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Siegel, R.L., Miller, K.D. and Jemal, A. (2015) Cancer Statistics, 2015. CA: A Cancer Journal for Clinicians, 65, 5-29.
http://dx.doi.org/10.3322/caac.21254

has been cited by the following article:

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

    AUTHORS: Gang Liu, Hong Quan, Xiaoqiang Li, Craig Stevens, Di Yan, Xuanfeng Ding

    KEYWORDS: Proton Therapy, Single Field Uniform Dose, Pencil Beam Scanning, 4DCT, Lung Tumor

    JOURNAL NAME: International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Vol.5 No.4, September 30, 2016

    ABSTRACT: 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.