Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 210016, China.
Department of Radiation Physics, Harbin Medical University Cancer Hospital, Harbin, 150081, China.
Med Phys. 2017 Oct;44(10):5325-5338. doi: 10.1002/mp.12468. Epub 2017 Sep 22.
This work investigated whether the Bragg peak (BP) positions of proton beams can be modulated to produce uniform doses and cover a tumor under the magnetic fields inside cancer patients, and whether magnetic field modulated proton therapy (MMPT) is effective in vital organ protection.
The authors initially constructed an ideal water phantom comprising a central tumor surrounded by cuboid organ regions using GEANT4. Second, we designed the proton beams passing through the gap between two adjacent organ regions during beam configuration. Third, we simulated the beam transports under magnetic fields inside the phantom through GEANT4. Then, the beams were discarded, which did not stop in the tumor. Fourth, the authors modulated the intensities of the remaining beams to produce uniform tumor doses. Subsequently, the calculated MMPT doses were compared with those of traditional methods, such as single, opposing, orthogonal, and box fields. Moreover, the authors repeated the above research procedures for abdominal anatomies comprising tumors at the pancreatic tail and liver to evaluate whether MMPT is effective for the human anatomy.
For the water phantom, the vital organ doses were approximately 50%, 30%, 30%, and 15% for the single, opposing, orthogonal, and box fields, respectively. As the vital organ doses decreased, the organ volume receiving proton irradiations for the opposing, orthogonal, and box fields increased by two, two, and four times compared with that for the single field. The vital organ volume receiving proton irradiations were controlled to a fairly low level through MMPT, whereas the BP positions of the proton beams were properly modulated through the magnetic fields inside the phantom. The tumor was sufficiently covered by a 95% dose line, and the maximum tumor doses were smaller than 110%. For the pancreatic tumor case, the proton beams were curved and bypassed the kidney to generate uniform doses inside the tumor through MMPT. In the liver tumor case, the liver volume receiving proton irradiations was reduced by approximately 40% through MMPT compared with traditional methods.
The BP positions can be intentionally modulated to produce uniform tumor doses under the magnetic fields inside cancer patients. In some special cases, the vital organs surrounding the tumor can almost be exempted from proton irradiations without sacrificing tumor dose coverage through MMPT. For the tumors inside parallel organs, the parallel organ volume receiving proton irradiations was largely reduced through MMPT. The results of this study can serve as beneficial implications for future proton therapy studies with reduced vital organ damage and complications.
本研究旨在探讨在癌症患者体内磁场下,质子射束的布拉格峰(BP)位置能否被调制以产生均匀剂量并覆盖肿瘤,以及磁场调制质子治疗(MMPT)是否能有效保护重要器官。
作者首先使用 GEANT4 构建了一个理想的水模,其中包含一个中央肿瘤和周围的长方体器官区域。其次,在射束配置过程中,设计了穿过两个相邻器官区域之间间隙的质子射束。第三,通过 GEANT4 模拟了在水模内磁场下的射束传输。然后,丢弃未停留在肿瘤内的射束。第四,作者调节剩余射束的强度以产生均匀的肿瘤剂量。随后,将计算得出的 MMPT 剂量与传统方法(如单野、对穿野、正交野和方野)进行比较。此外,作者还针对胰腺尾部和肝脏肿瘤的腹部解剖结构重复了上述研究过程,以评估 MMPT 是否对人体解剖结构有效。
对于水模,单野、对穿野、正交野和方野的重要器官剂量分别约为 50%、30%、30%和 15%。随着重要器官剂量的降低,对穿野、正交野和方野的器官体积接受质子照射的次数分别增加了两倍、两倍和四倍,而单野的器官体积接受质子照射的次数不变。通过 MMPT 将重要器官接受质子照射的体积控制在相当低的水平,同时通过水模内的磁场适当调节质子射束的 BP 位置。95%等剂量线完全覆盖肿瘤,最大肿瘤剂量小于 110%。对于胰腺肿瘤病例,质子射束通过 MMPT 弯曲并绕过肾脏,在肿瘤内产生均匀剂量。对于肝脏肿瘤病例,与传统方法相比,通过 MMPT 可使肝脏接受质子照射的体积减少约 40%。
可以通过在癌症患者体内的磁场下有意地调节 BP 位置,以产生均匀的肿瘤剂量。在某些特殊情况下,通过 MMPT 可以在不牺牲肿瘤剂量覆盖的情况下,使肿瘤周围的重要器官几乎免受质子照射。对于平行器官内的肿瘤,通过 MMPT 可以大大减少平行器官接受质子照射的体积。本研究的结果可为降低重要器官损伤和并发症的质子治疗研究提供有益的启示。