Robustness of daily dose for each beam angle and accumulated dose for inter-fractional anatomical changes in passive carbon-ion radiotherapy for pancreatic cancer: Bone matching versus tumor matching.

PURPOSE: We aimed to assess the robustness of accumulated dose distributions for inter-fractional changes in passive carbon-ion radiotherapy for pancreatic cancer. METHODS: Ninety-five daily CT image sets acquired after the treatment of eight patients with pancreatic cancer were used in this prospective study. Dose distributions with treatment beam fields were recalculated for bone matching (BM) and tumor matching (TM) positions on all daily CT images, the accumulated doses being calculated using deformable image registration methods. The prescribed dose was 55.2 Gy (relative biological effectiveness [RBE]) in 12 fractions. Dose volume parameters of V95 (%) for CTV and GTV, and D2cc (Gy(RBE)) for the stomach and duodenum were evaluated. RESULTS: The medians (range) of CTV V95 (%) were 91.9 (86.1-100.0), 80.5 (56.1-90.6), and 86.4 (72.5-96.5) for the Plan, accumulated with BM and TM, respectively; GTV values (%) were 98.0 (85.7-100.0), 93.3 (65.7-99.9), and 96.2 (84.8-100.0), respectively. There were significant differences between all combinations apart from the Plan and TM for both targets. The values of stomach D2cc (Gy(RBE)) were 36.0 (16.9-43.4), 36.7 (17.9-45.0), and 35.2 (16.8-43.5), respectively; duodenum values (Gy(RBE)) were 25.2 (21.3-40.3), 30.1 (23.3-48.6), and 28.3 (20.4-50.6), respectively. There was a significant difference between the Plan and BM for duodenum only. CONCLUSIONS: TM is recommended over BM because it can achieve higher target dose coverage than BM. Nevertheless, it is not enough in some cases. Further technical improvements are necessary to improve the target dose coverage.

Potential Pitfalls of Diaphragm Structural Matching in Carbon-ion Radiotherapy for Pancreatic Cancer.

BACKGROUND/AIM: To evaluate the effectiveness of diaphragm matching (DM) for carbon-ion radiotherapy (CIRT) of pancreatic cancer patients and develop a simple method to estimate tumour position. PATIENTS AND METHODS: Treatment planning CTs from 27 pancreatic cancer patients treated with CIRT in our facility were used in this study, and 32 other CT image datasets taken on different days were used for measuring tumour and diaphragm displacements. A correction method (SI-correction) was developed using the coefficient x of the regression line formula for the displacements between the diaphragm and tumour in the superior-inferior direction. The tumour positioning errors of bone matching (BM), DM, and SI-correction were measured. RESULTS: Mean (±standard deviation) absolute errors of BM, DM, and SI-correction were 5.10±3.31, 7.48±4.04, and 4.13±2.51 mm, respectively. DM showed significant differences compared to the other correction methods. CONCLUSION: DM was subject to larger errors than BM. Our correction method improved positional errors.

The Impact of Gadolinium-based Contrast Agent for Carbon Ion Radiotherapy.

PURPOSE: The contrast agent used in the diagnostic department has high atomic numbers and might influence dose deposition in the particle therapy. In particular, the influence of gadolinium-based (Gd) contrast agent on range in carbon ion radiotherapy has not yet been evaluated. For this reason, we avoid carbon treatment and planning computed tomography (CT) acquisition on days when the contrast-enhanced magnetic resonance image (MRI) is performed. In this study, we evaluated the time required for this beam range effect to vanish by evaluating the temporal changes in the CT values after an enhanced MRI as well as the stopping power of Gd solution. MATERIALS AND METHODS: Two types of diluted solutions with Gd contrast agent were used for comparing their transferred stopping power (TSP) and measured stopping power (MSP). The TSP was calculated with a CT value to stopping power ratio table that was created previously. Additionally, to evaluate in vivo attenuation, we measured the CT values in the renal pelvis from the CT images with and without contrast agent for 73 patients. RESULTS: The maximum difference between the TSP and MSP was 85%. The difference between the TSP after 4 hours and the TSP with non-enhanced cases was less than 1%. Moreover, the difference between the MSP after 1 hour and the MSP with non-enhanced cases was less than 0.1%. CONCLUSION: It was found that the impact of Gd contrast agent can be neglected 1 hour after administration for carbon beam irradiation and 4 hours after for planning the CT image acquisition.