Exploring the potential benefits of multi-field IMPT for stage I NSCLC SBRT: An in silico dosimetric comparison to IMRT and CyberKnife.

IF 3.6 Q4 Medicine

Precision Radiation Oncology Pub Date : 2025-08-26 eCollection Date: 2025-09-01 DOI:10.1002/pro6.70027

ZhangMing Chen, Xianrui Yan, Shu Xie, Pinjing Cheng, Dong Xiang, Cheng Tao, Qingtao Qiu, Tengxiang Li, Chengqiang Li, Huazhong Shu, Antoine Simon, Jian Zhu

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Abstract

Purpose: Multi-field intensity-modulated proton therapy (IMPT) is a novel treatment protocol design method proposed to reduce range uncertainty. This study aimed to investigate whether multi-field IMPT has a dose distribution advantage over photon intensity-modulated radiation therapy (IMRT) and CyberKnife in stereotactic body radiotherapy (SBRT) for stage I non-small cell lung cancer (NSCLC).

Methods: Twenty-nine patients who underwent photon SBRT from February 2021 to September 2022 at Shandong Cancer Hospital were included. Their Computed Tomography (CT) images were used to design CyberKnife and multi-field IMPT plans. For the photon plan (IMRT and CyberKnife), the planning target volume (PTV), which was extended from the internal gross target volume (IGTV), was prescribed at 50 Gy. For the proton plans, the planning beam-specific target volume (PBSTV) based on the IGTV was created to meet the same area as the photon PTV. Multi-field IMPT was simulated by adding additional beam angles to conventional IMPT. Dose distribution assessment factors included D_mean and dose gradient index (GI) for PTV/PBSTV, and D_mean and the hottest 0.1 cm³ dose (D_0.1cc) for organs at risk (OARs).

Results: With each patient receiving 7-11 beams, multi-field IMPT had a better target GI than IMRT. For the lung, heart, spinal cord, chest wall, and ribs doses, the D_mean of the multi-field IMPT was smaller than that of the other two plans for all metrics. CyberKnife was significantly less protective of the OARs than the other two planning modalities, owing to the presence of a high target center dose.

Conclusion: Multi-field IMPT achieves favorable target coverage and OAR protection compared to IMRT and CyberKnife for SBRT of NSCLC.

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探索多视野IMPT治疗I期NSCLC SBRT的潜在益处：与IMRT和射波刀的计算机剂量学比较。

目的：多场调强质子治疗（IMPT）是一种新的治疗方案设计方法，旨在减少范围不确定性。本研究旨在探讨在治疗I期非小细胞肺癌（NSCLC）的立体定向全身放疗（SBRT）中，多场IMPT是否比光子强度调制放疗（IMRT）和射波刀具有剂量分布优势。方法：选取2021年2月至2022年9月在山东省肿瘤医院行光子SBRT治疗的29例患者。他们的计算机断层扫描（CT）图像用于设计射波刀和多场IMPT计划。对于光子计划（IMRT和射波刀），从内部总靶体积（IGTV）延伸出来的计划靶体积（PTV）规定为50 Gy。对于质子计划，基于IGTV创建了计划束特定目标体积（PBSTV），以满足与光子PTV相同的面积。通过在常规IMPT的基础上增加额外的波束角，模拟了多场IMPT。剂量分布评估因子包括PTV/PBSTV的Dmean和剂量梯度指数（GI），危及器官（OARs）的Dmean和最热0.1 cm3剂量（D0.1cc）。结果：每例患者接受7-11束多场IMPT的靶GI优于IMRT。对于肺、心脏、脊髓、胸壁和肋骨剂量，多场IMPT的Dmean小于其他两种方案的所有指标。由于靶中心剂量高，射波刀对桨叶的保护作用明显低于其他两种计划方式。结论：与IMRT和射波刀相比，多视场IMPT在NSCLC SBRT治疗中具有更好的靶标覆盖和OAR保护。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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