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Current Status of Proton Thoracic Radiotherapy

H Li1*, S Both2*, S Flampouri3*, (1) Johns Hopkins Medicine, Washington, DC, (2) University Medical Center Groningen, Groningen,NL (3) Emory University, Atlanta, GA

Presentations

2:00 PM Treatment Planning and Delivery for Proton Thoracic Therapy – An US Center’s Experience - H Li, Presenting Author
2:25 PM Treatment Planning and Delivery for Proton Thoracic Therapy – A European Center’s Experience - S Both, Presenting Author
2:50 PM Parallels and Intersections in Thoracic Proton Therapy - S Flampouri, Presenting Author
2:55 PM Q&A - S Flampouri, Presenting Author

SU-D-TRACK 7-0 (Sunday, 7/25/2021) 2:00 PM - 3:00 PM [Eastern Time (GMT-4)]

Thoracic proton therapy is challenging because of high tissue heterogeneity and volatility. The effects of uncertainties on proton range are accentuated in the thorax due to the respiratory motion and time structure of the proton pencil beam, making implementation of new developments more intricate than for other sites. This session will focus on how technological advancements in a. Plan optimization and evaluation and b. Adaptive planning and delivered dose accumulation, are implemented for thoracic targets. The latest in treatment planning systems such as Monte Carlo-based 4-dimensional robust optimization and estimation of biological weighted dose will be presented along with their benefits, disadvantages, and inadequacies in and around the lungs. Robustness evaluation methods based on dose calculation of error and anatomy scenarios recently replaced PTV evaluations in proton therapy and will also be introduced. In addition, estimations of delivered dose will be explored in the session. Methods of reporting dose distributions that include delivery log files, daily IGRT and patient monitoring data, and repeated scan images will be presented. Remaining issues in reporting fractional and cumulative doses that include the effects of uncertainties, errors, physiological motions, and anatomical deformations as well as plan adaptations will be reviewed. Practice differences between photons, older and new technology protons and their repercussions will be discussed. The Dutch Model Based perspective from thoracic patient selection to planning techniques and treatment evaluation methods will be presented.

Learning Objectives:
1. Be updated on the latest treatment planning techniques applied in proton thoracic therapy
2. Learn about dose evaluation both planned and delivered
3. Explore differences between European and North American practices in thoracic proton therapy

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