Biomedical subjects

Hsiao-Ming Lu

Publications and source records attributed to Hsiao-Ming Lu.

8 recordsLinked to original sources

PubMed2006

Accelerated partial-breast irradiation using proton beams: initial clinical experience.

PURPOSE: We present our initial clinical experience with proton, three-dimensional, conformal, external beam, partial-breast irradiation (3D-CPBI). METHODS AND MATERIALS: Twenty patients with Stage I breast cancer were treated with proton 3D-CPBI in a Phase I/II clinical trial. Patients were followed at 3 to 4 weeks, 6 to 8 weeks, 6 months, and every 6 months thereafter for recurrent disease, cosmetic outcome, toxicity, and patient satisfaction. RESULTS: With a median follow-up of 12 months (range, 8-22 months), no recurrent disease has been detected. Global breast cosmesis was judged by physicians to be good or excellent in 89% and 100% of cases at 6 months and 12 months, respectively. Patients rated global breast cosmesis as good or excellent in 100% of cases at both 6 and 12 months. Proton 3D-CPBI produced significant acute skin toxicity with moderate to severe skin color changes in 79% of patients at 3 to 4 weeks and moderate to severe moist desquamation in 22% of patients at 6 to 8 weeks. Telangiectasia was noted in 3 patients. Three patients reported rib tenderness in the treated area, and one rib fracture was documented. At last follow-up, 95% of patients reported total satisfaction with proton 3D-CPBI. CONCLUSIONS: Based on our study results, proton 3D-CPBI offers good-to-excellent cosmetic outcomes in 89% to 100% of patients at 6-month and 12-month follow-up and nearly universal patient satisfaction. However, proton 3D-CPBI, as used in this study, does result in significant acute skin toxicity and may potentially be associated with late skin (telangiectasia) and rib toxicity. Because of the dosimetric advantages of proton 3D-CPBI, technique modifications are being explored to improve acute skin tolerance.

Aged↗

PubMed2006

Accelerated partial breast irradiation using proton beams: Initial dosimetric experience.

PURPOSE: The unique dosimetric features of proton radiotherapy make it an attractive modality for normal tissue sparing. We present our initial experience with protons for three-dimensional, conformal, external-beam accelerated partial breast irradiation (3D-CPBI). METHODS AND MATERIALS: From March 2004 to June 2005, 25 patients with tumors < or =2 cm and negative axillary nodes were treated with proton 3D-CPBI. The prescribed dose was 32 Cobalt Gray Equivalents (CGE) in 4 CGE fractions given twice daily. One to three fields were used to provide adequate planning target volume (PTV) coverage and dose homogeneity. RESULTS: Excellent PTV coverage and dose homogeneity were obtained in all patients with one to three proton beams. The median PTV receiving 95% of the prescribed dose was 100%. Dose inhomogeneity exceeded 10% in only 1 patient (4%). The median volume of nontarget breast tissue receiving 50% of the prescribed dose was 23%. Median volumes of ipsilateral lung receiving 20 CGE, 10 CGE, and 5 CGE were 0%, 1%, and 2%, respectively. The contralateral lung and heart received essentially no radiation dose. Cost analysis suggests that proton 3D-CPBI is only modestly more expensive (25%) than traditional whole-breast irradiation (WBI). CONCLUSION: Proton 3D-CPBI is technically feasible, providing both excellent PTV coverage and normal tissue sparing. It markedly reduces the volume of nontarget breast tissue irradiated compared with photon-based 3D-CPBI, addressing a principle disadvantage of external-beam approaches to PBI. As proton therapy becomes more widely available, it may prove an attractive tool for 3D-CPBI.

Aged↗

PubMed2006

Optimization of current modulation function for proton spread-out Bragg peak fields.

Proton treatments with spread-out Bragg peak (SOBP) fields often use a rotating modulation wheel of varying thickness to modulate the pristine Bragg peak in depth and intensity. The technique of modulating also the beam current independently over the wheel rotation provides an additional control over the intensities of the pulled-back Bragg peaks. As a result, a single wheel can be used over a large range of energies and SOBP parameters and field-specific wheels are no longer necessary. An essential task in commissioning a particular treatment depth is the determination of this current modulation function. We have developed a method for the optimization of the current modulation function. The basic idea is to treat the entire beam nozzle, housing the various beam scattering and modulating components, as a whole and to characterize its effect as a transformation from a modulating beam current to a depth-dose distribution. While this transformation is difficult to calculate theoretically due to the complex scattering paths in the nozzle and the phantom, it can, however, be determined by time-resolved dose measurements. Using this transformation, we can calculate SOBP depth-dose distributions for any current modulation function and optimize it by a simple numerical optimization. We have applied the new method to a number of proton beams with satisfactory results.

Computer Simulation↗

PubMed2006

On measuring depth-dose distribution of range-modulated proton therapy fields.

Depth-dose profile measurements are frequently performed for the characterization of spread-out Bragg peak treatment fields in proton therapy. The measured distribution often contains a significant amount of noise with a persistent pattern. As a result, substantial smoothing has to be applied which can alter a measurement. We explored the origin of the observed noise by closely examining the sampling process in the scanning algorithm. We will show that the time characteristics of the signal in the range-modulated proton therapy beams differ significantly from those in the photon beams, and as a result the measurement error is very sensitive to the sampling duration. The observed noise results mainly from inappropriate choices for this value, rather than from the dose distribution itself. Increasing the value arbitrarily may actually increase the noise magnitude. We will demonstrate that with an optimal value for the sampling duration and its accurate control, the noise magnitude can be reduced significantly, without increasing the measurement time.

Algorithms↗

PubMed2005

Prospective evaluation of concurrent paclitaxel and radiation therapy after adjuvant doxorubicin and cyclophosphamide chemotherapy for Stage II or III breast cancer.

PURPOSE: To evaluate the safety and feasibility of concurrent radiation therapy and paclitaxel-based adjuvant chemotherapy, given either weekly or every 3 weeks, after adjuvant doxorubicin and cyclophosphamide (AC). METHODS AND MATERIALS: After definitive breast surgery and AC chemotherapy, 40 patients with operable Stage II or III breast cancer received protocol-based treatment with concurrent paclitaxel and radiation therapy. Paclitaxel was evaluated on 2 schedules, with treatment given either weeklyx12 weeks (60 mg/m2), or every 3 weeksx4 cycles (135-175 mg/m2). Radiation fields and schedules were determined by the patient's surgery and pathology. The tolerability of concurrent therapy was evaluated in cohorts of 8 patients as a phase I study. RESULTS: Weekly paclitaxel treatment at 60 mg/m2 per week with concurrent radiation led to dose-limiting toxicity in 4 of 16 patients (25%), including 3 who developed pneumonitis (either Grade 2 [1 patient] or Grade 3 [2 patients]) requiring steroids. Efforts to eliminate this toxicity in combination with weekly paclitaxel through treatment scheduling and CT-based radiotherapy simulation were not successful. By contrast, dose-limiting toxicity was not encountered among patients receiving concurrent radiation with paclitaxel given every 3 weeks at 135-175 mg/m2. However, Grade 2 radiation pneumonitis not requiring steroid therapy was seen in 2 of 24 patients (8%) treated in such a fashion. Excessive radiation dermatitis was not observed with either paclitaxel schedule. CONCLUSIONS: Concurrent treatment with weekly paclitaxel and radiation therapy is not feasible after adjuvant AC chemotherapy for early-stage breast cancer. Concurrent treatment using a less frequent paclitaxel dosing schedule may be possible, but caution is warranted in light of the apparent possibility of pulmonary injury.

Adult↗

PubMed2005

A 3D digitzation system for conventional radiation therapy.

While the majority of patients receiving external beam radiation therapy treatment are planned by CT simulation, a significant number of them are still planned using conventional simulators for various reasons. The information-collection process in a conventional simulation is often fragmented and done with primitive tools. For example, in many institutions body contours are still acquired using solder wires and tracing paper, a time-consuming and error-prone procedure. We have developed a 3D digitization system to assist the information-acquisition process at conventional simulations. The system consists of an infrared camera assembly, a wireless digitizer probe, and Windows-based software. The system can provide 3D coordinates of any points in space accessible by the probe with submillimeter accuracy. It can be used to capture body contours, to record the coordinates of portal points, and to take various measurements for dose calculations as well as for patient setup. The software can display all the captured data together with the planned treatment fields, providing a comprehensive geometric verification of the treatment configuration. The system can also transfer all the information to dose planning programs in DICOM-RT format, providing an integrated information flow from simulation to dose planning.

Equipment Design↗

PubMed2005

Temporo-spatial IMRT optimization: concepts, implementation and initial results.

With the recent availability of 4D-CT, the accuracy of information on internal organ motion during respiration has improved significantly. We investigate the utility of organ motion information in IMRT treatment planning, using an in-house prototype optimization system. Four approaches are compared: (1) planning with optimized margins, based on motion information; (2) the 'motion kernel' approach, in which a more accurate description of the dose deposit from a pencil beam to a moving target is achieved either through time-weighted averaging of influence matrices, calculated for different instances of anatomy (subsets of 4D-CT data, corresponding to various phases of motion) or through convolution of the pencil beam kernel with the probability density function describing the target motion; (3) optimal gating, or tracking with beam intensity maps optimized independently for each instance of anatomy; and (4) optimal tracking with beam intensity maps optimized simultaneously for all instances of anatomy. The optimization is based on a gradient technique and can handle both physical (dose-volume) and equivalent uniform dose constraints. Optimization requires voxel mapping from phase to phase in order to score the dose in individual voxels as they move. The results show that, compared to the other approaches, margin expansion has a significant disadvantage by substantially increasing the integral dose to patient. While gating or tracking result in the best dose conformation to the target, the former elongates treatment time, and the latter significantly complicates the delivery procedure. The 'motion kernel' approach does not provide a dosimetric advantage, compared to optimal tracking or gating, but might lead to more efficient delivery. A combination of gating with the 'motion kernel' or margin expansion approach will increase the duty cycle and may provide one with the most efficient solution, in terms of complexity of the delivery procedure and dose conformality to the target.

Algorithms↗

PubMed2005

Maximum MLC opening effect in dynamic delivery of IMRT: leaf-positional analysis.

The analysis of dynamic multileaf collimator (MLC) positions for the delivered intensity-modulated radiotherapy (IMRT) plans is crucial in that it may capture dose delivery problems otherwise difficult to observe and quantify in the conventional dosimetric measurements with film or with an ionization chamber. In some IMRT systems, delivery of IMRT fields starts with a maximum MLC opening (roughly the shape of the target in the beam's-eye view) and then proceeds to the subsequent dynamic MLC subfields. No irradiation is required in going from the initial segment (maximum opening) to the next one, and theoretically, no dose should be delivered in that initial moment. However, due to a finite sampling time of the MLC controller, the finite speed of the MLC, and a finite leaf tolerance, there may be some dose delivered between the first and the second segment. The amount of the excess dose is higher for larger dose rates and for a smaller number of the total monitor units per IMRT field. The magnitude of the dose errors could be in the order of a few percent. Effects similar to the maximum MLC opening may occur in other situations as well, for instance, when leaves are forced to move over large distances in a short time. Confounding this are dose errors due to the uncertainty in the MLC transmission. The analysis of the actual leaf positions recorded in the dynamic MLC log file is helpful in differentiating between the two types of errors and in determining the optimal dynamic MLC delivery parameters.

Computer Simulation↗