PROTON THERAPY AND RADIOSURGERY

by Smit, Berend J.; Breuer, Hans

ISBN13: 9783540641001

ISBN10: 3540641009

Format: Hardcover

Pub. Date: 2000-02-01

Publisher(s): Springer Verlag

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Summary

The subject of the book is the medical application of high energy proton beams, emphasising the practical applications, indications, radiobiology and physics, including dosimetry and three dimensional planning. The detailed methods of patient immobilisation, data collection for planning and the execution of plans will be presented. This will supply "hands on" type of information that will enable any qualified radiotherapist to treat a patient with confidence. The radiobiology of large fractions will also be explained in detail. The special features will include conversion tables to equivalent values for multiple dose increments ("frations") from single dose values, photos and drawings of immobilisation techniques, tissue density values. The main benefit the reader will get is an in depth, practical text, covering all aspects of proton therapy.

Part I Radiation Physics

General Aspects

(4)

A Brief History of Charged Particle Radiotherapy

(1)

Heavy Charged Particle Radiotherapy Facilities

(3)

Proton Radiotherapy Facilities in Operation

(1)

Heavy Charged Particle Facilities in Operation

(1)

Facilities under Construction or at the Planning Stage

(2)

Basics

(14)

Protons

(2)

Physical Properties

(1)

The Proton's Position in the Hierarchy of Particles

(1)

Proton Radiotherapy

(2)

Sources of Protons

(3)

Proton Accelerators

(1)

General Requirements

(1)

Proton Accelerators Suitable for Radiotherapy

(1)

Comparison of Existing Proton Accelerator Types

(1)

The Proton Beam Line

(3)

Beam Transport System

(2)

Shielding of the Beam Transport System

(1)

A Future Proton Source for Medical Applications

(1)

Summary: Design Criteria for Radiotherapy Proton Beams

(5)

Clinical Requirements

(1)

Beam Penetration and Precision

(1)

Radiation Dose and Dose Rate

(1)

Patient Set-up

(1)

Accelerator

(3)

Interaction of Protons with Matter

(34)

Energy Loss

(5)

Energy Loss by Excitation and Ionization

(2)

Energy Loss by Nuclear Interactions

(1)

Elastic Nuclear Interactions

(1)

Inelastic Nuclear Interactions

(1)

Energy Losses for E ≤ 0.5 MeV

(1)

Summary

(1)

Proton Scattering

(6)

Elastic Coulomb Scattering

(1)

Introduction

(1)

Moliere Theory

(2)

Approximations for Moliere's Distribution

(1)

Comparison with Experiments

(1)

Inelastic Scattering

(1)

Energy-Range Relation

(5)

Pathlength, Mean Range and Water Equivalent Ratio

(3)

Range Straggling

(1)

Range Uncertainty

(1)

Bragg Distribution

(3)

Shape of the Bragg Distribution

(2)

Deviations from the Bragg Distribution

(1)

Particle Beam Diameter and the Bragg Peak

(1)

Influence of Inhomogeneous Media

(1)

Protons Penetrating Tissue

(5)

Taking Account of Tissue Densities

(2)

Tissue Density and CT Number

(1)

Definitions

(1)

Accuracy of the CT Numbers

(1)

Influence of Edges and Inhomogeneities

(1)

Edge Effects

(1)

Small Inhomogeneities

(1)

Narrow but Long (Thick) Inhomogeneities

(1)

Proton Dosimetry and Proton Dose Measurement

(7)

Dosimetry Units

(1)

Absorbed Radiation Dose

(1)

Ion Dose

(1)

Conversion of Ion Dose into Absorbed Radiation Dose

(1)

Dose Display

(1)

Isodose Lines

(1)

3D and Beam's-Eye View

(1)

Dose-Volume Histogram (DVH)

(1)

Instrumentation

(1)

Ionization Chamber

(1)

Faraday Cup

(1)

Silicon Diode

(1)

Calorimeter

(1)

Summary and Comparison with Photon Radiotherapy

(3)

Modifying the Proton Beam

(12)

Survey

(1)

Static Beam Shaping

(8)

Transverse Beam Shaping

(1)

Single Scatterer

(1)

Double Scatterer

(1)

Apertures

(1)

Longitudinal Beam Shaping

(1)

Shifting the Bragg Peak

(1)

Spread Out Bragg Peak (SOBP)

(2)

Generating a Spread Out Bragg Peak

(1)

Problems connected with the SOBP

(1)

Distal Isodose Shaping Device (DISD)

(1)

Beam Shaping and the Penumbra

(1)

Dynamic Radiation Field Shaping

(4)

Principle of Operation

(1)

Beam Scanner

(1)

Wobbler

(1)

Linear Scanner

(1)

Advantages and Disadvantages

(1)

Summary

(1)

Conformal Proton Radiotherapy Planning

(28)

Introduction

(4)

The Role of Inhomogeneities

(1)

Target Movements

(1)

The Influence of Multiple Scattering

(2)

Planning Methods

(14)

Data Input

(1)

Ultrasound

(1)

X-rays

(1)

Computer Tomography (CT)

(1)

Magnetic Resonance Imaging (MRI)

(1)

Fusion of Anatomical and Functional Data

(1)

Algorithms

(1)

Monte Carlo Method

(1)

Ray Tracing

(1)

Pencil Beam

(2)

Broad Beam

(1)

Planning for Eye Treatment

(1)

Input

(1)

Algorithms

(2)

Comparison of Treatment Planning Algorithms

(1)

Intercomparison of Different Algorithms

(1)

Comparison with Simplified Measurements

(2)

Summary

(2)

Overall Accuracy of Treatment Planning and Execution

(10)

General Considerations

(1)

Factors Influencing Accuracy and Precision

(1)

Accuracy

(2)

Precision

(1)

Other Factors

(1)

Overall Accuracy

(1)

General

(1)

Overall Accuracy of Eye Treatment

(1)

References for Part I

(6)

Part II Proton Therapy and Radiotherapy

General Aspects of Proton Therapy

(16)

General Clinical Overview

(16)

A Brief Medical History

(1)

Early Proton Therapy

(1)

Modern Proton Therapy

(1)

History of Non-proton Radiosurgery

(1)

Indications for Proton Therapy

(1)

Imaging and Planning Requirements

(2)

Beam Delivery Requirements

(1)

Patient Positioning and Immobilisation

(1)

Positioning for Extracranial Lesions

(1)

The Composition of Tissues and Proton Therapy Planning

(1)

Optimised Proton Beams versus Photon Based Radiosurgery Beams

100

(4)

Summary

104

(2)

References

106

(3)

The Rationale for Proton Therapy

109

(10)

Introduction

109

(1)

Bragg Peak Therapy

109

(5)

The Conformity Index

111

(1)

The Inhomogeneity Coefficient and Its Effects

111

(1)

The Localisation Factor

112

(2)

Plateau Therapy

114

(1)

Definition of Radiosurgery and Stereotactic Radiotherapy

115

(1)

Large Field Proton Therapy

116

(1)

Summary

117

(1)

References

118

(1)

Radiobiology

119

(26)

Radiobiology for Fractionated Proton Therapy

119

(11)

Introduction

119

(1)

Linear Energy Transfer

119

(1)

The Therapeutic Ratio

120

(1)

The Relative Biological Effectiveness

121

(1)

Dose Response Curves

122

(3)

The Importance of Fractionation

125

(1)

The Oxygen Enhancement Ratio - The OER

126

(1)

The Gamma Factor, Malignant Lesions and Fractionated Proton Therapy

126

(1)

Inhomogeneity of Dose and Its Effects

127

(1)

Radiosensitisers/Radioprotectors

128

(1)

Summary

128

(1)

References

129

(1)

The Radiobiology of Single Large Fractions

130

(6)

Introduction

130

(1)

The Effect of the RBE Variation in the Penumbra of Proton Beams

130

(2)

The Cobalt Gray Equivalent Dose

132

(1)

The Oxygen Enhancement Ratio and radiological effects of Large Single Doses

132

(1)

Inhomogeneity of Dose and Its Effects; the Volume Effect

133

(1)

Fractionated Dose Equivalents to Single Large Doses

133

(1)

Categories of Lesions in the Brain

133

(1)

AVMs and Similar Lesions

133

(1)

Meningiomas and Similar Lesions

134

(1)

Low Grade Astrocytoma and Similar Lesions

134

(1)

Metastatic Lesions

134

(1)

Summary

135

(1)

References

135

(1)

The Biologically Effective Dose and Fractionation

136

(9)

Introduction

136

(1)

Notational Convention for the BED

136

(1)

The Linear Quadratic Model of Cell and Tissue Response to Radiation and the BED

136

(1)

Some Commonly Used Values for the α/β Ratio

137

(1)

Inhomogeneity of Dose and the Relative Damage

138

(1)

Brain Tolerance

138

(1)

Optic Nerve and Retinal Tolerance

139

(2)

A Comparison of the Various Dose Levels Used to Treat Uveal Melanoma

141

(1)

Age Related Macular Degeneration

141

(1)

The RBE of Protons

142

(1)

The Dose-Volume Histogram

142

(1)

Summary

143

(1)

References

143

(2)

Dose-Volume Relationships in Proton Therapy and Radiosurgery for Arteriovenous Malformations, Skull Base Meningiomas and Recurrent Malignant Gliomas

145

(18)

Introduction

145

(1)

Arteriovenous Malformations

146

(5)

Kjelberg's Model for Protons

146

(1)

Dose-volume Observations of Voges et al. (1996)

147

(1)

Flickinger's Models for the Gamma Knife

147

(3)

Dose-volume Analysis of Lax and Karlsson (1996)

150

(1)

Karlsson and Lax et al. (1997)

150

(1)

General Discriminants Influencing Dose-volume Relationships

151

(3)

Illustration of the Effect of the Penumbra and the Prescription Isodose on a Volume of Brain Tissue Constrained to [10 Gy 10 cm3]

154

(1)

Methodology for Calculating the Effects of the Prescription Isodose and Penumbra on the Planning Target Volume Treatable to Safe Doses Within the Constraints of [10 Gy 10 cm3]

154

(3)

The Critical Isodose (CI)

154

(2)

Direct (Computer) Determination of the PTV

156

(1)

Dose-volume Graphs Based on Voges (1996)

157

(1)

Practical Implementation of the Various Dose-volume Relationships Available Presently for AVM Radiosurgery

158

(2)

Recurrent Previously Irradiated Brain Tumours

160

(1)

The Effects of Imperfect Conformation

160

(1)

Retreatment

161

(1)

Summary

161

(1)

References

161

(2)

Low Energy Proton Beam Therapy for Eye Lesions

163

(16)

Introduction

163

(1)

Benign Lesions

163

(3)

Peri-orbital Lesions

163

(1)

Age Related Macular Degeneration

164

(2)

Malignant Lesions: Uveal Melanoma

166

(7)

Introduction

166

(1)

Proton Therapy

166

(1)

General

166

(1)

Results of Proton Therapy

167

(1)

Techniques of Proton Irradiation

167

(4)

Treatment of Uveal Melanoma by Gamma Knife

171

(1)

Plaque Techniques

172

(1)

Metastatic Lesions in the Eye

173

(1)

Complications

174

(1)

Neovascular Glaucoma

174

(1)

Retinopathy, Optic Neuropathy, Rubeosis Iridis

174

(1)

Comparison of the Various Dose Levels Used to Treat Uveal Melanoma Using the BED

175

(1)

Tolerance of the Optic Nerve and Retina

175

(1)

Summary

175

(1)

References

176

(3)

High Energy Proton Therapy for Tumours in Body Sites other than the Brain

179

(16)

Introduction

179

(1)

Co-operative Proton Therapy Groups

179

(1)

The Proton Therapy Co-operative Oncology Group

179

(1)

The Proton Radiation Oncology Group

179

(1)

Protons for Superficial Tumours

180

(4)

Skin and Chest Wall

180

(1)

Ethmoid Sinus Tumours

180

(1)

Chordomas, Chondromas and Chondrosarcomas

181

(1)

Photon Therapy for Chondromas and Chordomas

181

(1)

Proton Therapy

182

(1)

Surgery plus Radiotherapy

183

(1)

Esthesioneuroblastoma and Chemo-Proton Radiation

184

(1)

Protons for Deep-Seated Body Tumours

184

(3)

Large Field Therapy with Horizontal Beams

184

(1)

Prostate Carcinoma

184

(1)

Large Field Therapy with Isocentric Beams

185

(1)

Prostate Carcinoma

185

(1)

Potential Improvement in the Results of Proton Irradiation for Prostate Cancer

186

(1)

Brachytherapy for Prostate Carcinoma

187

(1)

Oesophageal Carcinoma

187

(1)

Brain Metastases

187

(1)

Potential Gains with Protons in Various Anatomical Sites

187

(4)

Glioblastoma

188

(1)

Brain Tumours in Children

188

(1)

Maxillary Sinus

189

(1)

Cervical Carcinoma

189

(1)

Para-aortic Lymph Nodes

190

(1)

Retroperitoneal Cancer in a Child with Wilm's Tumour

191

(1)

Rectal Cancer

191

(1)

Summary

191

(1)

References

192

(3)

Radiosurgical Applications of Protons and Photons

195

(50)

Vascular Malformations

195

(20)

Introduction

195

(1)

Arteriovenous Malformations

195

(1)

Clinical Features of AVMs

196

(1)

Pathology and Prognostic Factors

196

(1)

Evaluation Methods for AVMs

197

(2)

Treatment Options for Ateriovenous Malformations

199

(1)

Multidisciplinary Teams

200

(1)

Proton Radiosurgery for AVMs and Other Methods

200

(1)

Quality Control

201

(1)

Grading the AVM

202

(1)

Assessing Treatment Outcome - The Scale of Drake

202

(1)

Assessing the Radiological Outcome of Radiosurgery

203

(1)

Treatment Related Risks

203

(1)

Post-Treatment Observation, Follow-up and Medication

203

(1)

Radiosurgical Prescription and Dose - CGyE for Proton

204

(1)

Recommended Doses for AVMs

204

(2)

Proton and Helium Ion Bragg Peak Therapy for AVMs

206

(1)

The Obliteration Rate of AVMs with Particles

207

(2)

The Obliteration Rate of AVMs by Gamma Knife and Linear Accelerator

209

(1)

Reducing the Risk of Radionecrosis

210

(1)

Side Effects of Treatment

210

(1)

Causes for Recurrence of AVMs

211

(1)

A Critique on Radiosurgical Techniques

211

(1)

Summary

212

(2)

References

214

(1)

Acoustic and Non-acoustic Neuromas

215

(5)

Introduction

215

(1)

Incidence and Symptoms

215

(1)

Radiation and Growth Arrest of Neuromas

215

(1)

Indications for Radiosurgery

216

(1)

Strategies for Hearing Preservation

216

(1)

Complications Other than Hearing Loss with Microsurgery

217

(1)

Clinical Results for Acoustic Neuromas

218

(1)

Proton Therapy

218

(1)

Gamma Knife and Linear Accelerator

218

(1)

Risk Factors for Complications

219

(1)

Recommended Doses for Acoustic Neuromas

219

(1)

Radiological Changes After Radiosurgery

220

(1)

Summary

220

(1)

Meningiomas

220

(6)

Incidence and Pathology

220

(1)

Treatment Options

221

(1)

Results of Treatment

222

(1)

Recommended Doses

222

(2)

Complications of Radiosurgery for Meningioma

224

(1)

Summary

224

(1)

References

225

(1)

Pituitary Tumours

226

(9)

Introduction

226

(1)

Anatomy

227

(1)

Classification

227

(1)

The Aims of Therapy

228

(1)

Signs and Symptoms

228

(1)

Diagnosis

228

(1)

Treatment

229

(1)

Conventional Radiation Therapy

229

(1)

Radiosurgery for Pituitary Tumours

230

(1)

Dose Response and Dose-Volume Relationships

231

(1)

Clinical Results

231

(2)

Complications

233

(1)

Summary

233

(1)

References

234

(1)

Proton and Stereotactic Radiotherapy for Primary and Secondary Brain Tumours

235

(4)

Introduction

235

(1)

The Importance of Fractionation

235

(1)

Clinical Results Obtained with Primary Malignant Brain Tumours with Radiosurgery

236

(1)

Selection Factors for Glioma Patients and the Hazard Ratio Model for Radiosurgey

237

(1)

Dose Response for Brain Tumours

238

(1)

Brain Tolerance

239

(1)

Secondary Malignant Brain Tumours

239

(3)

Conventional Radiotherapy (Whole Brain)

239

(1)

Radiosurgery

240

(1)

Radiosurgery for Metastases versus Surgery

241

(1)

Complications of Radiosurgery for Brain Tumours

241

(1)

Summary

242

(1)

References

242

(3)

The Complications of Single Large Intracranial Doses of Radiation and their Management

245

(12)

Introduction

245

(1)

Classification of Radiation Effects

245

(8)

Acute Effects

245

(2)

Late Effects

247

(1)

Cerebral Oedema

247

(2)

Cerebral Radionecrosis

249

(1)

Vascular Occlusion and Aneurysms

250

(1)

Other Reported Complications

251

(1)

Cranial Nerve Complications

251

(2)

Radiation Induced Complications from Pituitary Lesions, Skull Base Tumours, Uveal Melanoma, Nasopharyngeal Carcinomas and Sarcomas of the Skull Base

253

(1)

Cavernous Sinus Meningiomas

253

(1)

Parasagittal Meningiomas

253

(1)

Summary

253

(1)

References

254

(3)

Alternatives to Proton Therapy for Radiosurgery

257

(10)

Introduction

257

(5)

The Linear Accelerator

257

(1)

Ease of Conversion

257

(1)

Versatility and Flexibility

258

(1)

Relocatable Frames

258

(1)

Thermoplastic Masks

258

(1)

Good Beam Delivery and Planning

259

(1)

Extracranial Radiosurgery

259

(1)

Miniature Multileaf Collimators

259

(1)

The Leksell Gamma Knife

260

(1)

Limited Choice of Collimators

260

(1)

Fractionated Treatment

260

(1)

The Photon Radiosurgery System

261

(1)

A Comparison of the Fall-off in Dose

262

(1)

Comparative Clinical Results

262

(1)

Large Field Therapy and Alternatives to Protons

262

(1)

Eye Lesions and Protons

263

(1)

Reliability of Equipment

263

(1)

Summary

263

(1)

References

264

(3)

Costs of Proton Therapy and Radiosurgery

267

(6)

Introduction

267

(1)

Patient Fees for Stereotactic Treatment

268

(1)

Linear Accelerator

268

(1)

Gamma Knife

268

(1)

Proton Therapy

268

(1)

Installation Costs

269

(1)

Maintenance Costs

269

(1)

Life Span of Treatment Units

269

(1)

Cost Comparison: Surgery versus Radiosurgery

269

(1)

Summary

270

(1)

References

271

(2)

Appendix

273

(12)

The Spetzler Martin Grading System (with Some Remarks)

273

(1)

A Proposed Grading System for AVMs for Radiosurgery

274

(2)

Planning Target Volumes

276

(3)

Lateral Dose Fall-off of Various Stationary Radiation Beams

279

(1)

Expanded Tables Based on the Tables of Brenner, Martell and Hall (1991) for Fractionated Therapy for Recurrent Malignant Brain Tumours

279

(1)

Fractionated Treatment for AVMs

280

(1)

The Stereophotogrammetric System of Patient Positioning and Immobilisation

281

(4)

Subject Index

285

PROTON THERAPY AND RADIOSURGERY

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