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    Towards harmonizing clinical linear energy transfer (LET) reporting in proton radiotherapy: a European multi-centric study

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    Authors
    Hahn, C.
    Ödén, J.
    Dasu, A.
    Vestergaard, A.
    Fuglsang Jensen, M.
    Sokol, O.
    Pardi, C.
    Bourhaleb, F.
    Leite, A.
    de Marzi, L.
    Smith, Ed
    Aitkenhead, Adam H
    Rose, Christopher
    Merchant, Michael J
    Kirkby, Karen J
    Grzanka, L.
    Pawelke, J.
    Lühr, A.
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    Affiliation
    OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
    Issue Date
    2021
    
    Metadata
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    Abstract
    Background: Clinical data suggest that the relative biological effectiveness (RBE) in proton therapy (PT) varies with linear energy transfer (LET). However, LET calculations are neither standardized nor available in clinical routine. Here, the status of LET calculations among European PT institutions and their comparability are assessed. Materials and methods: Eight European PT institutions used suitable treatment planning systems with their center-specific beam model to create treatment plans in a water phantom covering different field arrangements and fulfilling commonly agreed dose objectives. They employed their locally established LET simulation environments and procedures to determine the corresponding LET distributions. Dose distributions D1.1 and DRBE assuming constant and variable RBE, respectively, and LET were compared among the institutions. Inter-center variability was assessed based on dose- and LET-volume-histogram parameters. Results: Treatment plans from six institutions fulfilled all clinical goals and were eligible for common analysis. D1.1 distributions in the target volume were comparable among PT institutions. However, corresponding LET values varied substantially between institutions for all field arrangements, primarily due to differences in LET averaging technique and considered secondary particle spectra. Consequently, DRBE using non-harmonized LET calculations increased inter-center dose variations substantially compared to D1.1 and significantly in mean dose to the target volume of perpendicular and opposing field arrangements (p < 0.05). Harmonizing LET reporting (dose-averaging, all protons, LET to water or to unit density tissue) reduced the inter-center variability in LET to the order of 10-15% within and outside the target volume for all beam arrangements. Consequentially, inter-institutional variability in DRBE decreased to that observed for D1.1. Conclusion: Harmonizing the reported LET among PT centers is feasible and allows for consistent multi-centric analysis and reporting of tumor control and toxicity in view of a variable RBE. It may serve as basis for harmonized variable RBE dose prescription in PT.
    Citation
    Hahn C, Ödén J, Dasu A, Vestergaard A, Fuglsang Jensen M, Sokol O, et al. Towards harmonizing clinical linear energy transfer (LET) reporting in proton radiotherapy: a European multi-centric study. Acta Oncol. 2021:1-9.
    Journal
    Acta Oncologica
    URI
    http://hdl.handle.net/10541/624791
    DOI
    10.1080/0284186x.2021.1992007
    PubMed ID
    34686122
    Additional Links
    https://dx.doi.org/10.1080/0284186x.2021.1992007
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1080/0284186x.2021.1992007
    Scopus Count
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