Carbon-ion scanning lung treatment planning with respiratory-gated phase-controlled rescanning: simulation study using 4-dimensional CT data.
BACKGROUND
To moving lung tumors, we applied a respiratory-gated strategy to carbon-ion pencil beam scanning with multiple phase-controlled rescanning (PCR). In this simulation study, we quantitatively evaluated dose distributions based on 4-dimensional CT (4DCT) treatment planning.


METHODS
Volumetric 4DCTs were acquired for 14 patients with lung tumors. Gross tumor volume, clinical target volume (CTV) and organs at risk (OARs) were delineated. Field-specific target volumes (FTVs) were calculated, and 48Gy(RBE) in a single fraction was prescribed to the FTVs delivered from four beam angles. The dose assessment metrics were quantified by changing the number of PCR and the results for the ungated and gated scenarios were then compared.


RESULTS
For the ungated strategy, the mean dose delivered to 95% of the volume of the CTV (CTV-D95) was in average 45.3 ± 0.9 Gy(RBE) even with a single rescanning (1 × PCR). Using 4 × PCR or more achieved adequate target coverage (CTV-D95 = 46.6 ± 0.3 Gy(RBE) for ungated 4 × PCR) and excellent dose homogeneity (homogeneity index =1.0 ± 0.2% for ungated 4 × PCR). Applying respiratory gating, percentage of lung receiving at least 20 Gy(RBE) (lung-V20) and heart maximal dose, averaged over all patients, significantly decreased by 12% (p < 0.05) and 13% (p < 0.05), respectively.


CONCLUSIONS
Four or more PCR during PBS-CIRT improved dose conformation to moving lung tumors without gating. The use of a respiratory-gated strategy in combination with PCR reduced excessive doses to OARs.
Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba-shi, Chiba, 263-8555, Japan. wataru.harry1@gmail.com.|Department of Radiology, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. wataru.harry1@gmail.com.
Wataru
W
Takahashi
Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba-shi, Chiba, 263-8555, Japan. shinshin@nirs.go.jp.
Shinichiro
S
Mori
Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba-shi, Chiba, 263-8555, Japan. mion@nirs.go.jp.
Mio
M
Nakajima
Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba-shi, Chiba, 263-8555, Japan. nao_y@nirs.go.jp.
Naoyoshi
N
Yamamoto
Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba-shi, Chiba, 263-8555, Japan. taku@nirs.go.jp.
Taku
T
Inaniwa
Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba-shi, Chiba, 263-8555, Japan. t_furu@nirs.go.jp.
Takuji
T
Furukawa
Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba-shi, Chiba, 263-8555, Japan. t_shirai@nirs.go.jp.
Toshiyuki
T
Shirai
Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba-shi, Chiba, 263-8555, Japan. noda_k@nirs.go.jp.
Koji
K
Noda
Department of Radiology, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. nakagawa-rad@umin.ac.jp.
Keiichi
K
Nakagawa
Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage-ku, Chiba-shi, Chiba, 263-8555, Japan. t_kamada@nirs.go.jp.
Tadashi
T
Kamada
D000368:Aged; D000369:Aged, 80 and over; D002244:Carbon / Q000627:therapeutic use*; D003198:Computer Simulation; D005260:Female; D005500:Follow-Up Studies; D056973:Four-Dimensional Computed Tomography / Q000379:methods*; D063193:Heavy Ion Radiotherapy; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D011379:Prognosis; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated; D055425:Respiratory-Gated Imaging Techniques / Q000295:instrumentation* / Q000379:methods
D002244:Carbon