Pro-con of proton: Dosimetric advantages of intensity-modulation over passive scatter for thoracic malignancies.

• 发表时间: Sep 2020
• 来源期刊: Tech Innov Patient Support Radiat Oncol
• DOI: 10.1016/j.tipsro.2019.11.005
• PMID: 32954018
• 文章类型: Journal Article
• 作者列表: Jie AW,Marignol L

关键词: BSPTV, Beam Specific Planning Target Volume; CT, Computed Tomography; DIBH, Deep Inspiration Breath-Hold; Dosimetry; EUD, Equivalent Uniform Dose; HI, Homogeneity Index; IMPT, Intensity Modulated Proton Therapy; IMRT, Intensity Modulated Radiation Therapy; ITV, Internal Target Volume; Intensity modulated proton therapy (IMPT); Interplay; MFO, Multi Field Optimisation; MU, Monitor Unit; NSCLC, Non-Small-Cell Lung cancer; OAR, Organ-At-Risk; Organ at risks; PSPT, Passively Scattered Proton Therapy; PTV, Planning Target Volume; Passively scattered proton therapy (PSPT); RT, Radiation Therapy; SFO, Single Field Optimisation; SFUD, Single Field Uniform Dose; Thoracic malignancies; iCTV, Internal Clinical Target Volume; iGTV/HU, Internal Gross Tumour Volume/Hounsfield Unit

Abstract

The use of passively scattered proton therapy (PSPT) or intensity modulated proton therapy (IMPT) opens the potential for dose escalation or critical structure sparing in thoracic malignancies. While the latter offers greater dose conformality, dose distributions are subjected to greater uncertainties, especially due to interplay effects. Exploration in this area is warranted to determine if there is any dosimetric advantages in using IMPT for thoracic malignancies. This review aims to both compare organs-at-risk sparing and plan robustness between PSPT and IMPT and examine the mitigation strategies for the reduction of interplay effects currently available. Early evidence suggests that IMPT is dosimetrically superior to PSPT in thoracic malignancies. Randomised control trials are required before any clinical benefit of IMPT can be confirmed.