Proton arc therapy reduces the dose delivered to circulating blood compared to intensity-modulated proton therapy for head-and-neck cancer

IF 2.5 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics Pub Date : 2026-10-20 DOI:10.1002/acm2.70864

Sebastian Tattenberg, Peilin Liu, Xiaoda Cong, Cornelia Hoehr, Xuanfeng Ding

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引用次数: 0

Abstract

Background

Compared to intensity-modulated proton therapy (IMPT), proton arc therapy (PAT) has various dosimetric advantages. However, questions have been raised over whether the larger low-dose bath during PAT may increase radiation-induced lymphocyte killing, which is correlated with adverse clinical outcomes.

Purpose

The purpose of this study is to quantitatively compare radiation dose delivery to circulating blood during IMPT and PAT.

Methods

For each of 10 head-and-neck cancer patients, one IMPT and one PAT treatment plan were created, and the hematological dose (HEDOS) blood dose model was used to simulate radiation dose delivery to circulating blood. HEDOS simulations utilized gantry angle-wise dose distributions (including for PAT) and considered gantry rotation and energy layer switching as well as irradiation times. Blood dose histograms as well as the mean dose to all simulation blood particles (D_mean) and the dose delivered to the 90% and 10% of blood particles receiving the highest dose (D_90% and D_10%) were then compared between IMPT and PAT.

Results

For IMPT, blood dose metrics (in the form of mean over all patients ± one standard deviation) were (0.522 ± 0.204)Gy(RBE) for D_90%, (0.563 ± 0.212)Gy(RBE) for D_mean, and (0.605 ± 0.219)Gy(RBE) for D_10%. For PAT, D_90% was (0.430 ± 0.184)Gy(RBE), D_mean was (0.483 ± 0.195)Gy(RBE), and D_10% was (0.538 ± 0.207)Gy(RBE). The Wilcoxon signed-rank test indicated statistically significant (p < 0.05) differences between blood dose metrics of IMPT and PAT for all patients, and IMPT did not increase the percentage of blood particles which received no radiation dose during the delivery of a single treatment fraction.

Conclusions

Compared to IMPT, proton arc therapy was associated with significantly lower radiation dose delivery to circulating blood across a variety of different metrics. Proton arc therapy for head-and-neck cancer is therefore not expected to result in higher radiation-induced killing of circulating lymphocytes compared to IMPT.

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与调强质子治疗头颈癌相比，质子弧治疗减少了输送到循环血液中的剂量

背景与调强质子治疗（IMPT）相比，质子弧治疗（PAT）具有多种剂量学优势。然而，关于PAT期间较大的低剂量浴是否会增加辐射诱导的淋巴细胞杀伤，这是否与不良临床结果相关的问题已经提出。目的本研究的目的是定量比较IMPT和PAT期间辐射剂量对循环血液的影响。方法对10例头颈癌患者分别制定1个IMPT和1个PAT治疗方案，采用血液学剂量（HEDOS）血剂量模型模拟辐射剂量传递到循环血液。HEDOS模拟利用了龙门架角度剂量分布（包括PAT），并考虑了龙门架旋转和能量层切换以及辐照时间。然后比较IMPT和PAT的血剂量直方图以及所有模拟血颗粒的平均剂量（Dmean）和接受最高剂量的90%和10%的血颗粒的剂量（D90%和D10%）。结果IMPT的血剂量指标（以所有患者的平均值±一个标准差的形式）为：D90%为（0.522±0.204）Gy(RBE)， Dmean为（0.563±0.212）Gy(RBE)， D10%为（0.605±0.219）Gy（RBE）。PAT的D90%为（0.430±0.184）Gy(RBE)， Dmean为（0.483±0.195）Gy(RBE)， D10%为（0.538±0.207）Gy（RBE）。Wilcoxon符号秩检验显示，所有患者的IMPT和PAT的血液剂量指标有统计学意义（p < 0.05）差异，并且IMPT在单一治疗分数的递送过程中没有增加未接受辐射剂量的血液颗粒的百分比。结论：与IMPT相比，质子弧治疗与各种不同指标的循环血液辐射剂量显著降低相关。因此，与IMPT相比，质子弧治疗头颈癌不会导致更高的辐射诱导循环淋巴细胞杀伤。

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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来源期刊

Journal of Applied Clinical Medical Physics 医学-核医学

CiteScore

3.60

自引率

19.00%

发文量

331

审稿时长

3 months

期刊介绍： Journal of Applied Clinical Medical Physics is an international Open Access publication dedicated to clinical medical physics. JACMP welcomes original contributions dealing with all aspects of medical physics from scientists working in the clinical medical physics around the world. JACMP accepts only online submission. JACMP will publish: -Original Contributions: Peer-reviewed, investigations that represent new and significant contributions to the field. Recommended word count: up to 7500. -Review Articles: Reviews of major areas or sub-areas in the field of clinical medical physics. These articles may be of any length and are peer reviewed. -Technical Notes: These should be no longer than 3000 words, including key references. -Letters to the Editor: Comments on papers published in JACMP or on any other matters of interest to clinical medical physics. These should not be more than 1250 (including the literature) and their publication is only based on the decision of the editor, who occasionally asks experts on the merit of the contents. -Book Reviews: The editorial office solicits Book Reviews. -Announcements of Forthcoming Meetings: The Editor may provide notice of forthcoming meetings, course offerings, and other events relevant to clinical medical physics. -Parallel Opposed Editorial: We welcome topics relevant to clinical practice and medical physics profession. The contents can be controversial debate or opposed aspects of an issue. One author argues for the position and the other against. Each side of the debate contains an opening statement up to 800 words, followed by a rebuttal up to 500 words. Readers interested in participating in this series should contact the moderator with a proposed title and a short description of the topic