Optimal Gating Window for Respiratory-Gated Pencil Beam Scanning Proton Therapy for Lung Cancer: A pilot study
Keywords:
proton therapy, respiratory gating, pencil beam scanning, gating window, treatment efficiencyAbstract
Backgrounds: Pencil beam scanning (PBS) proton therapy has the capability of delivering conformal dose to the target with a relatively low dose to normal tissues. Several studies have shown the advantages of PBS for lung cancer treatment. However, respiratory motion causes the interplay effect between organ motion and dynamic beam delivery.
Objective: To investigate the efficiency of gated PBS proton therapy for a lung cancer patient with the target motion of larger than 10 mm for different gating windows (GWs) by considering dosimetric parameters of organs at risk (OARs) and treatment time.
Materials and Methods: The four-dimensional computed tomography (4DCT) dataset of a lung cancer patient with the target motion of 11.6 mm was used in this study. The internal target motion was defined by deformable image registration of the GTV in each respiratory phase to end-exhalation phase, while the external motion was defined by using the RPMTM (Real-time-Position-Management) data. The relationship between external and internal motion was investigated. The treatment plans for the different GWs with internal motion ranging from 2 mm to 11.6 mm were created using matRad, an open-source treatment planning system for generic treatment machines. The dosimetric parameters for OARs from each plan were compared using the ungated plan as the reference. The treatment time was evaluated based on published data of Varian’s ProBeam.
Results: The treatment plans with the GWs of 10%-80%, 20%-70%, 30%-70% and 40%-60% resulted in the reduction of Dmean in the heart by 1.43-14.29% and the reduction of Dmean in the lung by 2.25-8.84%, while the treatment time ranged from 103.5-253.0 s, respectively. In this case, the GW of 30%-70% was found to be most optimized as dose in the heart and lung decreased by up to 4.6% compared to those of the 20%-70% GW and increased by up to 3.0% compared to those of the 40%-60% GW. However, the treatment time when using the 30%-70% GW was 24 s longer than using the 20%-70% GW but 95 s shorter than using 40%-60% GW.
Conclusion: Respiratory gating led to a reduction of the target volume and dose in surrounding normal tissues. A trade-off between the increased dose in the OARs and the shorter treatment time needed to be justified for determination of the optimal gating window.
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