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Outline4 Quatitative Research-Group 8
Outline4 Quatitative Research-Group 8
Also, this will be true within each treatment site individually, as well as within
groups based on replan requirement.
III. Materials and Methods
A. PI: Patient selection
1. Patient selection criteria
a. Inclusion criteria (phase-gated treatment, at least one verification, included
sites)
b. Exclusion criteria (non phase-gated treatment, not included treatment sites)
2. Study Population
a. Number of patients (18)
b. Lung patients (6)
c. Liver patients (5)
d. Esophagus patients (7)
B. PII-III: Verification Process
1. Data-set creation
a. Phase-gated average
b. Single-phase
2. Verification plan creation
a. MIM workflow
b. Eclipse import and verification plan process
c. Physics and physician review
C. PIV-V: Physician Review
1. Contour creation
2. Evaluation
D. PVI: Data Collection and Statistical Analysis
1. Dose statistics
2. T-test for dependent means
3. Evaluation cohorts
IV. Results
A. PI: Comprehensive Cohort Comparison (Quantitative Analysis)
1. All treatment sites (Table 1, Figure 1)
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a. Rigid CTV contour (n=7): mean difference is –0.75% ± 1.1% (p= 0.120)
b. Deformable CTV contour (n=7): mean difference is -1.02%± 2.4% (p=0.313)
c. New phase-gated CTV contour (n=8): mean difference is –1.34% ± 1.9%
(p=0.079)
d. New phase-gated vs. New 50-phase contour (n=8): mean difference is –0.65%
± 2.0%. (p=0.379)
e. Target coverage (V95%) is within ± 5% for all contours
6. PVI: No Replan (Figure 6)
a. Rigid CTV contour (n=20): mean difference is –0.15% ± 0.4% (p= 0.088)
b. Deformable CTV contour (n=20): mean difference is 0.38% ± 1.1% (p=0.138)
c. New phase-gated CTV contour (n=12): mean difference is –0.16% ± 0.5%
(p=0.313)
d. New phase-gated vs. New 50-phase contour (n=12): mean difference is –
0.32% ± 0.7%. (p=0.137)
e. Target coverage (V95%) is within ± 5% for all contours
7. PVII: Hypothesis evaluation
B. PVIII-IX: Qualitative Analysis
1. Physician review process
2. Results within each site group
a. Lung
b. Liver
c. Esophagus
V. Discussion
A. PI: Summarize purpose and findings
B. PII: Small mean differences support single-phase verification as viable for lung, liver,
and esophagus patients, streamlining proton therapy.
C. PIII: Single-phase verification plans align with clinical decisions but may vary
slightly, primarily for lung and liver patients.
D. PIV: Lung, liver, and esophagus findings
E. PV: Limitations of the study
F. PVI: Future research
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VI. Conclusion
A. PI: Summarize the study
1. Problem: The problem is that the verification process for phase-gated treatments
requires the creation of a new phase-gated average scan which is time-consuming
and incompatible with current workflows utilizing automated software.
2. Purpose: The purpose of this study was to compare target coverage reported on
phase-gated average verification plans to target coverage on single-phase
verification plans using the same scan to determine whether a single-phase
verification is an acceptable surrogate.
B. PII: Quantitative/Qualitative Analysis
C. PIII: Limitations/future research
1. Limitations: small sample size, specific treatment sites
2. Future research: expand patient populations, broader range of treatment sites,
explore automated processes.
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References
1. Deiter N, Chu F, Lenards N, Hunzeker A, Lang K, & Mundy D. Evaluation of replanning
in intensity-modulated proton therapy for oropharyngeal cancer: Factors influencing plan
robustness. Med Dosim. 2020;45(4):384-392.
https://doi.org/10.1016/j.meddos.2020.06.002
2. Tryggestad EJ, Liu W, Pepin MD, Hallemeier CL, & Sio TT. Managing treatment-related
uncertainties in proton beam radiotherapy for gastrointestinal cancers. J of Gastrointest
Oncol. 2020;11(1):212-224. https://doi.org/10.21037/jgo.2019.11.07
3. Knäusl B, Lebbink F, Fossati P, Engwall E, Georg D, Stock M. Patient breathing motion
and delivery specifics influencing the robustness of a proton pancreas irradiation.
Cancers. 2023;15(9):2550. https://doi.org/10.3390/cancers15092550
4. Hu YH, Harper, RH, Deiter NC, et al. Analysis of the rate of re-planning in spot-scanning
proton therapy. Int J of Part Ther. 2022;9(2):49-58. https://doi.org/10.14338/IJPT-21-
00043.1
5. Smolders A, Hengeveld AC, Both S, et al. Inter- and intrafractional 4D dose
accumulation for evaluating ΔNTCP robustness in lung cancer. Radiother Oncol.
2023;182:109488. https://doi.org/10.1016/j.radonc.2023.109488
6. Evans JD, Harper RH, Petersen M, et al. The importance of verification CT-QA scans in
patients treated with IMPT for head and neck cancers. Int J of Part Ther. 2020;7(1):41-
53. https://doi.org/10.14338/IJPT-20-00006.1
7. Green OL, Henke LE, & Hugo GD. Practical clinical workflows for online and offline
adaptive radiation therapy. Semin in radiat oncol.
2019;29(3):219-227. https://doi.org/10.1016/j.semradonc.2019.02.004
8. Gelover E, Deisher AJ, Herman MG, Johnson J E, Kruse JJ, & Tryggestad EJ. Clinical
implementation of respiratory‐gated spot‐scanning proton therapy: an efficiency analysis
of active motion management. J of Appl Clin Med Phys.
2019;20(5):99-108. https://doi.org/10.1002/acm2.12584
9. Gut P, Krieger M, Lomax T, Weber DC, & Hrbacek J. Combining rescanning and gating
for a time-efficient treatment of mobile tumors using pencil beam scanning proton
therapy. Radiother Oncol. 2021;160: 82-89.
https://doi.org/10.1016/j.radonc.2021.03.041
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10. Taasti VT, Hattu D, Vaassen F, et al. Treatment planning and 4D robust evaluation
strategy for proton therapy of lung tumors with large motion amplitude. Med Phys.
2021;48(8):4425-4437. https://doi.org/10.1002/mp.15067
11. Paganetti H, Botas P, Sharp GC, Winey B. Adaptive proton therapy. Phys in Med & Biol.
2021;66(22). https://doi.org/10.1088/1361-6560/ac344f
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Figures
Figure 1. Difference in target coverage (V95%) for comprehensive treatment site cohort.
Figure 5. Difference in target coverage (V95%) for cohort initially requiring a replan.
Figure 6. Difference in target coverage (V95%) for cohort not initially requiring a replan.
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Tables
Lung
Rigid Contour -1.72 1.8 0.043
Deformable Contour -1.13 2.2 0.220
New Phase-gated contour -1.67 1.9 0.057
New Phase-gated vs. New Single-phase Contour -1.08 2.2 0.234
Liver
Rigid Contour 0.03 0.2 0.593
Deformable Contour 0.94 1.3 0.052
Esophagus
Rigid Contour -0.16 0.3 0.053
Deformable Contour -0.41 1.3 0.288
New Phase-gated contour -0.07 0.3 0.328
New Phase-gated vs. New Single-phase Contour -0.12 0.3 0.124
Re-Plan
Rigid Contour -0.75 1.1 0.120
Deformable Contour -1.02 2.4 0.313
New Phase-gated contour -1.34 1.9 0.079
New Phase-gated vs. New Single-phase Contour -0.65 2.0 0.379
No Re-Plan
Rigid Contour -0.15 0.4 0.088
Deformable Contour 0.38 1.1 0.138
New Phase-gated contour -0.16 0.5 0.313
New Phase-gated vs. New Single-phase Contour -0.32 0.7 0.137