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Cancers
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Advances in Proton Pencil Beam Scanning Therapy
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Advances in Proton Pencil Beam Scanning Therapy

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: closed (1 September 2024) | Viewed by 7239

Special Issue Editors

Dr. Nicolas Depauw

E-Mail Website
Guest Editor
Radiation Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
Interests: proton therapy; treatment planning; dosimetry; PBS
Dr. Sara St. James

E-Mail Website
Guest Editor
Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112, USA
Interests: proton therapy; quality assurance; dosimetry; PBS; clinical trials

Special Issue Information

Dear Colleagues,

Cancers is pleased to announce a new Special Issue, entitled “Advances in Proton Pencil Beam Scanning Therapy”. Proton pencil beam scanning (PBS) is a technology in which a narrow beam of charged particles is used to treat complex cancers with unparalleled precision. The beam is energized and deflected such that it mirrors the tumor's shape for maximum conformality. This reduces the risk of side effects that are associated with standard radiation therapy. This Special Issue will focus on the latest developments in PBS. 

Manuscripts reflecting original research, as well as critical review articles on current knowledge and future perspectives, will be welcome. The Special Issue will address topics such as improvements in beam delivery systems, selecting optimal PBS parameters for cancer treatment, clinical outcomes based on the dosimetric and biological modeling of proton therapy, and reductions in secondary cancer risks, among others. The Special Issue shall also report on the limitations and future directions of proton PBS.

This Special Issue will be an excellent resource for researchers and clinicians who are interested in learning about recent advancements in proton pencil beam scanning therapy for cancer treatment.

Dr. Nicolas Depauw
Dr. Sara St. James
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • proton therapy
  • pencil beam scanning
  • dosimetry
  • beam delivery
  • biological modelling
  • secondary cancer

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Published Papers (5 papers)

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Research

9 pages, 1103 KiB  
Article
Proton Beam Therapy for Advanced Periocular Skin Cancer: An Eye-Sparing Approach
by Yingying Zhang, Isabela C. S. Lima, Alessandra A. Woo, Stephen Zieminski, Judith A. Adams, Megan A. Hughes and Annie W. Chan
Cancers 2025, 17(2), 327; https://doi.org/10.3390/cancers17020327 - 20 Jan 2025
Viewed by 1134
Abstract
Background/Objectives: The management of periocular skin malignancies presents a unique challenge. Proton beam therapy, due to its sharp dose fall-off, allows for the delivery of a tumoricidal dose to the tumor while sparing adjacent normal tissues. Methods: Thirteen patients with a median age [...] Read more.
Background/Objectives: The management of periocular skin malignancies presents a unique challenge. Proton beam therapy, due to its sharp dose fall-off, allows for the delivery of a tumoricidal dose to the tumor while sparing adjacent normal tissues. Methods: Thirteen patients with a median age of 76.5 years received protons at our institution to a median dose of 66.6 Gy (RBE). Sixty-four percent of the lesions were basal cell carcinoma, and 22% were squamous cell carcinoma. Eighty-six percent of patients underwent biopsy only or partial resection. Fifty-seven percent of the lesions were located in the medial or lateral canthus. There was orbital invasion in 93% of the cases. Locoregional control probability and overall survival were estimated with the Kaplan–Meier method. Treatment toxicity was scored using the CTCAE 4.0. Results: At a median follow-up of 96 months, there was no local recurrence. The rate of orbital preservation was 100%. Functional vision was maintained in all the patients. There was no acute or late grade 3 or higher toxicity. Conclusions: Protons allow for long-term tumor control with eye preservation in patients with locally advanced periocular skin cancers. Larger prospective multi-institutional trials with standardized ophthalmological assessments are needed to confirm our findings. Full article
(This article belongs to the Special Issue Advances in Proton Pencil Beam Scanning Therapy)
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17 pages, 22352 KiB  
Article
A Fast 3D Range-Modulator Delivery Approach: Validation of the FLUKA Model on a Varian ProBeam System Including a Robustness Analysis
by Yuri Simeonov, Ulrich Weber, Miriam Krieger, Christoph Schuy, Michael Folkerts, Gerard Paquet, Pierre Lansonneur, Petar Penchev and Klemens Zink
Cancers 2024, 16(20), 3498; https://doi.org/10.3390/cancers16203498 - 16 Oct 2024
Viewed by 1452
Abstract
A 3D range-modulator (RM), optimized for a single energy and a specific target shape, is a promising and viable solution for the ultra-fast dose delivery in particle therapy. The aim of this work was to investigate the impact of potential beam and modulator [...] Read more.
A 3D range-modulator (RM), optimized for a single energy and a specific target shape, is a promising and viable solution for the ultra-fast dose delivery in particle therapy. The aim of this work was to investigate the impact of potential beam and modulator misalignments on the dose distribution. Moreover, the FLUKA Monte Carlo model, capable of simulating 3D RMs, was adjusted and validated for the 250 MeV single-energy proton irradiation from a Varian ProBeam system. A 3D RM was designed for a cube target shape rotated 45° around two axes using a Varian-internal research version of the Eclipse treatment planning software, and the resulting dose distribution was simulated in a water phantom. Deviations from the ideal alignment were introduced, and the dose distributions from the modified simulations were compared to the original unmodified one. Finally, the FLUKA model and the workflow were validated with base-line data measurements and dose measurements of the manufactured modulator prototype at the HollandPTC facility in Delft. The adjusted FLUKA model, optimized particularly in the scope of a single-energy FLASH irradiation with a PMMA pre-absorber, demonstrated very good agreement with the measured dose distribution resulting from the 3D RM. Dose deviations resulting from modulator-beam axis misalignments depend on the specific 3D RM and its shape, pin aspect ratio, rotation angle, rotation point, etc. A minor modulator shift was found to be more relevant for the distal dose distribution than for the spread-out Bragg Peak (SOBP) homogeneity. On the other hand, a modulator tilt (rotation away from the beam axis) substantially affected not only the depth dose profile, transforming a flat SOBP into a broad, Gaussian-like distribution with increasing rotation angle, but also shifted the lateral dose distribution considerably. This work strives to increase awareness and highlight potential pitfalls as the 3D RM method progresses from a purely research concept to pre-clinical studies and human trials. Ensuring that gantry rotation and the combined weight of RM, PMMA, and aperture do not introduce alignment issues is critical. Given all the other range and positioning uncertainties, etc., not related to the modulator, the RM must be aligned with an accuracy below 1° in order to preserve a clinically acceptable total uncertainty budget. Careful consideration of critical parameters like the pin aspect ratio and possibly a novel robust modulator geometry optimization are potential additional strategies to mitigate the impact of positioning on the resulting dose. Finally, even the rotated cube 3D modulator with high aspect ratio pin structures (~80 mm height to 3 mm pin base width) was found to be relatively robust against a slight misalignment of 0.5° rotation or a 1.5 mm shift in one dimension perpendicular to the beam axis. Given a reliable positioning and QA concept, the additional uncertainties introduced by the 3D RM can be successfully managed adopting the concept into the clinical routine. Full article
(This article belongs to the Special Issue Advances in Proton Pencil Beam Scanning Therapy)
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10 pages, 2004 KiB  
Article
Proton Pencil Beam Scanning Facilitates the Safe Treatment of Extended Radiation Targets for Hodgkin Lymphoma: A Report from the Proton Collaborative Group Registry
by Maryam Ebadi, Mark Pankuch, Sean Boyer, John Chang, Craig Stevens, Matthew D. Hall, Shaakir Hasan, James E. Bates, Stella Flampouri, Adam J. Kole, Pranshu Mohindra, Carl Rossi, Parag Sanghvi, Lisa McGee, Zaker Rana and Yolanda D. Tseng
Cancers 2024, 16(15), 2736; https://doi.org/10.3390/cancers16152736 - 1 Aug 2024
Cited by 1 | Viewed by 1420
Abstract
Because proton beam therapy (PBT) can lower the dose of radiation to the heart, lungs, and breast, it is an established radiation modality for patients with Hodgkin lymphoma (HL). Pencil beam scanning (PBS) PBT facilitates the treatment of more extensive targets. This may [...] Read more.
Because proton beam therapy (PBT) can lower the dose of radiation to the heart, lungs, and breast, it is an established radiation modality for patients with Hodgkin lymphoma (HL). Pencil beam scanning (PBS) PBT facilitates the treatment of more extensive targets. This may be especially of value for lymphoma patients who require RT to both mediastinal and axillary targets, defined here as extended target RT (ETRT), given the target distribution and need to minimize the lung, heart, and breast dose. Using the Proton Collaborative Group registry, we identified patients with HL treated with PBT to both their mediastinum and axilla, for which DICOM-RT was available. All patients were treated with PBS. To evaluate the dosimetric impact of PBS, we compared delivered PBS plans with VMAT butterfly photon plans optimized to have the same target volume coverage, when feasible. Between 2016 and 2021, twelve patients (median 26 years) received PBS ETRT (median 30.6 Gy (RBE)). Despite the large superior/inferior (SI, median 22.2 cm) and left/right (LR, median 22.8 cm) extent of the ETRT targets, all patients were treated with one isocenter except for two patients (both with SI and LR > 30 cm). Most commonly, anterior beams, with or without posterior beams, were used. Compared to photons, PBS had greater target coverage, better conformity, and lower dose heterogeneity while achieving lower doses to the lungs and heart, but not to the breast. No acute grade 3+ toxicities were reported, including pneumonitis. Proton ETRT in this small cohort was safely delivered with PBS and was associated with an improved sparing of the heart and lungs compared to VMAT. Full article
(This article belongs to the Special Issue Advances in Proton Pencil Beam Scanning Therapy)
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10 pages, 1603 KiB  
Article
Beam Position Projection Algorithms in Proton Pencil Beam Scanning
by Konrad P. Nesteruk, Stephen G. Bradley, Hanne M. Kooy and Benjamin M. Clasie
Cancers 2024, 16(11), 2098; https://doi.org/10.3390/cancers16112098 - 31 May 2024
Viewed by 871
Abstract
Beam position uncertainties along the beam trajectory arise from the accelerator, beamline, and scanning magnets (SMs). They can be monitored in real time, e.g., through strip ionization chambers (ICs), and treatments can be paused if needed. Delivery is more reliable and accurate if [...] Read more.
Beam position uncertainties along the beam trajectory arise from the accelerator, beamline, and scanning magnets (SMs). They can be monitored in real time, e.g., through strip ionization chambers (ICs), and treatments can be paused if needed. Delivery is more reliable and accurate if the beam position is projected from monitored nozzle parameters to the isocenter, allowing for accurate online corrections to be performed. Beam position projection algorithms are also used in post-delivery log file analyses. In this paper, we investigate the four potential algorithms that can be applied to all pencil beam scanning (PBS) nozzles. For some combinations of nozzle configurations and algorithms, however, the projection uses beam properties determined offline (e.g., through beam tuning or technical commissioning). The best algorithm minimizes either the total uncertainty (i.e., offline and online) or the total offline uncertainty in the projection. Four beam position algorithms are analyzed (A1–A4). Two nozzle lengths are used as examples: a large nozzle (1.5 m length) and a small nozzle (0.4 m length). Three nozzle configurations are considered: IC after SM, IC before SM, and ICs on both sides. Default uncertainties are selected for ion chamber measurements, nozzle entrance beam position and angle, and scanning magnet angle. The results for other uncertainties can be determined by scaling these results or repeating the error propagation. We show the propagation of errors from two locations and the SM angle to the isocenter for all the algorithms. The best choice of algorithm depends on the nozzle length and is A1 and A3 for the large and small nozzles, respectively. If the total offline uncertainty is to be minimized (a better choice if the offline uncertainty is not stable), the best choice of algorithm changes to A1 for the small nozzle for some hardware configurations. Reducing the nozzle length can help to reduce the gantry size and make proton therapy more accessible. This work is important for designing smaller nozzles and, consequently, smaller gantries. This work is also important for log file analyses. Full article
(This article belongs to the Special Issue Advances in Proton Pencil Beam Scanning Therapy)
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22 pages, 13337 KiB  
Article
Proton PBS Planning Techniques, Robustness Evaluation, and OAR Sparing for the Whole-Brain Part of Craniospinal Axis Irradiation
by Witold P. Matysiak, Marieke C. Landeweerd, Agata Bannink, Hiska L. van der Weide, Charlotte L. Brouwer, Johannes A. Langendijk, Stefan Both and John H. Maduro
Cancers 2024, 16(5), 892; https://doi.org/10.3390/cancers16050892 - 22 Feb 2024
Cited by 1 | Viewed by 1331
Abstract
Proton therapy is a promising modality for craniospinal irradiation (CSI), offering dosimetric advantages over conventional treatments. While significant attention has been paid to spine fields, for the brain fields, only dose reduction to the lens of the eye has been reported. Hence, the [...] Read more.
Proton therapy is a promising modality for craniospinal irradiation (CSI), offering dosimetric advantages over conventional treatments. While significant attention has been paid to spine fields, for the brain fields, only dose reduction to the lens of the eye has been reported. Hence, the objective of this study is to assess the potential gains and feasibility of adopting different treatment planning techniques for the entire brain within the CSI target. To this end, eight previously treated CSI patients underwent retrospective replanning using various techniques: (1) intensity modulated proton therapy (IMPT) optimization, (2) the modification/addition of field directions, and (3) the pre-optimization removal of superficially placed spots. The target coverage robustness was evaluated and dose comparisons for lenses, cochleae, and scalp were conducted, considering potential biological dose increases. The target coverage robustness was maintained across all plans, with minor reductions when superficial spot removal was utilized. Single- and multifield optimization showed comparable target coverage robustness and organ-at-risk sparing. A significant scalp sparing was achieved in adults but only limited in pediatric cases. Superficial spot removal contributed to scalp V30 Gy reduction at the expense of lower coverage robustness in specific cases. Lens sparing benefits from multiple field directions, while cochlear sparing remains impractical. Based on the results, all investigated plan types are deemed clinically adoptable. Full article
(This article belongs to the Special Issue Advances in Proton Pencil Beam Scanning Therapy)
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