W Liu¹*, A Knopf²*, J Langendijk³*, J Unkelbach⁴*, S Yan⁵*, (1) Mayo Clinic Arizona, Phoenix, AZ, (2) University of Groningen, Cologne, DE, (3) University of Groningen, University Of Groningen, DE, (4) University Hospital Zurich, Zurich, ZH, CH, (5) Massachusetts General Hospital, Boston, MA

• 
  W Liu
• 
  A Knopf
• 
  J Langendijk
• 
  J Unkelbach
• 
  S Yan

WE-CD-TRACK 5-0 (Wednesday, 7/28/2021) 1:00 PM - 3:00 PM [Eastern Time (GMT-4)]

Proton therapy (PT), especially pencil beam scanned proton therapy (PBS-PT), has been increasingly used to treat cancer patients. PT has a physical advantage, and thus in some cases a demonstrated clinical advantage over standard radiation therapy with photons. Despite the physics advantage, PT poses many challenges. Therefore, while at least 15% of all patients who receive radiation are expected to benefit from proton therapy, less than 1% receive this form of treatment. In this symposium we will present recent advances in treatment planning, modeling, and delivery technology that may broaden the accessibility of proton therapy from a “luxury” treatment option for relatively few selected patients to all patients who are expected to benefit from it.

In the first talk, we will discuss the unanticipated adverse events in PT induced by its high linear energy transfer (LET) at the end of proton ranges via a newly developed tool, dose-LET volume histogram (DLVH). The need of understanding LET effect for PT from patient outcomes combining both dose and LET for evaluation and treatment planning will be discussed.

In the second talk, we will discuss the 4D adaptive PT to account for the intra-fractional anatomical changes in PT to treat mobile tumors. 4D adaptive proton therapy will enable an automated seamless workflow by integrating imaging, treatment planning, and treatment quality assurance into a real-time adaptive PT treatment loop.

In the third talk, we will discuss the model-based selection of those patients who are expected to benefit from proton therapy, which can be considered an alternative evidence-based method for randomized studies. This approach has been implemented for patient selection in the Netherlands. Positive experiences as well as challenges will be reported.

In the fourth talk, we will cover recent advances in combined photon and proton optimization. The role of combined treatments for maximizing the benefit of limited proton resources for a population of patients will be analyzed. Situations in which individual patients benefit from a combination of protons and photons will be discussed.

In the fifth talk, we will discuss technological advances that have recently enabled the installation of proton therapy in spaces designed for conventional radiotherapy and future developments to the level of standard radiation therapy. This will dramatically increase the availability of proton therapy to more patients and reduce the disability adjusted life year.

In the last part of the symposium, we will have a Q&A session for some further in-depth discussion between session organizers, speakers, and audience.

Learning objectives:
1. Describe advanced concepts of integrating the variable linear energy transfer (LET) in the adverse events study.
2. Identify the most important factors requiring treatment adaptation.
3. Describe the motivation behind model-based patient selection.
4. Name two advantages of combining proton and photon therapy.
5. What are the main drivers of proton therapy cost?

Handouts

• 166-58749-15651646-171385-483986346.pdf (Wei Liu)
• 166-58750-15651646-178104-606130373.pdf (Antje Knopf)
• 166-58751-15651646-178107-980141602.pdf (Johannes Langendijk)
• 166-58752-15651646-177910-768968794.pdf (Jan Unkelbach)

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