Dynamic Proton arc therapy for paediatric parameningeal rhabdomyosarcoma.
4 affiliations
- 1Cancer Clinic, Haukeland University Hospital, Bergen, Norway.
- 2Department of Physics and Technology, University of Bergen, Bergen, Norway.
- 3Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA.
- 4University of Florida Health Proton Therapy Institute, Jacksonville, Florida, USA.
Abstract
Background
Parameningeal rhabdomyosarcomas (PM-RMS) are pediatric tumors with a high risk of local failure and severe toxicity. Intensity modulated proton therapy (IMPT) offers improved healthy tissue sparing compared to conventional photon-based radiotherapy, and proton arc therapy (PAT) might offer further improvement in healthy tissue sparing for these patients, thus emphasizing the need for systematic studies specifically focusing on PM-RMS patients. Additionally, the relative biological effectiveness (RBE) of protons is known to vary with linear energy transfer (LET).Purpose
The aim of this study was to investigate the potential of LET-optimized PAT for PM-RMS treatment.Methods
Volumetric modulated arc therapy (VMAT) plans, IMPT and PAT plans, both with and without LET optimization were made for 13 PM-RMS patients using Raystation version 2023B. The plans were evaluated based on the achievement of clinical goals, homogeneity index, delivery time, robustness, LET and variable RBE-weighted dose within the target and selected OARs.Results
LET optimization increased the mean LET in the target from 2.5 keV/µm [2.1, 2.8] to 3.4 keV/µm [2.7, 4.1] for IMPT and from 2.8 keV/µm [2.5, 3.1] to 3.4 keV/µm [2.7, 4.0] for PAT with minor changes in dose distributions. Target coverage and OAR doses were comparable between IMPT and PAT, while both had an expected improvement in OAR sparing compared to VMAT. Delivery times were 134.5 [95.3, 203.7] seconds for the IMPT plans and 197.4 [138.9, 244.6] seconds for the PAT plans before LET optimization, and were for both modalities reduced by around 2-5 seconds after LET optimization.Conclusions
The dose distribution was similar across PAT and IMPT in this study, and superior compared to VMAT. LET optimization in the proton plans achieved LET improvements in both target and OARs without compromising dose.
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BibTeX
@article{handeland2026dynamic,
title = {{Dynamic Proton arc therapy for paediatric parameningeal rhabdomyosarcoma.}},
author = {Andreas Havsgård Handeland and Hardev Singh Grewal and Camilla Grindeland Boer and Daniel J Indelicato and Kristian Smeland Ytre-Hauge and Helge Henjum and Camilla Hanquist Stokkevåg},
journal = {Journal of applied clinical medical physics},
year = {2026},
month = oct,
doi = {10.1002/acm2.70867},
url = {https://europepmc.org/article/MED/42900561},
note = {CC BY},
}
RIS
TY - JOUR
TI - Dynamic Proton arc therapy for paediatric parameningeal rhabdomyosarcoma.
AU - Andreas Havsgård Handeland
AU - Hardev Singh Grewal
AU - Camilla Grindeland Boer
AU - Daniel J Indelicato
AU - Kristian Smeland Ytre-Hauge
AU - Helge Henjum
AU - Camilla Hanquist Stokkevåg
PY - 2026
DA - 2026/10/30
JO - Journal of applied clinical medical physics
DO - 10.1002/acm2.70867
UR - https://europepmc.org/article/MED/42900561
AB - Background Parameningeal rhabdomyosarcomas (PM-RMS) are pediatric tumors with a high risk of local failure and severe toxicity. Intensity modulated proton therapy (IMPT) offers improved healthy tissue sparing compared to conventional photon-based radiotherapy, and proton arc therapy (PAT) might offer further improvement in healthy tissue sparing for these patients, thus emphasizing the need for systematic studies specifically focusing on PM-RMS patients. Additionally, the relative biological effectiveness (RBE) of protons is known to vary with linear energy transfer (LET).Purpose The aim of this study was to investigate the potential of LET-optimized PAT for PM-RMS treatment.Methods Volumetric modulated arc therapy (VMAT) plans, IMPT and PAT plans, both with and without LET optimization were made for 13 PM-RMS patients using Raystation version 2023B. The plans were evaluated based on the achievement of clinical goals, homogeneity index, delivery time, robustness, LET and variable RBE-weighted dose within the target and selected OARs.Results LET optimization increased the mean LET in the target from 2.5 keV/µm [2.1, 2.8] to 3.4 keV/µm [2.7, 4.1] for IMPT and from 2.8 keV/µm [2.5, 3.1] to 3.4 keV/µm [2.7, 4.0] for PAT with minor changes in dose distributions. Target coverage and OAR doses were comparable between IMPT and PAT, while both had an expected improvement in OAR sparing compared to VMAT. Delivery times were 134.5 [95.3, 203.7] seconds for the IMPT plans and 197.4 [138.9, 244.6] seconds for the PAT plans before LET optimization, and were for both modalities reduced by around 2-5 seconds after LET optimization.Conclusions The dose distribution was similar across PAT and IMPT in this study, and superior compared to VMAT. LET optimization in the proton plans achieved LET improvements in both target and OARs without compromising dose.
SN - 1526-9914
ER -