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Assessing proton plans with 3 different beam lines vs photon plans for early-stage lung cancer.

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Title: Assessing proton plans with 3 different beam lines vs photon plans for early-stage lung cancer.
Authors: Gray, Tara1 (AUTHOR), Liu, Chieh-Wen1 (AUTHOR), Kolano, Anna Maria2,3 (AUTHOR), Donaghue, Jeremy1 (AUTHOR), Stephans, Kevin1 (AUTHOR), Videtic, Gregory1 (AUTHOR), Xia, Ping1 (AUTHOR) xiap@ccf.org, Farr, Jonathan2,3 (AUTHOR)
Source: Medical Dosimetry. Fall2025, Vol. 50 Issue 3, p209-215. 7p.
Subjects: Proton accelerators, Wilcoxon signed-rank test, Proton therapy, Volumetric-modulated arc therapy, Robust optimization, Proton beams
Abstract: To compare proton plans (IMPT) to VMAT plans and intercompare proton plans using 3 different spot sizes with robustness: cyclotron-generated proton beams (CPB) (σ: 2.7-7.0 mm), linear accelerator proton beams (LPB) (σ: 2.9-5.5 mm), and linear accelerator proton mini beams (LPMB) (σ: 0.9-3.9 mm) for the treatment of early-stage lung cancer. Twenty-two lesions from a total of twenty patients with early-stage lung cancer, originally treated with SBRT, were replanned using CPBs, LPBs, LPMBs, and VMAT using the same treatment planning system and dose calculation algorithm. The average intensity projected CTs (AIP-CT) were used for planning and 3D robust optimization was used for all proton plans. Conformity index (CI), homogeneity index (HI), R 50 , lung V 20 Gy , and mean lung dose were compared among all proton plan types and with VMAT plans. Set-up uncertainties of ±5 mm and ±3.5% range uncertainty were included in the IMPT robust optimization and evaluation, using V 100%Rx > 98% of the ITV. The Wilcoxon signed-rank test was used to evaluate statistical differences between VMAT plans and all proton plan types. When compared to VMAT plans, all proton plans generally show improvement in CI, HI, Lung V 20 Gy , Mean lung dose, and R 50. The LPMB plans showed the most improvement from VMAT plans. Comparison between CPB and linear accelerator proton plans showed statistical significance (p < 0.05). R 50 and mean lung dose for the CPB, LPB and LPMB plans were 3.6 ± 0.9, 3.1 ± 0.8 and 2.6 ± 0.6; 2.2 ± 1.1 Gy, 1.9 ± 1 Gy and 1.6 ± 0.9 Gy, respectively (p < 0.05). The mean R 50 and mean lung dose from the VMAT plans were 4.1 ± 0.4 and 3.8 ± 2 Gy, respectively. The V 20 Gy (%) of lung and mean lung dose were improved across all proton plans when compared with those of VMAT plans. When evaluated for robustness in the worst-case scenario at V 100%Rx of the ITV > 98%, average ITV coverage of 98.6 ± 0.3%, 98.6 ± 0.6%, and 98.9 ± 0.6% were achieved for CPB plans, LPB plans, and LPMB plans, respectively. With decreased spot size, the LPB and LPMB plans are excellent alternatives to VMAT and cyclotron-generated proton plans with reduced dose to normal tissue and improved plan quality for early-stage lung cancer treatments. [ABSTRACT FROM AUTHOR]
Copyright of Medical Dosimetry is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Assessing proton plans with 3 different beam lines vs photon plans for early-stage lung cancer.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Gray%2C+Tara%22&quot;&gt;Gray, Tara&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Liu%2C+Chieh-Wen%22&quot;&gt;Liu, Chieh-Wen&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Kolano%2C+Anna+Maria%22&quot;&gt;Kolano, Anna Maria&lt;/searchLink&gt;&lt;relatesTo&gt;2,3&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Donaghue%2C+Jeremy%22&quot;&gt;Donaghue, Jeremy&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Stephans%2C+Kevin%22&quot;&gt;Stephans, Kevin&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Videtic%2C+Gregory%22&quot;&gt;Videtic, Gregory&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Xia%2C+Ping%22&quot;&gt;Xia, Ping&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt; (AUTHOR)&lt;i&gt; xiap@ccf.org&lt;/i&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Farr%2C+Jonathan%22&quot;&gt;Farr, Jonathan&lt;/searchLink&gt;&lt;relatesTo&gt;2,3&lt;/relatesTo&gt; (AUTHOR)
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Medical+Dosimetry%22&quot;&gt;Medical Dosimetry&lt;/searchLink&gt;. Fall2025, Vol. 50 Issue 3, p209-215. 7p.
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  Data: To compare proton plans (IMPT) to VMAT plans and intercompare proton plans using 3 different spot sizes with robustness: cyclotron-generated proton beams (CPB) (σ: 2.7-7.0 mm), linear accelerator proton beams (LPB) (σ: 2.9-5.5 mm), and linear accelerator proton mini beams (LPMB) (σ: 0.9-3.9 mm) for the treatment of early-stage lung cancer. Twenty-two lesions from a total of twenty patients with early-stage lung cancer, originally treated with SBRT, were replanned using CPBs, LPBs, LPMBs, and VMAT using the same treatment planning system and dose calculation algorithm. The average intensity projected CTs (AIP-CT) were used for planning and 3D robust optimization was used for all proton plans. Conformity index (CI), homogeneity index (HI), R 50 , lung V 20 Gy , and mean lung dose were compared among all proton plan types and with VMAT plans. Set-up uncertainties of &#177;5 mm and &#177;3.5% range uncertainty were included in the IMPT robust optimization and evaluation, using V 100%Rx &gt; 98% of the ITV. The Wilcoxon signed-rank test was used to evaluate statistical differences between VMAT plans and all proton plan types. When compared to VMAT plans, all proton plans generally show improvement in CI, HI, Lung V 20 Gy , Mean lung dose, and R 50. The LPMB plans showed the most improvement from VMAT plans. Comparison between CPB and linear accelerator proton plans showed statistical significance (p &lt; 0.05). R 50 and mean lung dose for the CPB, LPB and LPMB plans were 3.6 &#177; 0.9, 3.1 &#177; 0.8 and 2.6 &#177; 0.6; 2.2 &#177; 1.1 Gy, 1.9 &#177; 1 Gy and 1.6 &#177; 0.9 Gy, respectively (p &lt; 0.05). The mean R 50 and mean lung dose from the VMAT plans were 4.1 &#177; 0.4 and 3.8 &#177; 2 Gy, respectively. The V 20 Gy (%) of lung and mean lung dose were improved across all proton plans when compared with those of VMAT plans. When evaluated for robustness in the worst-case scenario at V 100%Rx of the ITV &gt; 98%, average ITV coverage of 98.6 &#177; 0.3%, 98.6 &#177; 0.6%, and 98.9 &#177; 0.6% were achieved for CPB plans, LPB plans, and LPMB plans, respectively. With decreased spot size, the LPB and LPMB plans are excellent alternatives to VMAT and cyclotron-generated proton plans with reduced dose to normal tissue and improved plan quality for early-stage lung cancer treatments. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: &lt;i&gt;Copyright of Medical Dosimetry is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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      – Type: doi
        Value: 10.1016/j.meddos.2025.01.006
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        Text: English
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        PageCount: 7
        StartPage: 209
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      – SubjectFull: Proton accelerators
        Type: general
      – SubjectFull: Wilcoxon signed-rank test
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      – SubjectFull: Proton therapy
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      – SubjectFull: Volumetric-modulated arc therapy
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      – SubjectFull: Robust optimization
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      – SubjectFull: Proton beams
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      – TitleFull: Assessing proton plans with 3 different beam lines vs photon plans for early-stage lung cancer.
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              M: 09
              Text: Fall2025
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