by Alejandro Mazal, Juan Antonio Vera Sanchez, Daniel Sanchez-Parcerisa, Jose Manuel Udias, Samuel España, Victor Sanchez-Tembleque, Luis Mario Fraile, Paloma Bragado, Alvaro Gutierrez-Uzquiza, Nuria Gordillo, Gaston Garcia, Juan Castro Novais, Juan Maria Perez Moreno, Lina Mayorga Ortiz, Amaia Ilundain Idoate, Marta Cremades Sendino, Carme Ares, Raymond Miralbell and Niek Schreuder
Abstract:
Proton therapy has advantages and pitfalls comparing with photon therapy in radiation therapy. Among the limitations of protons in clinical practice we can selectively mention: uncertainties in range, lateral penumbra, deposition of higher LET outside the target, entrance dose, dose in the beam path, dose constraints in critical organs close to the target volume, organ movements and cost. In this review, we combine proposals under study to mitigate those pitfalls by using individually or in combination: (a) biological approaches of beam management in time (very high dose rate “FLASH” irradiations in the order of 100 Gy/sec) and (b) modulation in space (a combination of mini-beams of millimetric extent), together with mechanical approaches such as (c) rotational techniques (optimized in partial arcs) and, in an effort to reduce cost, (d) gantry-less delivery systems. In some cases, these proposals are synergic (e.g. FLASH and minibeams), in others they are hardly compatible (mini-beam and rotation). Fixed lines have been used in pioneer centers, or for specific indications (ophthalmic, radiosurgery,…), they logically evolved to isocentric gantries. The present proposals to produce fixed lines is somewhat controversial. Rotational techniques, minibeams and FLASH in proton therapy are making their way, with an increasing degree of complexity in these three approaches, but with a high interest in the basic science and clinical communities. All of them must be proven in clinical applications.
Reference:
Alejandro Mazal, Juan Antonio Vera Sanchez, Daniel Sanchez-Parcerisa, Jose Manuel Udias, Samuel España, Victor Sanchez-Tembleque, Luis Mario Fraile, Paloma Bragado, Alvaro Gutierrez-Uzquiza, Nuria Gordillo, Gaston Garcia, Juan Castro Novais, Juan Maria Perez Moreno, Lina Mayorga Ortiz, Amaia Ilundain Idoate, Marta Cremades Sendino, Carme Ares, Raymond Miralbell and Niek Schreuder, “Biological and Mechanical Synergies to Deal With Proton Therapy Pitfalls: Minibeams, FLASH, Arcs, and Gantryless Rooms”, Frontiers in Oncology, vol. 10.
Bibtex Entry:
@article{mazal_biological_2021,
title = {Biological and {Mechanical} {Synergies} to {Deal} {With} {Proton} {Therapy} {Pitfalls}: {Minibeams}, {FLASH}, {Arcs}, and {Gantryless} {Rooms}},
volume = {10},
issn = {2234-943X},
shorttitle = {Biological and {Mechanical} {Synergies} to {Deal} {With} {Proton} {Therapy} {Pitfalls}},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2020.613669/full},
doi = {10.3389/fonc.2020.613669},
abstract = {Proton therapy has advantages and pitfalls comparing with photon therapy in radiation therapy. Among the limitations of protons in clinical practice we can selectively mention: uncertainties in range, lateral penumbra, deposition of higher LET outside the target, entrance dose, dose in the beam path, dose constraints in critical organs close to the target volume, organ movements and cost. In this review, we combine proposals under study to mitigate those pitfalls by using individually or in combination: (a) biological approaches of beam management in time (very high dose rate “FLASH” irradiations in the order of 100 Gy/sec) and (b) modulation in space (a combination of mini-beams of millimetric extent), together with mechanical approaches such as (c) rotational techniques (optimized in partial arcs) and, in an effort to reduce cost, (d) gantry-less delivery systems. In some cases, these proposals are synergic (e.g. FLASH and minibeams), in others they are hardly compatible (mini-beam and rotation). Fixed lines have been used in pioneer centers, or for specific indications (ophthalmic, radiosurgery,…), they logically evolved to isocentric gantries. The present proposals to produce fixed lines is somewhat controversial. Rotational techniques, minibeams and FLASH in proton therapy are making their way, with an increasing degree of complexity in these three approaches, but with a high interest in the basic science and clinical communities. All of them must be proven in clinical applications.},
language = {English},
urldate = {2021-02-04},
journal = {Frontiers in Oncology},
author = {Mazal, Alejandro and Vera Sanchez, Juan Antonio and Sanchez-Parcerisa, Daniel and Udias, Jose Manuel and España, Samuel and Sanchez-Tembleque, Victor and Fraile, Luis Mario and Bragado, Paloma and Gutierrez-Uzquiza, Alvaro and Gordillo, Nuria and Garcia, Gaston and Castro Novais, Juan and Perez Moreno, Juan Maria and Mayorga Ortiz, Lina and Ilundain Idoate, Amaia and Cremades Sendino, Marta and Ares, Carme and Miralbell, Raymond and Schreuder, Niek},
year = {2021},
keywords = {Arctherapy, flash, Gantry, Minibeams, Protontherapy},
file = {Full Text PDF:E:\Usuarios\Administrator\Zotero\storage\X9ULYTH4\Mazal et al. - 2021 - Biological and Mechanical Synergies to Deal With P.pdf:application/pdf},
}