Consensus Guidelines for Implementing Pencil-Beam Scanning Proton Therapy for Thoracic Malignancies on Behalf of the PTCOG Thoracic and Lymphoma Subcommittee

Publication date: 1 September 2017
Source:International Journal of Radiation Oncology*Biology*Physics, Volume 99, Issue 1
Author(s): Joe Y. Chang, Xiaodong Zhang, Antje Knopf, Heng Li, Shinichiro Mori, Lei Dong, Hsiao-Ming Lu, Wei Liu, Shahed N. Badiyan, Stephen Both, Arturs Meijers, Liyong Lin, Stella Flampouri, Zuofeng Li, Kikuo Umegaki, Charles B. Simone, Xiaorong R. Zhu
Pencil-beam scanning (PBS) proton therapy (PT), particularly intensity modulated PT, represents the latest advanced PT technology for treating cancers, including thoracic malignancies. On the basis of virtual clinical studies, PBS-PT appears to have great potential in its ability to tightly tailor the dose to the target while sparing critical structures, thereby reducing treatment-related toxicities, particularly for tumors in areas with complicated anatomy. However, implementing PBS-PT for moving targets has several additional technical challenges compared with intensity modulated photon radiation therapy or passive scattering PT. Four-dimensional computed tomography–based motion management and robust optimization and evaluation are crucial for minimizing uncertainties associated with beam range and organ motion. Rigorous quality assurance is required to validate dose delivery both before and during the course of treatment. Active motion management (eg, breath hold), beam gating, rescanning, tracking, or adaptive planning may be needed for cases involving significant motion or changes in motion or anatomy over the course of treatment.



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