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Open Access 01-12-2015 | Research

Optimization of carbon ion and proton treatment plans using the raster-scanning technique for patients with unresectable pancreatic cancer

Authors: Constantin Dreher, Daniel Habermehl, Swantje Ecker, Stephan Brons, Rami El-Shafie, Oliver Jäkel, Jürgen Debus, Stephanie E. Combs

Published in: Radiation Oncology | Issue 1/2015

Abstract

Background

The aim of the thesis is to improve radiation plans of patients with locally advanced, unresectable pancreatic cancer by using carbon ion and proton beams.

Patients and methods

Using the treatment planning system Syngo RT Planning (Siemens, Erlangen, Germany) a total of 50 treatment plans have been created for five patients with the dose schedule 15 × 3 Gy(RBE). With reference to the anatomy, five field configurations were considered to be relevant. The plans were analyzed with respect to dose distribution and individual anatomy, and compared using a customized index.

Results

Within the index the three-field configurations yielded the best results, though with a high variety of score points (field setup 5, carbon ion: median 74 (range 48–101)). The maximum dose in the myelon is low (e.g. case 3, carbon ion: 21.5 Gy(RBE)). A single posterior field generally spares the organs at risk, but the maximum dose in the myelon is high (e.g. case 3, carbon ion: 32.9 Gy(RBE)). Two oblique posterior fields resulted in acceptable maximum doses in the myelon (e.g. case 3, carbon ion: 26.9 Gy(RBE)). The single-field configuration and the two oblique posterior fields had a small score dispersion (carbon ion: median 66 and 58 (range 62–72 and 40–69)). In cases with topographic proximity of the organs at risk to the target volume, the single-field configuration scored as well as the three-field configurations.

Conclusion

In summary, the three-field configurations showed the best dose distributions. A single posterior field seems to be robust and beneficial in case of difficult topographical conditions and topographical proximity of organs at risk to the target volume. A setup with two oblique posterior fields is a reasonable compromise between three-field and single-field configurations.

Raimondi S, Maisonneuve P, Lowenfels AB. Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol. 2009;6(12):699–708. doi:10.1038/nrgastro.2009.177.CrossRefPubMed

Gillen S, Schuster T, Meyer Zum Buschenfelde C, Friess H, Kleeff J. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7(4):e1000267. doi:10.1371/journal.pmed.1000267.PubMedCentralCrossRefPubMed

Habermehl D, Kessel K, Welzel T, Hof H, Abdollahi A, Bergmann F, et al. Neoadjuvant chemoradiation with gemcitabine for locally advanced pancreatic cancer. Radiat Oncol. 2012;7:28. doi:10.1186/1748-717X-7-28.PubMedCentralCrossRefPubMed

Naumann P, Habermehl D, Welzel T, Debus J, Combs SE. Outcome after neoadjuvant chemoradiation and correlation with nutritional status in patients with locally advanced pancreatic cancer. Strahlenther Onkol. 2013;189(9):745–52. doi:10.1007/s00066-013-0393-3.CrossRefPubMed

Habermehl D, Brecht IC, Bergmann F, Welzel T, Rieken S, Werner J, et al. Chemoradiation in patients with isolated recurrent pancreatic cancer - therapeutical efficacy and probability of re-resection. Radiat Oncol. 2013;8:27. doi:10.1186/1748-717X-8-27.PubMedCentralCrossRefPubMed

Nakamura A, Itasaka S, Takaori K, Kawaguchi Y, Shibuya K, Yoshimura M, et al. Radiotherapy for patients with isolated local recurrence of primary resected pancreatic cancer. Prolonged disease-free interval associated with favorable prognosis. Strahlenther Onkol. 2014;190(5):485–90.CrossRefPubMed

Yovino S, Poppe M, Jabbour S, David V, Garofalo M, Pandya N, et al. Intensity-modulated radiation therapy significantly improves acute gastrointestinal toxicity in pancreatic and ampullary cancers. Int J Radiat Oncol Biol Phys. 2011;79(1):158–62. doi:10.1016/j.ijrobp.2009.10.043.CrossRefPubMed

Combs SE, Habermehl D, Kessel K, Bergmann F, Werner J, Brecht I, et al. Intensity modulated radiotherapy as neoadjuvant chemoradiation for the treatment of patients with locally advanced pancreatic cancer : Outcome analysis and comparison with a 3D-treated patient cohort. Strahlenther Onkol. 2013;189(9):738–44. doi:10.1007/s00066-013-0391-5.CrossRefPubMed

Suit H, DeLaney T, Goldberg S, Paganetti H, Clasie B, Gerweck L, et al. Proton vs carbon ion beams in the definitive radiation treatment of cancer patients. Radiother Oncol. 2010;95(1):3–22. doi:10.1016/j.radonc.2010.01.015.CrossRefPubMed

10.

Prescribing, recording, and reporting proton-beam therapy. International Commission on Radiation Units and Measurements2007 December 1, 2007. doi: 10.1093/jicru/ndm021

11.

El Shafie RA, Habermehl D, Rieken S, Mairani A, Orschiedt L, Brons S, et al. In vitro evaluation of photon and raster-scanned carbon ion radiotherapy in combination with gemcitabine in pancreatic cancer cell lines. J Radiat Res. 2013;54 Suppl 1:i113–9. doi:10.1093/jrr/rrt052.PubMedCentralCrossRefPubMed

12.

Georgakilas AG, O’Neill P, Stewart RD. Induction and repair of clustered DNA lesions: what do we know so far? Radiat Res. 2013;180(1):100–9. doi:10.1667/RR3041.1.CrossRefPubMed

13.

Habermehl D, Ilicic K, Dehne S, Rieken S, Orschiedt L, Brons S, et al. The relative biological effectiveness for carbon and oxygen ion beams using the raster-scanning technique in hepatocellular carcinoma cell lines. PLoS ONE. 2014;9(12):e113591. doi:10.1371/journal.pone.0113591.PubMedCentralCrossRefPubMed

14.

Oonishi K, Cui X, Hirakawa H, Fujimori A, Kamijo T, Yamada S, et al. Different effects of carbon ion beams and X-rays on clonogenic survival and DNA repair in human pancreatic cancer stem-like cells. Radiother Oncol. 2012;105(2):258–65. doi:10.1016/j.radonc.2012.08.009.CrossRefPubMed

15.

Habermehl D, Debus J, Ganten T, Ganten MK, Bauer J, Brecht IC, et al. Hypofractionated carbon ion therapy delivered with scanned ion beams for patients with hepatocellular carcinoma - feasibility and clinical response. Radiat Oncol. 2013;8:59. doi:10.1186/1748-717X-8-59.PubMedCentralCrossRefPubMed

16.

Shinoto M, Yamada S, Yasuda S, Imada H, Shioyama Y, Honda H, et al. Phase 1 trial of preoperative, short-course carbon-ion radiotherapy for patients with resectable pancreatic cancer. Cancer. 2013;119(1):45–51. doi:10.1002/cncr.27723.CrossRefPubMed

17.

Schneider RA, Vitolo V, Albertini F, Koch T, Ares C, Lomax A, et al. Small bowel toxicity after high dose spot scanning-based proton beam therapy for paraspinal/retroperitoneal neoplasms. Strahlenther Onkol. 2013;189(12):1020–5. doi:10.1007/s00066-013-0432-0.CrossRefPubMed

18.

Okada T, Kamada T, Tsuji H, Mizoe JE, Baba M, Kato S, et al. Carbon ion radiotherapy: clinical experiences at National Institute of Radiological Science (NIRS). J Radiat Res. 2010;51(4):355–64.CrossRefPubMed

19.

Haberer T, Becher W, Schardt D, Kraft G. Magnetic scanning system for heavy ion therapy. Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipment. 1993;330(1–2):296–305. doi:http://dx.doi.org/10.1016/0168-9002(93)91335-K

20.

Kramer M, Scholz M. Treatment planning for heavy-ion radiotherapy: calculation and optimization of biologically effective dose. Phys Med Biol. 2000;45(11):3319–30.CrossRefPubMed

21.

Combs SE, Habermehl D, Kieser M, Dreher C, Werner J, Haselmann R, et al. Phase I study evaluating the treatment of patients with locally advanced pancreatic cancer with carbon ion radiotherapy: the PHOENIX-01 trial. BMC Cancer. 2013;13:419. doi:10.1186/1471-2407-13-419.PubMedCentralCrossRefPubMed

22.

Kumagai M, Hara R, Mori S, Yanagi T, Asakura H, Kishimoto R, et al. Impact of intrafractional bowel gas movement on carbon ion beam dose distribution in pancreatic radiotherapy. Int J Radiat Oncol Biol Phys. 2009;73(4):1276–81. doi:10.1016/j.ijrobp.2008.10.055.CrossRefPubMed

23.

Cattaneo GM, Passoni P, Sangalli G, Slim N, Longobardi B, Mancosu P, et al. Internal target volume defined by contrast-enhanced 4D-CT scan in unresectable pancreatic tumour: evaluation and reproducibility. Radiother Oncol. 2010;97(3):525–9. doi:10.1016/j.radonc.2010.08.007.CrossRefPubMed

24.

Taniguchi CM, Murphy JD, Eclov N, Atwood TF, Kielar KN, Christman-Skieller C, et al. Dosimetric analysis of organs at risk during expiratory gating in stereotactic body radiation therapy for pancreatic cancer. Int J Radiat Oncol Biol Phys. 2013;85(4):1090–5. doi:10.1016/j.ijrobp.2012.07.2366.CrossRefPubMed

25.

Bert C, Durante M. Motion in radiotherapy: particle therapy. Phys Med Biol. 2011;56(16):R113–44. doi:10.1088/0031-9155/56/16/R01.CrossRefPubMed

26.

Liu F, Erickson B, Peng C, Li XA. Characterization and management of interfractional anatomic changes for pancreatic cancer radiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(3):e423–9. doi:10.1016/j.ijrobp.2011.12.073.CrossRefPubMed

27.

Batista V, Richter D, Jaekel O, Combs S. OC-0390: Inter-fractional robustness of beam angles and margins in scanned carbon treatment of pancreatic tumors. Radiother Oncol. 2014;111(1):S152–3. doi:10.1016/S0167-8140(15)30495-3.CrossRef

28.

Richter D, Graeff C, Jakel O, Combs SE, Durante M, Bert C. Residual motion mitigation in scanned carbon ion beam therapy of liver tumors using enlarged pencil beam overlap. Radiother Oncol. 2014;113(2):290–5. doi:10.1016/j.radonc.2014.11.020.CrossRefPubMed

29.

Richter D, Saito N, Chaudhri N, Hartig M, Ellerbrock M, Jakel O, et al. Four-dimensional patient dose reconstruction for scanned ion beam therapy of moving liver tumors. Int J Radiat Oncol Biol Phys. 2014;89(1):175–81. doi:10.1016/j.ijrobp.2014.01.043.CrossRefPubMed

30.

Combs SE, Kalbe A, Nikoghosyan A, Ackermann B, Jakel O, Haberer T, et al. Carbon ion radiotherapy performed as re-irradiation using active beam delivery in patients with tumors of the brain, skull base and sacral region. Radiother Oncol. 2011;98(1):63–7. doi:10.1016/j.radonc.2010.10.010.CrossRefPubMed

31.

Habermehl D, Wagner M, Ellerbrock M, Buchler MW, Jakel O, Debus J, et al. Reirradiation using carbon ions in patients with locally recurrent rectal cancer at HIT: first results. Ann Surg Oncol. 2014. doi:10.1245/s10434-014-4219-z.

32.

Kirkpatrick JP, van der Kogel AJ, Schultheiss TE. Radiation dose–volume effects in the spinal cord. Int J Radiat Oncol Biol Phys. 2010;76(3):S42–9. doi:10.1016/j.ijrobp.2009.04.095.CrossRefPubMed

33.

Elsasser T, Weyrather WK, Friedrich T, Durante M, Iancu G, Kramer M, et al. Quantification of the relative biological effectiveness for ion beam radiotherapy: direct experimental comparison of proton and carbon ion beams and a novel approach for treatment planning. Int J Radiat Oncol Biol Phys. 2010;78(4):1177–83. doi:10.1016/j.ijrobp.2010.05.014.CrossRefPubMed

34.

Scholz M, Kellerer AM, Kraft-Weyrather W, Kraft G. Computation of cell survival in heavy ion beams for therapy. The model and its approximation. Radiat Environ Biophys. 1997;36(1):59–66.CrossRefPubMed

35.

Grun R, Friedrich T, Elsasser T, Kramer M, Zink K, Karger CP, et al. Impact of enhancements in the local effect model (LEM) on the predicted RBE-weighted target dose distribution in carbon ion therapy. Physics in medicine and biology. 2012;57(22):7261–74. doi:10.1088/0031-9155/57/22/7261.CrossRefPubMed

Title: Optimization of carbon ion and proton treatment plans using the raster-scanning technique for patients with unresectable pancreatic cancer
Authors: Constantin Dreher
Daniel Habermehl
Swantje Ecker
Stephan Brons
Rami El-Shafie
Oliver Jäkel
Jürgen Debus
Stephanie E. Combs
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2015
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-015-0538-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Optimization of carbon ion and proton treatment plans using the raster-scanning technique for patients with unresectable pancreatic cancer

Abstract

Background

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

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