Proton Therapy: Indications, Techniques and Outcomes

Cover
Inside front cover
Proton therapy
Copyright
Dedication
List of contributors
Preface
Acknowledgment
Table of contents
SECTION I: Introduction
1 Principles of radiobiology
	Keywords:
	Introduction
	DNA damage and repair
		DNA damage
		DNA damage repair
	Cell death
		Cell mitotic catastrophe
		Cell senescence
		Cell apoptosis
		Cell necrosis
	Relative biological effectiveness
	Immune response
		Immunoactivation effect of photon and proton beams
		Indirect immunoactivation effect of photon and proton beams
		Immune suppression effect of photon and proton beams
	Angiogenic signal pathway
	Conclusions and remarks
	References available online.
2 Principles of proton beam therapy
	Keywords:
	Introduction
	Physical characteristics of protons
	Proton biological characteristics
		Biological effects in the current practice of proton therapy
		Laboratory and clinical studies to quantify proton biological effects accurately
		Deducing proton relative biological effectiveness from clinical response
		Modeling of proton biological effects
	Proton therapy delivery system
		Proton accelerators
		Passively scattered proton therapy
		Scanning beams
	Proton therapy planning and plan evaluation
	Incorporating variable relative biological effectiveness in evaluating and optimizing proton dose distributions
	Current research and development activities, future prospects, and summary
	References available online.
SECTION II:
Physics and Treatment Planning
3 Clinical commissioning of pencil beam scanning for intensity-modulated proton therapy
	Keywords:
	Introduction
	Calibration of computed tomography numbers for proton therapy
	Detectors and measurement techniques
		Ionization chambers
		Integral depth doses: Measurements and corrections
		Lateral profiles
			Ionization chamber detectors: The size effect
			Two-dimensional scintillation detectors and films
	Treatment planning system
		Proton dose algorithms
		Typical input data required by the treatment planning system
		Beam model configuration
		Validating the beam model
			Water phantom
			Patient-specific plan measurements
	Treatment delivery system
		Interlocks
			Dose monitor
			Spot position monitor
			Minimum and maximum spot monitor units
			Bending magnetic field interlock
		Calibration
			Definition of charge per monitor unit
			Dose monitor linearity
		Dosimetric parameters of spots
			Energies, range, and depth doses
			Spot position and size
		End-to-end testing
	Summary
	References available online.
4 Immobilization and simulation
	Keywords:
	Introduction
	Immobilization devices: General considerations
	Immobilization devices and modeling by the treatment planning system
	Site-specific examples
		Head and neck and brain patients
	Thoracic and abdomen
	Pelvis and prostate
	Craniospinal irradiation
	Summary
	References available online.
5 Principles of intensity-modulated proton therapy treatment planning
	Keywords:
	Intensity-modulated proton therapy is effective for complex targets
	Uncertainties
		Range uncertainties
		Setup uncertainties
		Motion/interplay uncertainties
		Anatomical change uncertainties
	Robust evaluations
		Planning target volume and clinical target volume concept
		Worst-case robust evaluation
		Robust evaluation considering motion
	Robust optimization
		Intensity-modulated proton therapy plan design
		Beam angle
		Energy spacing
		Spot spacing
	Planning parameters for inverse planning
	Site-specific treatment planning design
		Treatment planning for prostate cancer
		Treatment planning for prostate cancer involving pelvic lymph nodes
		Treatment planning for lung cancer
		Treatment planning for head and neck cancer
	Verification and adaptive planning strategies
	References available online.
6 Physics quality assurance
	Keywords:
	Introduction
	Machine quality assurance
		Daily quality assurance
			X-ray, laser, and couch alignment check
			Proton pencil beam range check
				Range check before 2016
				Range check since 2016
			Spot position accuracy check
			Volumetric dose check
		Weekly machine quality assurance checks
		Monthly quality assurance
			Mechanical quality assurance checks
			Gantry isocentricity check with x-ray imaging system
			Couch rotation isocentricity check
			Patient position image analysis system shift calculation accuracy check
			Radiation versus mechanical isocenter coincidence check
			Output as a function of gantry
		Annual quality assurance checks
			Mechanical quality assurance checks
			X-ray imaging system performance quality checks
			Dosimetric quality assurance checks
				Formal calibration of the dose monitors
				Daily quality assurance dosimetry system baseline verification
				Dose and monitor unit linearity test and dynamic monitor unit delivery check
				Validation of inverse square factor for change in dose with source-to-detector distance
				Spot size in air
				Output as a function of gantry angle
				Proton pencil beam range test
				Spot position test
				Bragg peak chamber measurements of dose at a depth of 2 CM
		Machine quality assurance programs for scanning proton pencil beams at other institutions
	Patient treatment plan–specific quality assurance checks
		Materials and methods
		Results of patient treatment plan–specific quality assurance at the university of texas md anderson cancer center proton ...
		Patient treatment plan–specific quality assurance at other institutions
	Summary
	References available online.
7 Intensity-modulated proton therapy patient treatments
	Keywords:
	Introduction
	Intensity-modulated proton therapy treatment delivery
	Motion management
	In-room imaging for intensity-modulated proton therapy treatments
	Future intensity-modulated proton therapy directions at university of texas md anderson cancer center proton therapy cente ...
	References available online.
SECTION III:
Disease Sites
8 Proton radiotherapy for breast cancer
	Keywords:
	Introduction
	Complex geometry/locally advanced breast cancer
		Postmastectomy radiation planning
		Silicone implants
		Tissue expanders
			Dosimetric results
	Accelerated partial breast irradiation
	Value
	Future studies
	References available online.
9 Adult central nervous system tumors
	Keywords:
	Introduction
	Gliomas: Low and high grade
		Low-grade gliomas
		High-grade gliomas
	Meningioma
	Pituitary tumors and vestibular schwannomas
	Medulloblastoma and other malignancies
	Radiation techniques and treatment planning
	Biological consequences
	Conclusions and future directions
	Acknowledgments
	References available online.
10 Gastrointestinal
	Keywords:
	Introduction
		Gastric
			The role of radiation therapy
			The rationale for proton therapy
			Dosimetric studies
			Clinical studies
		Pancreas
			The role of radiation therapy
			The rationale for proton therapy
			Dosimetric studies
			Clinical studies
		Primary liver
			The role of radiation therapy
			The rationale for proton therapy
			Dosimetric studies
			Clinical studies
		Metastatic liver
			The role of radiation therapy
			The rationale for proton therapy
			Dosimetric studies
			Clinical studies
		Rectal
			The role of radiation therapy
			The rationale for proton therapy
			Dosimetric studies
			Clinical studies
		Anal
			The role of radiation therapy
			The rationale for proton therapy
			Dosimetric studies
			Clinical studies
	Conclusion
	References available online.
11 Proton therapy for gynecologic malignancies
	Keywords:
	Introduction
	After hysterectomy
		Intact cervical cancer
	Reirradiation
	Simulation, target delineation, and treatment planning
	Target delineation
	Treatment planning
	Treatment delivery
	Conclusions
	References available online.
12 Proton therapy for prostate cancer
	Keywords:
	Introduction
	Physics of proton beam radiation therapy
	Modes of proton delivery
	Clinical outcomes
	Proton treatment at md anderson cancer center
		Patient selection
	Fiducial placement
	Simulation
	Contouring
	Dosing
	Image guidance
	Conclusions
	References available online.
13 Head and neck
	Keywords:
	Introduction
	Base-of-skull tumors: Chordoma and chondrosarcoma
	Sinonasal tumors
	Pharyngeal and oral tumors
		Oropharyngeal cancer
		Nasopharyngeal carcinoma
	Reirradiation of local-regional recurrence
	Periorbital tumors
	Skin, salivary gland, and unilateral neck treatment
	Adenoid cystic carcinoma
	Conclusions
	References available online.
14 Proton therapy for hematologic malignancies
	Keywords:
	Introduction
		Dosimetric advantage of protons compared with photon-based three-dimensional conformal and intensity-modulated radiation t ...
		Proton therapy for hematologic malignancies outside the mediastinum
		Potential for decreased late effects with proton therapy
		Other considerations for using proton therapy for lymphoma
			Management of tumor motion
			Mediastinal anatomy
			Craniospinal irradiation
	Indications
	References available online.
15 Pediatric considerations for proton therapy
	Keywords:
	Introduction
	Unique problems in children
	Proton therapy literature on children
		Medulloblastoma
		Ependymoma
		Craniopharyngioma
		Intracranial germ cell tumors
		Low-grade glioma
		Atypical teratoid/rhabdoid tumor
		Retinoblastoma
		Rhabdomyosarcoma
		Ewing sarcoma
		Chordoma/chondrosarcoma
		Neuroblastoma
		Wilms tumor
	Patient selection for proton therapy
	Summary
	References available online.
16 Proton therapy and sarcomas
	Keywords:
	Introduction
		Sarcomas and proton beam radiation
		Chordomas and chondrosarcomas
		Rhabdomyosarcoma
		Retroperitoneal sarcomas
		Sarcomas of the extremities and superficial trunk
	Conclusion
	References available online.
17 Esophagus cancer
	Keywords:
	Introduction
	Treatment simulation
	Radiation dose and fractionation, target delineation, and treatment verification
		Radiation dose and fractionation
		Target delineation
		Treatment verification
	Treatment planning
		Passive scattering proton beam therapy
		Intensity-modulated proton therapy
	Dosimetric and toxicity comparisons of proton versus photon therapy
	Conclusions and future directions
	Acknowledgments
	References available online.
18 Lung cancer
	Keywords:
	Introduction
	Patient selection criteria
		Passive scattering proton therapy
		Intensity-modulated proton therapy
	Treatment simulation
	Radiation dose and fractionation, target delineation, and treatment verification
		Radiation dose and fractionation
		Target delineation
		Treatment verification
	Dose constraints
	Treatment planning
		Passive scattering proton beam therapy
		Intensity-modulated proton therapy
	Clinical outcomes after proton beam therapy for lung cancer
	Conclusions and future directions
	Acknowledgments
	References available online.
SECTION
IV: Future Outcomes and Advancements
19 Technological advancements and outlook in proton therapy
	Keywords:
	Introduction
	Accelerator and beam delivery technologies
	Range uncertainty
	Treatment plans and dose calculations
	Motion interplay effect
	Biological uncertainties
	Variation of anatomy
	Response of proton therapy
	Summary
	References available online.
APPENDIX 1 The university of texas md anderson cancer centers recommended proton therapy indications
	Recommended breast cancer proton therapy indications
		Indications
		Scientific evidence
	Recommended central nervous system proton therapy indications
		Indications
		Scientific evidence
	Recommended esophagus cancer proton therapy indications
		Indications
		Scientific evidence
	Recommended gastrointestinal cancer proton therapy indications
		Indications
		Scientific evidence
	Recommended head and neck cancer proton therapy indications
		Indications
		Scientific evidence
	Recommended hematologic cancer proton therapy indications
		Indications
		Scientific evidence
	Recommended pediatric cancer proton therapy indications
		Indications
		Scientific evidence
	Recommended prostate cancer proton therapy indications
		Indications
		Scientific evidence
	Recommended thoracic cancer proton therapy indications
		Indications
		Scientific evidence
Appendix 2 MD Anderson cancer center head and neck proton case library
	Case 1: Unknown primary squamous cell carcinoma T0N1, p16 positive
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 2: Skull base recurrence from nasopharynx carcinoma
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 3: Paraganglioma of the neck
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 4: Squamous cell carcinoma lacrimal sac
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 5: T2N1 tonsil squamous cell carcinoma, p16 positive
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 6: T2N0 adenoid cystic carcinoma of the maxillary sinus
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 7: Squamous cell carcinoma oral tongue T1N1
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 8: Parotid gland mucoepidermoid T1N0
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 9: Left parotid adenoid cystic carcinoma T3N0
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 10: T4aN3 base-of-tongue squamous cell carcinoma p16 positive
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 11: Nasopharynx carcinoma, Epstein-Barr virus positive, World Health Organization type III, stage T4 N0
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 12: Hypopharynx squamous cell carcinoma stage T4aN0
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 13: Intraobital recurrence of right forehead squamous cell carcinoma
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 14: T3N2c squamous cell carcinoma of the base of tongue, human papillomavirus positive
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
	Case 15: T4aN0 adenoid cystic carcinoma of the lacrimal gland
		a) Clinical scenario
		b) Treatment simulation and planning
		c) Treatment course
		d) Posttreatment course
Index
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	U
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	X
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