IOeRT conventional and FLASH treatment planning system implementation exploiting fast GPU Monte Carlo: The case of breast cancer

G Franciosini; D Carlotti; F Cattani; A De Gregorio; V De Liso; F De Rosa; M Di Francesco; F Di Martino; G Felici; J Harold Pensavalle; M C Leonardi; M Marafini; A Muscato; F Paiar; V Patera; P Poortmans; A Sciubba; A Schiavi; M Toppi; G Traini; A Trigilio; A Sarti

doi:10.1016/j.ejmp.2024.103346

IOeRT conventional and FLASH treatment planning system implementation exploiting fast GPU Monte Carlo: The case of breast cancer

Phys Med. 2024 May:121:103346. doi: 10.1016/j.ejmp.2024.103346. Epub 2024 Apr 11.

Authors

G Franciosini¹, D Carlotti², F Cattani³, A De Gregorio⁴, V De Liso⁵, F De Rosa⁶, M Di Francesco⁵, F Di Martino⁷, G Felici⁵, J Harold Pensavalle⁸, M C Leonardi⁹, M Marafini¹⁰, A Muscato¹¹, F Paiar¹², V Patera¹, P Poortmans¹³, A Sciubba¹⁴, A Schiavi¹, M Toppi¹, G Traini¹⁵, A Trigilio¹⁶, A Sarti¹⁷

Affiliations

¹ Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy.
² Operative Research Unit of Radiation Oncology, Fondazione Policlinico Universitatio Campus-Bio Medico, Rome, Italy.
³ Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy.
⁴ National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy; Sapienza, University of Rome, Department of Physics, Rome, Italy.
⁵ S.I.T. Sordina IORT Technologies S.p.A, Aprilia, Italy.
⁶ Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy.
⁷ Centro Pisano Multidisciplinare sulla Ricerca e Implementazione Clinica della Flash Radiotherapy (CPFR), Pisa, Italy; University of Pisa, Department of Physics, Pisa, Italy; Azienda Ospedaliero Universitaria Pisa (AOUP), Fisica Sanitaria, Pisa, Italy; National Institute of Nuclear Physics, INFN, Section of Pisa, Pisa, Italy.
⁸ S.I.T. Sordina IORT Technologies S.p.A, Aprilia, Italy; Centro Pisano Multidisciplinare sulla Ricerca e Implementazione Clinica della Flash Radiotherapy (CPFR), Pisa, Italy; National Institute of Nuclear Physics, INFN, Section of Pisa, Pisa, Italy.
⁹ Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy.
¹⁰ National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy; Museo Storico della Fisica e Centro Studi e Ricerche "E. Fermi", Rome, Italy.
¹¹ National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy; Specialty School of Medical Physics, La Sapienza University of Rome, Rome, Italy.
¹² Centro Pisano Multidisciplinare sulla Ricerca e Implementazione Clinica della Flash Radiotherapy (CPFR), Pisa, Italy; Azienda Ospedaliero Universitaria Pisa (AOUP), Fisica Sanitaria, Pisa, Italy.
¹³ Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium.
¹⁴ Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Frascati National Laboratories (LNF), Rome, Italy.
¹⁵ National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy.
¹⁶ Sapienza, University of Rome, Department of Physics, Rome, Italy; National Institute of Nuclear Physics, INFN, Frascati National Laboratories (LNF), Rome, Italy.
¹⁷ Sapienza, University of Rome, Department of Scienze di Base e Applicate all'Ingegneria, Rome, Italy; National Institute of Nuclear Physics, INFN, Section of Rome I, Rome, Italy. Electronic address: alessio.sarti@uniroma1.it.

PMID: 38608421
DOI: 10.1016/j.ejmp.2024.103346

Abstract

Partial breast irradiation for the treatment of early-stage breast cancer patients can be performed by means of Intra Operative electron Radiation Therapy (IOeRT). One of the main limitations of this technique is the absence of a treatment planning system (TPS) that could greatly help in ensuring a proper coverage of the target volume during irradiation. An IOeRT TPS has been developed using a fast Monte Carlo (MC) and an ultrasound imaging system to provide the best irradiation strategy (electron beam energy, applicator position and bevel angle) and to facilitate the optimisation of dose prescription and delivery to the target volume while maximising the organs at risk sparing. The study has been performed in silico, exploiting MC simulations of a breast cancer treatment. Ultrasound-based input has been used to compute the absorbed dose maps in different irradiation strategies and a quantitative comparison between the different options was carried out using Dose Volume Histograms. The system was capable of exploring different beam energies and applicator positions in few minutes, identifying the best strategy with an overall computation time that was found to be completely compatible with clinical implementation. The systematic uncertainty related to tissue deformation during treatment delivery with respect to imaging acquisition was taken into account. The potential and feasibility of a GPU based full MC TPS implementation of IOeRT breast cancer treatments has been demonstrated in-silico. This long awaited tool will greatly improve the treatment safety and efficacy, overcoming the limits identified within the clinical trials carried out so far.

Keywords: Breast cancer; FLASH; GPU; IORT; IOeRT; Monte Carlo; Partial breast irradiation; TPS.

MeSH terms

Breast Neoplasms* / diagnostic imaging
Breast Neoplasms* / radiotherapy
Computer Graphics
Electrons / therapeutic use
Female
Humans
Monte Carlo Method*
Organs at Risk / radiation effects
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted* / methods
Time Factors