Carbon ion radiotherapy optimization techniques for pancreatic cancer: accounting for the effect of bowel gas variation
Year: 2025
Type: article
Abstract: BACKGROUND: Dose variation due to changes in bowel air poses significant challenges for carbon radiotherapy in pancreatic cancer. This retrospective study evaluated a density-override optimization technique to mitigate dosimetric uncertainties caused by bowel air changes. MATERIALS AND METHODS: Planning CT and cone-beam CT data from 8 patients with locally advanced pancreatic cancer undergoing stereotactic ablative radiotherapy were analyzed. Treatment simulations used a dose of 55.2 GyE in 12 fractions with a four-field setup (anterior, lateral, posterior, posterior oblique). Four density-override patterns were compared: pattern 0 (no override), pattern 1 (replacing bowel gas with water), pattern 2 (replacing the entire bowel with mean bowel HU), and pattern 3 (replacing bowel gas with mean bowel HU). Dose evaluations included fraction-wise and accumulated dose analyses, focusing on target coverage, homogeneity index, and organs at risk doses. RESULTS: Pattern 2 achieved the largest clinical tumor volume coverage and the fewest fractions with > 5% coverage loss for the anterior beam, followed by pattern 3. However, pattern 2 demonstrated poorer homogeneity for the lateral beam compared to patterns 1 and 3 and a higher gastrointestinal (GI) dose for the anterior beam. CONCLUSION: This study evaluated the importance of density overrides to address bowel air variations. For patients where a more uniform dose is desirable or whose tumor is adjacent to the GI tract, a pattern 3 density-override should be considered.
Source: Strahlentherapie und Onkologie
Institutions: Seoul National University, Seoul National University Hospital
Language: English
Subfield: Radiation
Field: Physics and Astronomy
Domain: Physical Sciences
Open Access status: hybrid
Estimated APC paid: $4,390
OpenAlex ID: W4413369265