Gantry-based pencil beam scanning proton therapy for uveal melanoma: IMPT versus proton arc therapy Journal Article
| Authors: | Qi, H.; Hu, L.; Huang, S.; Lee, Y. P.; Yu, F.; Chen, Q.; Yang, Y.; Kang, M.; Zhai, H.; Vermeulen, M.; Shim, A.; Park, P.; Ding, X.; Zhou, J.; Abramson, D. H.; Francis, J. H.; Simone, C. B. 2nd; Barker, C. A.; Lin, H. |
| Article Title: | Gantry-based pencil beam scanning proton therapy for uveal melanoma: IMPT versus proton arc therapy |
| Abstract: | Background: This study reports the single-institution clinical experience of multifield pencil beam scanning (PBS) intensity-modulated proton therapy (IMPT) and dosimetric comparison to proton arc for uveal melanoma (UM) in a regular PBS gantry room. Methods: Eleven consecutive UM patients were treated with IMPT to 50 Gy in 5 fractions. A customized gaze-fixation device attached to the thermoplastic mask was used to reproduce the globe position for each patient. IMPT plans were robustly optimized with perturbations of 3 mm setup and 3.5% range uncertainties using 3–4 fields without apertures. Each plan was robustly reoptimized (using the same perturbation parameters) using two non-coplanar arc fields in the RayStation treatment planning system. Treatment quality for both plans was evaluated daily using CBCT-generated synthetic CT. Target coverage, conformity, and mean/maximum doses to adjacent organs were assessed. Results: Proton arc plans provided comparable plan quality compared to IMPT plans. Similar target coverage was achieved, with an average GTV D95% equal to 101.1% 1.0% and 101.4% 0.4% for IMPT and proton arc plans, respectively. Proton arc improves the conformity index (RTOG) compared to IMPT plans (average 0.96 0.23 vs. 0.88 0.18, p = 0.11). Both modalities met all the clinical goals for organs-at-risk (OARs), while proton arc significantly reduced the maximum dose for the retina from, on average, 54.5 0.7 to 53.2 0.3 Gy (p < 0.01). Treatment evaluation on synthetic CT showed that the doses received by patients were highly consistent with the planned doses, with a relative target coverage (D95%) difference within 3.5% for IMPT and 3.1% for proton arc, and the D95% of actual delivery exceeding 98.7% and 98.2%, respectively. The doses delivered to OARs did not exceed clinical constraints. Conclusions: This is a novel report on proton arc for ocular tumors and gantry-based multifield PBS proton treatment for these tumors. This study demonstrated that both modalities can meet the clinical goals. The IMPT is currently clinically implanted, and 2-field non-coplanar proton arc plans can achieve comparable dosimetric metrics to those of IMPT plans when the deliver technique is matured. © The Author(s) 2025. |
| Keywords: | clinical article; controlled study; aged; middle aged; intensity modulated radiation therapy; comparative study; radiation dose; treatment indication; quality control; melanoma; computer assisted tomography; radiotherapy dosage; radiotherapy; cohort analysis; pathology; cancer therapy; radiation response; risk assessment; radiotherapy, intensity-modulated; dosimetry; retina; clinical effectiveness; radiotherapy planning, computer-assisted; uvea melanoma; uvea tumor; uveal neoplasms; clinical target volume; comparative effectiveness; process optimization; proton therapy; uveal melanoma; procedures; process design; organs at risk; humans; human; male; female; article; evaluation study; radiotherapy planning system; intensity modulated proton therapy; pencil beam scanning; radiographic parameter; proton arc therapy |
| Journal Title: | Radiation Oncology |
| Volume: | 20 |
| ISSN: | 1748-717X |
| Publisher: | Biomed Central Ltd |
| Date Published: | 2025-04-02 |
| Start Page: | 48 |
| Language: | English |
| DOI: | 10.1186/s13014-025-02621-y |
| PUBMED: | 40176046 |
| PROVIDER: | scopus |
| PMCID: | PMC11963511 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Haibo Lin -- Source: Scopus |
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