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Interplay Effect of Splenic Motion for Total Lymphoid Irradiation in Pediatric Proton Therapy
SIMPLE SUMMARY: This study addresses the challenge of respiratory motion in pediatric patients undergoing proton therapy for total lymphoid irradiation (TLI), an essential component of reduced-intensity conditioning regimens for hematopoietic cell transplant (HCT) patients. The primary concern is th...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10650483/ https://www.ncbi.nlm.nih.gov/pubmed/37958335 http://dx.doi.org/10.3390/cancers15215161 |
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author | Ates, Ozgur Uh, Jinsoo Pirlepesov, Fakhriddin Hua, Chia-ho Triplett, Brandon Qudeimat, Amr Sharma, Akshay Merchant, Thomas E. Lucas, John T. |
author_facet | Ates, Ozgur Uh, Jinsoo Pirlepesov, Fakhriddin Hua, Chia-ho Triplett, Brandon Qudeimat, Amr Sharma, Akshay Merchant, Thomas E. Lucas, John T. |
author_sort | Ates, Ozgur |
collection | PubMed |
description | SIMPLE SUMMARY: This study addresses the challenge of respiratory motion in pediatric patients undergoing proton therapy for total lymphoid irradiation (TLI), an essential component of reduced-intensity conditioning regimens for hematopoietic cell transplant (HCT) patients. The primary concern is the interplay effect, which can cause deviations from the planned dose during respiratory motion. The research utilized static and 4D CT images from ten patients to simulate the interplay effect and assess its impact on treatment planning. The study concludes that 4D plan evaluation and robust optimization techniques can help address respiratory motion challenges in proton TLI treatments, especially in cases where other motion management strategies like breath-holding are not feasible due to the patient’s young age, the need for anesthesia, or medical conditions. Patient-specific respiratory motion evaluations are crucial to ensure adequate dosimetric coverage in proton therapy for pediatric patients. ABSTRACT: (1) Background: The most significant cause of an unacceptable deviation from the planned dose during respiratory motion is the interplay effect. We examined the correlation between the magnitude of splenic motion and its impact on plan quality for total lymphoid irradiation (TLI); (2) Methods: Static and 4D CT images from ten patients were used for interplay effect simulations. Patients’ original plans were optimized based on the average CT extracted from the 4D CT and planned with two posterior beams using scenario-based optimization (±3 mm of setup and ±3% of range uncertainty) and gradient matching at the level of mid-spleen. Dynamically accumulated 4D doses (interplay effect dose) were calculated based on the time-dependent delivery sequence of radiation fluence across all phases of the 4D CT. Dose volume parameters for each simulated treatment delivery were evaluated for plan quality; (3) Results: Peak-to-peak splenic motion (≤12 mm) was measured from the 4D CT of ten patients. Interplay effect simulations revealed that the ITV coverage of the spleen remained within the protocol tolerance for splenic motion, ≤8 mm. The D100% coverage for ITV spleen decreased from 95.0% (nominal plan) to 89.3% with 10 mm and 87.2% with 12 mm of splenic motion; (4) Conclusions: 4D plan evaluation and robust optimization may overcome problems associated with respiratory motion in proton TLI treatments. Patient-specific respiratory motion evaluations are essential to confirming adequate dosimetric coverage when proton therapy is utilized. |
format | Online Article Text |
id | pubmed-10650483 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-106504832023-10-26 Interplay Effect of Splenic Motion for Total Lymphoid Irradiation in Pediatric Proton Therapy Ates, Ozgur Uh, Jinsoo Pirlepesov, Fakhriddin Hua, Chia-ho Triplett, Brandon Qudeimat, Amr Sharma, Akshay Merchant, Thomas E. Lucas, John T. Cancers (Basel) Article SIMPLE SUMMARY: This study addresses the challenge of respiratory motion in pediatric patients undergoing proton therapy for total lymphoid irradiation (TLI), an essential component of reduced-intensity conditioning regimens for hematopoietic cell transplant (HCT) patients. The primary concern is the interplay effect, which can cause deviations from the planned dose during respiratory motion. The research utilized static and 4D CT images from ten patients to simulate the interplay effect and assess its impact on treatment planning. The study concludes that 4D plan evaluation and robust optimization techniques can help address respiratory motion challenges in proton TLI treatments, especially in cases where other motion management strategies like breath-holding are not feasible due to the patient’s young age, the need for anesthesia, or medical conditions. Patient-specific respiratory motion evaluations are crucial to ensure adequate dosimetric coverage in proton therapy for pediatric patients. ABSTRACT: (1) Background: The most significant cause of an unacceptable deviation from the planned dose during respiratory motion is the interplay effect. We examined the correlation between the magnitude of splenic motion and its impact on plan quality for total lymphoid irradiation (TLI); (2) Methods: Static and 4D CT images from ten patients were used for interplay effect simulations. Patients’ original plans were optimized based on the average CT extracted from the 4D CT and planned with two posterior beams using scenario-based optimization (±3 mm of setup and ±3% of range uncertainty) and gradient matching at the level of mid-spleen. Dynamically accumulated 4D doses (interplay effect dose) were calculated based on the time-dependent delivery sequence of radiation fluence across all phases of the 4D CT. Dose volume parameters for each simulated treatment delivery were evaluated for plan quality; (3) Results: Peak-to-peak splenic motion (≤12 mm) was measured from the 4D CT of ten patients. Interplay effect simulations revealed that the ITV coverage of the spleen remained within the protocol tolerance for splenic motion, ≤8 mm. The D100% coverage for ITV spleen decreased from 95.0% (nominal plan) to 89.3% with 10 mm and 87.2% with 12 mm of splenic motion; (4) Conclusions: 4D plan evaluation and robust optimization may overcome problems associated with respiratory motion in proton TLI treatments. Patient-specific respiratory motion evaluations are essential to confirming adequate dosimetric coverage when proton therapy is utilized. MDPI 2023-10-26 /pmc/articles/PMC10650483/ /pubmed/37958335 http://dx.doi.org/10.3390/cancers15215161 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Ates, Ozgur Uh, Jinsoo Pirlepesov, Fakhriddin Hua, Chia-ho Triplett, Brandon Qudeimat, Amr Sharma, Akshay Merchant, Thomas E. Lucas, John T. Interplay Effect of Splenic Motion for Total Lymphoid Irradiation in Pediatric Proton Therapy |
title | Interplay Effect of Splenic Motion for Total Lymphoid Irradiation in Pediatric Proton Therapy |
title_full | Interplay Effect of Splenic Motion for Total Lymphoid Irradiation in Pediatric Proton Therapy |
title_fullStr | Interplay Effect of Splenic Motion for Total Lymphoid Irradiation in Pediatric Proton Therapy |
title_full_unstemmed | Interplay Effect of Splenic Motion for Total Lymphoid Irradiation in Pediatric Proton Therapy |
title_short | Interplay Effect of Splenic Motion for Total Lymphoid Irradiation in Pediatric Proton Therapy |
title_sort | interplay effect of splenic motion for total lymphoid irradiation in pediatric proton therapy |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10650483/ https://www.ncbi.nlm.nih.gov/pubmed/37958335 http://dx.doi.org/10.3390/cancers15215161 |
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