Liu Peilin, Zhao Lewei, Liu Gang, Cao Xi, Qin An, Yan Di, Li Xiaoqiang, Stevens Craig, Deraniyagala Rohan, Ding Xuanfeng
Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI 48084, USA.
Cancer Center, Corewell Health William Beaumont University Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 48073, PR China.
Int J Part Ther. 2025 May 22;16:100750. doi: 10.1016/j.ijpt.2025.100750. eCollection 2025 Jun.
Photon radiotherapy is the conventional method in the treatment of bilateral whole-lung metastasis. However, uncertainties, longer delivery times, large lateral penumbra, and motion interplay limit intensity-modulated proton therapy (IMPT)'s use in bilateral lung metastases. To overcome such limitations in IMPT, this study explores the feasibility of using a novel proton therapy technique, Spot-scanning Proton Arc (SPArc) therapy, to improve the dose sparing to the heart and other healthy tissue for this pediatric patient compared to the volumetric modulated arc therapy (VMAT) and IMPT.
A 13-year-old patient with a malignant neoplasm of bone and articular cartilage, presenting with bilateral whole-lung metastasis, received whole-lung irradiation of 15 Gy in 10 fractions using VMAT. For comparative analysis, plans were generated using IMPT and SPArc.
The study showed that SPArc was superior in sparing the heart and enhancing delivery efficiency compared to both VMAT and IMPT. The mean heart dose was 5.41 Gy for SPArc, 8.48 Gy for IMPT, and 9.56 Gy for VMAT. D50 of the heart was 3.06 Gy for SPArc, 9.13 Gy for IMPT, and 9.12 Gy for VMAT. The integral body dose was 137 Gy·L in VMAT,189 Gy·L in IMPT, and 98 Gy·L in SPArc.
Spot-scanning proton arc demonstrated effective heart sparing and lower body-integral dose for whole-lung irradiation. Delivery simulations suggested improved efficiency compared with IMPT.
光子放射疗法是治疗双侧全肺转移的传统方法。然而，不确定性、较长的治疗时间、较大的侧向半影和运动相互作用限制了调强质子治疗（IMPT）在双侧肺转移中的应用。为了克服IMPT的这些局限性，本研究探讨了使用一种新型质子治疗技术——点扫描质子弧（SPArc）治疗，与容积调强弧形治疗（VMAT）和IMPT相比，为该儿科患者提高对心脏和其他健康组织的剂量 sparing。
一名13岁的骨和关节软骨恶性肿瘤患者，出现双侧全肺转移，使用VMAT在10次分割中接受了15 Gy的全肺照射。为了进行比较分析，使用IMPT和SPArc生成了计划。
研究表明，与VMAT和IMPT相比，SPArc在保护心脏和提高治疗效率方面更具优势。SPArc的平均心脏剂量为5.41 Gy，IMPT为8.48 Gy，VMAT为9.56 Gy。心脏的D50，SPArc为3.06 Gy，IMPT为9.13 Gy，VMAT为9.12 Gy。VMAT的全身积分剂量为137 Gy·L，IMPT为189 Gy·L，SPArc为98 Gy·L。
点扫描质子弧在全肺照射中显示出有效的心脏保护作用和较低的全身积分剂量。治疗模拟表明与IMPT相比效率有所提高。
