Biological and Mechanical Synergies to Deal With Proton Therapy Pitfalls: Minibeams, FLASH, Arcs, and Gantryless Rooms



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Mazal, Alejandro and Vera Sánchez, Juan Antonio and Sánchez Parcerisa, Daniel and Udías Moinelo, José Manuel and España, Samuel and Sánchez-Tembleque Verbo, Victor and Fraile, Luis Mario and Bragado, Paloma and Gutierrez Uzquiza, Álvaro and Gordillo, Nuria and García, Gastón and Castro Novais, Juan and Pérez Moreno, Juan María and Mayorga Ortiz, Lina and Ilundáin Idoate, Amaia and Cremades Sendino, Marta and Ares, Carme and Miralbell, Raymond and Schreuder, Niek (2021) Biological and Mechanical Synergies to Deal With Proton Therapy Pitfalls: Minibeams, FLASH, Arcs, and Gantryless Rooms. Frontiers in Oncology, 10 . p. 613669. ISSN 2234-943X

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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/s) 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 theyare 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 are 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.

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This work was partially funded by Comunidad de Madrid (Project B2017/BMD-3888 PRONTO-CM “Proton therapy and nuclear techniques for oncology” and project 2017-T1/BMD5468), Spanish Government (RTI2018-098868-B-I00, RTC2015-3772-1, PID2019-104991RB-I00), European Regional Funds, EU Marie Sklodowska-Curie program (grant agreement 793576-CAPPERAM) is acknowledged.

Uncontrolled Keywords:proton therapy, FLASH, minibeams, arc therapy, gantry
Subjects:Medical sciences > Medicine > Oncology
ID Code:63711
Deposited On:22 Jan 2021 13:25
Last Modified:14 Jan 2022 12:25

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