A model-based risk-minimizing proton treatment planning concept for brain injury prevention in low-grade glioma patients
PURPOSE: Late-occurring contrast-enhancing brain lesions (CEBLs) have been observed on MRI follow-up in low-grade glioma (LGG) patients post-proton therapy. Predictive risk-models for this endpoint identified a dose-averaged linear energy transfer (LETd)-dependent proton relative biological effectiv...
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| Main Authors: | , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
10 October 2024
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| In: |
Radiotherapy and oncology
Year: 2024, Volume: 201, Pages: 1-7 |
| ISSN: | 1879-0887 |
| DOI: | 10.1016/j.radonc.2024.110579 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.radonc.2024.110579 Resolving-System, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0167814024035576?via%3Dihub 
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| Author Notes: | H. Sallem, S. Harrabi, E. Traneus, K. Herfarth, J. Debus, J. Bauer |
| Summary: | PURPOSE: Late-occurring contrast-enhancing brain lesions (CEBLs) have been observed on MRI follow-up in low-grade glioma (LGG) patients post-proton therapy. Predictive risk-models for this endpoint identified a dose-averaged linear energy transfer (LETd)-dependent proton relative biological effectiveness (RBE) effect on CEBL occurrence and increased radiosensitivity of the cerebral periventricular region (VP4mm). This work aimed to design a stable risk-minimizing treatment planning (TP) concept addressing these intertwined risk factors through a classically formulated optimization problem. - MATERIAL AND METHODS: The concept was developed in RayStation-research 11B IonPG featuring a variable-RBE-based optimizer involving 20 LGG patients with varying target volume localizations and risk-factor contributions. Classical cost functions penalizing dose, dose-volume-histogram points, and equivalent uniform dose were used to formulate the optimization problem, and a new set of structures was introduced to actively spare the VP4mm, control high LETd regions, and de-escalate the dose outside the gross tumor volume. Target volume coverage and organ-at-risk sparing were robustly evaluated, and Normal Tissue Complication Probabilities (NTCP) for CEBL occurrence were quantified. - RESULTS: The concept yielded stable optimization outcomes for all considered subjects. Risk hot spots were successfully mitigated, and an NTCP reduction of up to 79 % was observed compared to conventional TP while maintaining target coverage, demonstrating the feasibility of the chosen model-based approach. - CONCLUSION: With the proposed TP protocol, we close the gap between predictive risk-modeling and practical risk-mitigation in the clinic and provide a concept for CEBL avoidance with the potential to advance treatment precision for LGG patients. |
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| Item Description: | Artikelversion: 23. Oktober 2024 Gesehen am 13.05.2025 |
| Physical Description: | Online Resource |
| ISSN: | 1879-0887 |
| DOI: | 10.1016/j.radonc.2024.110579 |