tomography (4D-CT). PBS plans were compared with 3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and proton double scattering (DS). In order to evaluate the feasibility of PBS and the plan robustness against inter- and intra-fractional uncertainties, the 4D dose was calculated on initial and verification CTs. The deviation of planned dose from delivered dose was measured. The same proton beamline was used for all patients, while another beamline with larger spots was employed for patients with large motion perpendicular to the beam. PBS provided the lowest mean lung dose (MLD) and mean heart dose (MHD) for all patients in comparison with 3D-CRT, IMRT, and DS. For eight patients, internal target volume (ITV) D was degraded by 
ISSN:0284-186X
1651-226X
DOI:10.1080/0284186x.2016.1191665