Impact of anatomical changes on simulated proton arc therapy and intensity-modulated proton therapy for lung cancer

IF 2.5 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Journal of Applied Clinical Medical Physics Pub Date : 2026-10-26 DOI:10.1002/acm2.70881

Wenguang Chen, Feng Yang, Fanrui Zeng, Hao Guo, Yuankang Xu, Tianyu Zhang, Junxiang Wu, Da Zhang, Gang Liu, Xuanfeng Ding, Xianliang Wang

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Abstract

Purpose

: During lung cancer radiotherapy, inter-fractional anatomical changes may cause the delivered dose to deviate from the primary plan, affecting tumor control and increasing the risk of normal tissue damage. This study aims to evaluate the impact of anatomical changes on the dosimetric and radiobiological performance of simulated proton arc therapy (sPAT) versus intensity-modulated proton therapy (IMPT) for lung cancer patients under patient-specific anatomical changes.

Methods

: Data from 21 lung cancer patients were retrospectively analyzed. The prescribed dose for all patients was 6000 cGy (relative biological effectiveness, RBE). Each patient with a primary planning computed tomography (pCT) and a mid-treatment adaptive-planning CT (aCT) acquired at a median of 29 days into treatment due to notable tumor volume changes. Primary plans for sPAT and IMPT were designed on the pCT. After rigid registration of the pCT and aCT, non-adaptive plans (sPAT_p-a, IMPT_p-a) were generated by directly recalculating the doses of the primary plans on the aCT. The comparison evaluated the dosimetric impact of anatomical changes by comparing non-adaptive plans (sPAT_p-a vs. IMPT_p-a). Dose-volume histogram (DVH) parameters for targets and organs at risk (OARs) and tumor control probability (TCP) and normal tissue complication probability (NTCP) were evaluated.

Results

: For the primary plans, sPAT and IMPT achieved similar target coverage, while the doses to OARs were generally lower in sPAT_p. Under anatomical changes, both non-adaptive plans exhibited a decrease in target coverage, sPAT_p-a achieved a D_95% of 5567.57 cGy[RBE] compared with 5423.33 cGy[RBE] for IMPT_p-a (p < 0.001), indicating that sPAT better preserved target coverage. Compared with the primary plans, sPAT_p-a and IMPT_p-a exhibited TCP reductions of 5.83% and 8.07%, respectively.

Conclusions

: Compared with IMPT, sPAT exhibits enhanced robustness against inter-fractional anatomical changes occurring in lung-cancer radiotherapy.

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解剖改变对肺癌模拟质子弧治疗和调强质子治疗的影响

目的：肺癌放射治疗过程中，分段间解剖改变可能导致给药剂量偏离原计划，影响肿瘤控制，增加正常组织损伤的风险。本研究旨在评估解剖改变对模拟质子弧治疗（sPAT）和强度调节质子治疗（IMPT）在肺癌患者特异性解剖改变下的剂量学和放射生物学性能的影响。方法：回顾性分析21例肺癌患者的资料。所有患者的处方剂量为6000 cGy（相对生物有效性，RBE）。由于肿瘤体积的显著变化，每位患者在治疗的中位时间29天接受了一次初始计划计算机断层扫描（pCT）和一次治疗中期适应性计划CT （aCT）。在pCT上设计了sPAT和IMPT的主要计划，在pCT和aCT严格注册后，通过在aCT上直接重新计算主要计划的剂量产生非适应性计划（sPATp-a, IMPTp-a）。通过比较非适应性方案（sPATp-a与IMPTp-a）来评估解剖改变的剂量学影响。评估靶和危险器官（OARs）的剂量-体积直方图（DVH）参数、肿瘤控制概率（TCP）和正常组织并发症概率（NTCP）。结果：在初级计划中，sPAT和IMPT实现了相似的目标覆盖率，而sPAT对OARs的剂量普遍较低。在解剖改变下，两种非适应性方案均表现出靶盖度的降低，sPATp-a方案的D95%为5567.57 cGy[RBE]，而IMPTp-a方案的D95%为5423.33 cGy[RBE] (p < 0.001)，表明sptp方案更好地保留了靶盖度。与主要方案相比，sptp -a和IMPTp-a的TCP分别减少了5.83%和8.07%。结论：与IMPT相比，spv对肺癌放疗中发生的分级间解剖变化具有更强的稳健性。

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