Publication: Biological and Mechanical Synergies to Deal With Proton Therapy Pitfalls: Minibeams, FLASH, Arcs, and
Gantryless Rooms
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Publication Date
2021-01-21
Authors
Mazal, Alejandro
Vera Sánchez, Juan Antonio
España, Samuel
Sánchez-Tembleque Verbo, Victor
Fraile, Luis Mario
Bragado, Paloma
Gutierrez Uzquiza, Álvaro
Gordillo, Nuria
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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/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.