A Critical Review of LET-Based Intensity-Modulated Proton Therapy Plan Evaluation and Optimization for Head and Neck Cancer Management.

IF 2.1 Q3 ONCOLOGY
International Journal of Particle Therapy Pub Date : 2021-06-25 eCollection Date: 2021-01-01 DOI:10.14338/IJPT-20-00049.1
Wei Deng, Yunze Yang, Chenbin Liu, Martin Bues, Radhe Mohan, William W Wong, Robert H Foote, Samir H Patel, Wei Liu
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引用次数: 21

Abstract

In this review article, we review the 3 important aspects of linear-energy-transfer (LET) in intensity-modulated proton therapy (IMPT) for head and neck (H&N) cancer management. Accurate LET calculation methods are essential for LET-guided plan evaluation and optimization, which can be calculated either by analytical methods or by Monte Carlo (MC) simulations. Recently, some new 3D analytical approaches to calculate LET accurately and efficiently have been proposed. On the other hand, several fast MC codes have also been developed to speed up the MC simulation by simplifying nonessential physics models and/or using the graphics processor unit (GPU)-acceleration approach. Some concepts related to LET are also briefly summarized including (1) dose-weighted versus fluence-weighted LET; (2) restricted versus unrestricted LET; and (3) microdosimetry versus macrodosimetry. LET-guided plan evaluation has been clinically done in some proton centers. Recently, more and more studies using patient outcomes as the biological endpoint have shown a positive correlation between high LET and adverse events sites, indicating the importance of LET-guided plan evaluation in proton clinics. Various LET-guided plan optimization methods have been proposed to generate proton plans to achieve biologically optimized IMPT plans. Different optimization frameworks were used, including 2-step optimization, 1-step optimization, and worst-case robust optimization. They either indirectly or directly optimize the LET distribution in patients while trying to maintain the same dose distribution and plan robustness. It is important to consider the impact of uncertainties in LET-guided optimization (ie, LET-guided robust optimization) in IMPT, since IMPT is sensitive to uncertainties including both the dose and LET distributions. We believe that the advancement of the LET-guided plan evaluation and optimization will help us exploit the unique biological characteristics of proton beams to improve the therapeutic ratio of IMPT to treat H&N and other cancers.

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基于let的调强质子治疗方案评估和优化头颈癌治疗的综述。
在这篇综述文章中,我们回顾了线性能量转移(LET)在强度调节质子治疗(IMPT)头颈部(H&N)癌症治疗中的三个重要方面。精确的LET计算方法对于LET引导的规划评估和优化至关重要,可以通过解析方法或蒙特卡罗(MC)模拟来计算。近年来,人们提出了一些新的三维解析方法来准确有效地计算LET。另一方面,一些快速MC代码也被开发出来,通过简化非必要的物理模型和/或使用图形处理器单元(GPU)加速方法来加速MC模拟。本文还简要总结了与LET相关的一些概念,包括(1)剂量加权LET与影响加权LET;(2)限制LET与无限制LET;(3)微剂量学与大剂量学。一些质子中心已在临床上进行了let引导的计划评估。近年来,越来越多以患者预后为生物学终点的研究显示,高LET与不良事件部位呈正相关,表明LET引导的计划评估在质子临床中的重要性。人们提出了各种let引导的计划优化方法来生成质子计划,以实现生物优化的IMPT计划。采用了不同的优化框架,包括两步优化、一步优化和最坏情况鲁棒优化。他们或间接或直接地优化患者的LET分布,同时试图保持相同的剂量分布和计划稳健性。考虑不确定性对IMPT中LET引导优化(即LET引导鲁棒优化)的影响是很重要的,因为IMPT对包括剂量和LET分布在内的不确定性很敏感。我们相信,let引导计划评估和优化的进展将有助于我们利用质子束独特的生物学特性,提高IMPT治疗H&N和其他癌症的治疗率。
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
International Journal of Particle Therapy
International Journal of Particle Therapy Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
3.70
自引率
5.90%
发文量
23
审稿时长
20 weeks
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