Intensity Modulated Proton Therapy for Hepatocellular Carcinoma
Examensarbete för masterexamen
Biomedical engineering (MPBME), MSc
Gotby Westlund, Lovisa
This is a preliminary study investigating the advantages and drawbacks of using intensity modulated proton therapy (IMPT) in the treatment of hepatocellular carcinoma (HCC) and compares this treatment modality with photon stereotactic body radiation therapy (SBRT). One patient, previously treated with photon SBRT, has been replanned and by benefiting from the protons finite range and the fact that most of the dose is deposited in the Bragg peak, proton treatment plans which efficiently spare the organs-at-risk (OARs) have been generated. The challenge with using IMPT when treating HCC however, is that the tumor moves over time due to breathing and the sensitive spatio-temporal resolution of the IMPT is therefore compromised in the treatment delivery, giving rise to the so-called interplay effect. This effect can be mitigated by, for example, breath hold, beam gating, tumor tracking or rescanning. The impact of interplay effect has been simulated for treatment delivery in breath hold as well as for free-breathing and the benefit of using rescanning has been investigated. All IMPT plans have superior tumor coverage in comparison with the photon SBRT plan, at the same time as having better OAR sparing. The dose delivery simulations show promising results for future clinical applications of robust proton therapy treatment plans for both delivery techniques, the trade-off between dose delivery in breath hold and freebreathing being treatment time versus sparing of OARs. However, more patient cases are needed in order to draw more general conclusions.
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