Integration of ultrasound-guided motion management into proton therapy treatment plans for ventricular tachycardia non-invasive radio ablation.

Background: Stereotactic arrhythmia radioablation (STAR) is an emerging, non-invasive treatment for refractory ventricular arrhythmias. The technology requires target motion management.

Purpose: We studied the integration of a novel ultrasound probe and holder for heart motion management into proton-beam STAR treatment plans.

Predicting sacral insufficiency fractures in carbon ion therapy for sacral chordoma: The role of RBE-weighted dose, dose-averaged LET, and volume.

Background: A previous retrospective analysis on clinical outcomes of carbon-ion radiation therapy (CIRT) for large sacral chordoma patients highlighted the potential correlation between tumor relapse and suboptimal dose-averaged LET (LET) distribution, triggering the need for implementation of LET-based objectives in clinical practice.

Purpose: To investigate the synergetic role played by RBE-weighted dose (D) and LET in the occurrence of sacral insufficiency fractures (SIF) after CIRT for sacral chordoma patients, in view of the clinical application of LET-based plan optimization.

Methods: We retrospectively analyzed 73 patients, consecutively treated between 2013 and 2021, with radical CIRT and classified the occurrence of SIF during follow-up.

Microdosimetric evaluation of a clinical carbon ion beam using a tissue-equivalent proportional counter.

. Microdosimetry provides critical insights into radiation quality and relative biological effectiveness (RBE) in carbon ion therapy. However, its application in modern pulsed scanning beams is limited due to detector response challenges at high dose rates.

Tumor control probability in large sacral chordomas treated with carbon ions radiotherapy integrating advanced microstructural modelling.

Purpose: To integrate patient-specific cell count data from diffusion-weighted MRI (DWI) into the linear-quadratic (LQ) Poisson tumor control probability (TCP) model for sacral chordomas (SC) treated with carbon ion radiotherapy (CIRT), aiming to improve local control (LC) and local relapse (LR) prediction.

Materials And Methods: We considered data from 37 of the first 50 SC patients consecutively treated at the National Centre for Oncological Hadrontherapy (CNAO, Pavia, Italy). LQ Poisson formalism was revised to integrate either a linear (TCP) or logarithmic (TCP) dependence on clonogenic cell count, derived from baseline DWI through an optimal match with in-silico simulations.

Comparison of the alanine response to clinical proton and carbon ion beams.

Purposes: Hadrontherapy with proton and carbon ion scanning beams is an advanced radiation treatment modality mainly exploiting the finite range of those particles in the matter, to better spare critical organs close to the tumor volume as compared to photons. However, its complexity requires careful management of dosimetric uncertainties to guarantee patient safety. This study aims to reassess the suitability of alanine-based dosimetry for modern hadrontherapy applications.

Transmission beam planning for improved robustness and efficiency in proton therapy for head and neck cancer.

Background And Purpose: Optimizing head and neck cancer (HNC) plans with single-energy proton beams that fully traverse the patient (transmission beams) can improve robustness and delivery efficiency, complementing conventional approaches.

Materials And Methods: Experimental measurements, validated with Monte Carlo (MC) simulations, were carried out on a uniform water-equivalent plastic phantom (RW3) containing a metal component (2-Euro coins) irradiated with a single high energy proton field (228.6 MeV) to verify the transmission beam concept.

Deep-learning synthetized 4DCT from 4DMRI of the abdominal site in carbon-ion radiotherapy.

Purpose: To investigate the feasibility of deep-learning-based synthetic 4DCT (4D-sCT) generation from 4DMRI data of abdominal patients undergoing Carbon Ion Radiotherapy (CIRT).

Material And Methods: A 3-channel conditional Generative Adversarial Network (cGAN) was trained and tested on twenty-six patients, using paired T1-weighted 4DMRI and 4DCT volumes. 4D-sCT data were generated via the cGAN following a 3-channels segmentation approach (air, bone, soft tissue) in two scenarios: (a) 4DCT-based approach (i.

Evaluation of motion mitigation strategies for carbon ion therapy of abdominal tumors based on non-periodic imaging data.

To identify suitable combination strategies for treatment planning and beam delivery in scanned carbon ion therapy of moving tumors.. Carbon ion treatment plans for five abdominal tumors were optimized on four-dimensional (4D) computed tomography (CT) data using the following approaches.

Defective homologous recombination and genomic instability predict increased responsiveness to carbon ion radiotherapy in pancreatic cancer.

Pancreatic ductal adenocarcinoma (PDAC) is notably resistant to conventional chemotherapy and radiation treatment. However, clinical trials indicate that carbon ion radiotherapy (CIRT) with concurrent gemcitabine is effective for unresectable locally advanced PDAC. This study aimed to identify patient characteristics predictive of CIRT response.

Characterization of LiF TLD-100 in carbon ion beams for remote audits.

Background: A passive dosimeter framework for the measurement of dose in carbon ion beams has yet to be characterized or implemented for regular use.

Purpose: This work determined the dose calculation correction factors for absorbed dose in thermoluminescent dosimeters (TLDs) in a therapeutic carbon ion beam. TLD could be a useful tool for remote audits, particularly in the context of clinical trials as new protocols are developed for carbon ion radiotherapy.

Balancing benefits and limitations of linear energy transfer optimization in carbon ion radiotherapy for large sacral chordomas.

Background And Purpose: A low linear energy transfer (LET) in the target can reduce the effectiveness of carbon ion radiotherapy (CIRT). This study aimed at exploring benefits and limitations of LET optimization for large sacral chordomas (SC) undergoing CIRT.

Materials And Methods: Seventeen cases were used to tune LET-based optimization, and seven to independently test interfraction plan robustness.

Dosimetric Comparison Between Proton and Photon Radiation Therapies for Pediatric Neuroblastoma.

Purpose: The aim of this study is to determine the most beneficial radiation treatment technique for pediatric patients with thoracic and abdominal neuroblastoma (NBL), through a dosimetric comparison between photon Volumetric Modulated Arc Therapy and proton Intensity-Modulated Proton Therapy treatment plans.

Materials And Methods: A retrospective analysis was conducted on a multicentre case series of 19 patients with thoracic and/or abdominal NBL who underwent radiation therapy, following the recommendations of the European protocol for high-risk NBL (HR-NBL2/SIOPEN). The prescribed dose was 21.

A dosiomics approach to treatment outcome modeling in carbon ion radiotherapy for skull base chordomas.

Purpose: To investigate the role of dosiomics features extracted from physical dose (D), RBE-weighted dose (D) and dose-averaged Linear Energy Transfer (LET), to predict the risk of local recurrence (LR) in skull base chordoma (SBC) treated with Carbon Ion Radiotherapy (CIRT). Thus, define and evaluate dosiomics-driven tumor control probability (TCP) models.

Materials And Methods: 54 SBC patients were retrospectively selected for this study.

Proton therapy for intracranial meningioma: a single-institution retrospective analysis of efficacy, survival and toxicity outcomes.

Purpose: To report the outcomes of a large series of intracranial meningiomas (IMs) submitted to proton therapy (PT) with curative intent.

Methods: We conducted a retrospective analysis on all consecutive IM patients treated between 2014 and 2021. The median PT prescription dose was 55.

OSLD nanoDot characterization for carbon radiotherapy dosimetry.

. This study characterized optically-stimulated luminescent dosimeter (OSLD) nanoDots for use in a therapeutic carbon beam using the Imaging and Radiation Oncology Core (IROC) framework for remote output verification..

Technical note: Radiological clinical equivalence for phantom materials in carbon ion therapy.

Purpose: As carbon ion radiotherapy increases in use, there are limited phantom materials for heterogeneous or anthropomorphic phantom measurements. This work characterized the radiological clinical equivalence of several phantom materials in a therapeutic carbon ion beam.

Methods: Eight materials were tested for radiological material-equivalence in a carbon ion beam.

Effects of nuclear interaction corrections and trichrome fragment spectra modelling on dose and linear energy transfer distributions in carbon ion radiotherapy.

Background And Purpose: Nuclear interaction correction (NIC) and trichrome fragment spectra modelling improve relative biological effectiveness-weighted dose (D) and dose-averaged linear energy transfer (LET) calculation for carbon ions. The effect of those novel approaches on the clinical dose and LET distributions was investigated.

Materials And Methods: The effect of the NIC and trichrome algorithm was assessed, creating single beam plans for a virtual water phantom with standard settings and NIC + trichrome corrections.

Synthetic CT imaging for PET monitoring in proton therapy: a simulation study.

This study addresses a fundamental limitation of in-beam positron emission tomography (IB-PET) in proton therapy: the lack of direct anatomical representation in the images it produces. We aim to overcome this shortcoming by pioneering the application of deep learning techniques to create synthetic control CT images (sCT) from combining IB-PET and planning CT scan data.We conducted simulations involving six patients who underwent irradiation with proton beams.

Using the photon isoeffective dose formalism to compare and combine BNCT and CIRT in a head and neck tumour.

Boron Neutron Capture Therapy (BNCT) is a radiotherapy technique based on the enrichment of tumour cells with suitable 10-boron concentration and on subsequent neutron irradiation. Low-energy neutron irradiation produces a localized deposition of radiation dose caused by boron neutron capture reactions. Boron is vehiculated into tumour cells via proper borated formulations, able to accumulate in the malignancy more than in normal tissues.

The Role of Carbon Ion Therapy in the Changing Oncology Landscape-A Narrative Review of the Literature and the Decade of Carbon Ion Experience at the Italian National Center for Oncological Hadrontherapy.

Background: Currently, 13 Asian and European facilities deliver carbon ion radiotherapy (CIRT) for preclinical and clinical activity, and, to date, 55 clinical studies including CIRT for adult and paediatric solid neoplasms have been registered. The National Center for Oncological Hadrontherapy (CNAO) is the only Italian facility able to accelerate both protons and carbon ions for oncological treatment and research.

Methods: To summarise and critically evaluate state-of-the-art knowledge on the application of carbon ion radiotherapy in oncological settings, the authors conducted a literature search till December 2022 in the following electronic databases: PubMed, Web of Science, MEDLINE, Google Scholar, and Cochrane.

Characterization of a flat-panel detector for 2D dosimetry in scanned proton and carbon ion beams.

Purpose: To fully characterize the flat panel detector of the new Sphinx Compact device with scanned proton and carbon ion beams.

Materials And Methods: The Sphinx Compact is designed for daily QA in particle therapy. We tested its repeatability and dose rate dependence as well as its proportionality with an increasing number of particles and potential quenching effect.

Synthetic CT in Carbon Ion Radiotherapy of the Abdominal Site.

The generation of synthetic CT for carbon ion radiotherapy (CIRT) applications is challenging, since high accuracy is required in treatment planning and delivery, especially in an anatomical site as complex as the abdomen. Thirty-nine abdominal MRI-CT volume pairs were collected and a three-channel cGAN (accounting for air, bones, soft tissues) was used to generate sCTs. The network was tested on five held-out MRI volumes for two scenarios: (i) a CT-based segmentation of the MRI channels, to assess the quality of sCTs and (ii) an MRI manual segmentation, to simulate an MRI-only treatment scenario.