Evaluation of Single Field Uniform Dose (SFUD) Proton Pencil Beam Scanning (PBS) Planning Strategy for Lung Mobile Tumor Using a Digital Phantom

Purpose: To quantitatively evaluate four different Proton SFUD PBS initial planning strategies for lung mobile tumor. Methods and Materials: A virtual lung patient’s four-dimensional computed tomography (4DCT) was generated in this study. To avoid the uncertainties from target delineation and imaging artifacts, a sphere with diameter of 3 cm representing a rigid mobile target (GTV) was inserted into the right side of the lung. The target motion is set in superior-inferior (SI) direction from ?5 mm to 5 mm. Four SFUD planning strategies were used based on: 1) Maximum-In-tensity-Projection Image (MIP-CT);2) CT_average with ITV overridden to muscle density (CTavg_muscle);3) CT_average with ITV overridden to tumor density (CTavg_tumor);4) CT_average without any override density (CTavg_only). Dose distributions were recalculated on each individual phase and accumulated together to assess the “actual” treatment. To estimate the impact of proton range uncertainties, +/?3.5% CT calibration curve was applied to the 4DCT phase images. Results: Comparing initial plan to the dose accumulation: MIP-CT based GTV D98 degraded 2.42 Gy (60.10 Gy vs 57.68 Gy). Heart D1 increased 6.19 Gy (1.88 Gy vs 8.07 Gy);CTavg_tumor based GTV D98 degraded 0.34 Gy (60.07 Gy vs 59.73 Gy). Heart D1 increased 2.24 Gy (3.74 Gy vs 5.98 Gy);CTavg_muscle based initial GTV D98 degraded 0.31 Gy (60.4 Gy vs 60.19 Gy). Heart D1 increased 3.44 Gy (4.38 Gy vs 7.82 Gy);CTavg_only based Initial GTV D98 degraded 6.63 Gy (60.11 Gy vs 53.48 Gy). Heart D1 increased 0.30 Gy (2.69 Gy vs 2.96 Gy);in the presence of ±3.5% range uncertainties, CTavg_tumor based plan’s accumulated GTV D98 degraded to 57.99 Gy (+3.5%) 59.38 Gy (?3.5%), and CTavg_muscle based plan’s accumulated GTV D98 degraded to 59.37 Gy (+3.5%) 59.37 Gy (?3.5%). Conclusion: This study shows that CTavg_Tumor and CTavg_Muscle based planning strategies provide the most robust GTV coverage. However, clinicians need to be aware that the actual dose to OARs at distal end of target may increase. The study also indicates that the current SFUD PBS planning strategy might not be sufficient to compensate the CT calibration uncertainty.

Application of biological optimization of hypofractionated radiotherapy post conservative surgery for breast cancer

Objective The aim of the study was to discuss the application of biological optimization and its difference from physical optimization in hypofractionated radiotherapy for breast cancer after conservative surgery.Methods This retrospective study enrolled 15 randomly chosen patients with left-sided breast cancer who received radiotherapy.The volumetric arc therapy(VMAT)technique was used to redesign treatment plans with physical functions(PF)group,biological-physical functions combined(BF+PF and PF+BF)groups,and biological functions(BF)group.The dosimetric differences based on the above four optimization methods were assessed by calculating and analyzing the corresponding dose-volume parameters.Results The target parameters of the four groups differed significantly(P<0.05)except for the conformity index(CI).The tumor control probability(TCP)values in the BF and BF+PF groups were higher than those in the PF and PF+BF groups.Moreover,the dose-volume parameters of the ipsilateral lung in the BF group were less than those of three other groups,while the monitor unit(MU)in the BF group was approximately 16%lower than those of the PF and PF+BF groups.Conclusion Biological functions were useful to increase the equivalent uniform dose(EUD)and TCP values of the target,decrease the dose-volume parameters of the organs-at-risk(OARs),and improve treatment efficiency.

EQUIVALENT UNIFORM DOSE SENSITIVITY TO CHANGES IN ABSORBED DOSE DISTRIBUTION

Treatment planning in external beam radiation therapy （EBRT） utilizes dose volume histograms （DVHs） as optimization and evaluation tools. They present the fraction of planning target volume （PTV） receiving more than a given absorbed dose, against the absorbed dose values, and a number of radiobiological indices can be computed with their help. Equivalent uniform dose （EUD） is the absorbed dose that, uniformly imparted, would yield the same biological effect on a tumor as the dose distribution described by the DVH. Uncertainty and missing information can affect the dose distribution, therefore DVHs can be modeled as samples from a set of possible outcomes. This work studies the sensitivity of the EUD index when a small change in absorbed dose distribution takes place. EUD is treated as a functional on the set of DVHs. Defining a Levy distance on this set and using a suitable expansion of the functional, a very simple expression for a bound on the variation of EUD when the dose distribution changes is found. This bound is easily interpreted in terms of standard treatment planning practice.

An aerosol formulation of R-salbutamol sulfate for pulmonary inhalation

An aerosol formulation containing 7.5 mg of R-salbutamol sulfate was developed.The aerosol was nebulized with an air-jet nebulizer,and further assessed according to the new European Medicines Agency(EMA)guidelines.A breath simulator was used for studies of delivery rate and total amount of the active ingredient at volume of 3 mL.A next generation impactor(NGI)with a cooler was used for analysis of the particle size and in vitro lung deposition rate of the active ingredient at 51C.The anti-asthmatic efficacy of the aerosol formulation was assessed in guinea pigs with asthma evoked by intravenous injection of histamine compared with racemic salbutamol.Our results show that this aerosol formulation of R-salbutamol sulfate met all the requirements of the new EMA guidelines for nebulizer.The efficacy of a half-dose of R-salbutamol equaled that of a normal dose of racemic salbutamol.