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    A Monte Carlo study of different LET definitions and calculation parameters for proton beam therapy

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    Authors
    Smith, Edward A K
    Winterhalter, Carla
    Underwood, Tracy S A
    Aitkenhead, Adam H
    Richardson, Jenny C
    Merchant, Michael J
    Kirkby, Norman
    Kirkby, Karen J
    Mackay, Ranald I
    Affiliation
    Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Rd, Manchester, M13 9PL
    Issue Date
    2021
    
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    Abstract
    The strongin vitroevidence that proton Relative Biological Effectiveness (RBE) varies with Linear Energy Transfer (LET) has led to an interest in applying LET within treatment planning. However, there is a lack of consensus on LET definition, Monte Carlo (MC) parameters or clinical methodology. This work aims to investigate how common variations of LET definition may affect potential clinical applications. MC simulations (GATE/GEANT4) were used to calculate absorbed dose and different types of LET for a simple Spread Out Bragg Peak (SOBP) and for four clinical PBT plans covering a range of tumour sites. Variations in the following LET calculation methods were considered: (i) averaging (dose-averaged LET (LETd) & track-averaged LET); (ii) scoring (LETdto water, to medium and to mass density); (iii) particle inclusion (LETdto all protons, to primary protons and to particles); (iv) MC settings (hit type and Maximum Step Size (MSS)). LET distributions were compared using: qualitative comparison, LET Volume Histograms (LVHs), single value criteria (maximum and mean values) and optimised LET-weighted dose models. Substantial differences were found between LET values in averaging, scoring and particle type. These differences depended on the methodology, but for one patient a difference of ∼100% was observed between the maximum LETdfor all particles and maximum LETdfor all protons within the brainstem in the high isodose region (4 keVμm-1and 8 keVμm-1respectively). An RBE model using LETdincluding heavier ions was found to predict substantially different LET-weighted dose compared to those using other LET definitions. In conclusion, the selection of LET definition may affect the results of clinical metrics considered in treatment planning and the results of an RBE model. The authors' advocate for the scoring of dose-averaged LET to water for primary and secondary protons using a random hit type and automated MSS.
    Citation
    Smith EAK, Winterhalter C, Underwood TSA, Aitkenhead AH, Richardson JC, Merchant MJ, et al. A Monte Carlo study of different LET definitions and calculation parameters for proton beam therapy Vol. 8, Biomedical Physics & Engineering Express. IOP Publishing; 2021. p. 015024.
    Journal
    Biomedical Physics and Engineering Express
    URI
    http://hdl.handle.net/10541/624940
    DOI
    10.1088/2057-1976/ac3f50
    PubMed ID
    34874308
    Type
    Article
    ae974a485f413a2113503eed53cd6c53
    10.1088/2057-1976/ac3f50
    Scopus Count
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