FLASH stereotactic body radiation therapy for spine tumors using a single-energy proton pristine Bragg peak delivery technique Journal Article
| Authors: | Selvaraj, B.; Zhao, X.; Lin, H.; Shen, J.; Cheng, C.; Bookbinder, A.; Wu, H.; Zhai, H.; Choi, J. I.; Chhabra, A. M.; Hasan, S.; Simone, C. B. 2nd; Yamada, Y.; Kang, M. |
| Article Title: | FLASH stereotactic body radiation therapy for spine tumors using a single-energy proton pristine Bragg peak delivery technique |
| Abstract: | Purpose: To investigate the dosimetric performance and dose rate of Bragg peak FLASH (BP-FLASH) for spinal cord stereotactic body radiation therapy (SBRT). Methods and Materials: Ten consecutive patients with spinal tumors treated with conventional intensity modulated proton therapy (CONV-IMPT) SBRT (40 Gy in 5 fractions) were selected for this study. These patients were reoptimized using an in-house FLASH algorithm and a single-energy Bragg peak approach. The dose distributions and dose metrics for target coverage and critical organs-at-risk (OARs) were compared. BP-FLASH plans dose rates were calculated using an average-dose-rate. The FLASH ratios (V40Gy/s) were assessed with dose thresholds at 0.2, 2, and 5 Gy. The doses and dose rates for the 10 patients were averaged, and a t test was performed comparing CONV-IMPT and BP-FLASH. Results: Dosimetric analysis revealed that the BP-FLASH plans deliver a similar dose as CONV-IMPT plans to critical OARs. However, in BP-FLASH, the clinical target volume received a higher maximum dose than CONV-IMPT (115.1% versus 108.9%, P = .001). No notable differences were observed in the maximum doses to the spinal cord (P = .122) or esophagus (P = .327). FLASH dose rates for all the OARs exceeded 80% with 2 Gy dose threshold. When increased to 5 Gy, V40Gy/s increased to >95% for composite plan doses. Conclusions: BP-FLASH SBRT is a promising treatment for challenging spinal cord cancers, which achieved ultra-high-dose rates for FLASH effect and maintained the same dosimetry quality as the CONV-IMPT plans. © 2025 The Author(s) |
| Keywords: | clinical article; controlled study; intensity modulated radiation therapy; treatment planning; comparative study; algorithm; dosimetry; spinal cord; clinical evaluation; stereotactic body radiation therapy; radiation dose distribution; esophagus; proton; spine tumor; clinical target volume; maximum permissible dose; proton therapy; dose volume histogram; organs at risk; human; article; flash radiotherapy; proton pencil beam scanning; single energy proton pristine bragg peak delivery technique |
| Journal Title: | Advances in Radiation Oncology |
| Volume: | 10 |
| Issue: | 6 |
| ISSN: | 2452-1094 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2025-05-31 |
| Start Page: | 101776 |
| Language: | English |
| DOI: | 10.1016/j.adro.2025.101776 |
| PROVIDER: | scopus |
| PMCID: | PMC12098142 |
| PUBMED: | 40416512 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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