Abstract
Simple SummaryIf reference studies can be found on the uncertainties linked to the clinical context of proton therapy, they, although equally critical, are very patchy in a preclinical context, and are specific to each beam line. This work provides the community with a complete assessment of the sources of uncertainties for a preclinical proton beam line. This aims to ensure that, in this line, the biological results observed and the dose–response relationships are obtained without any bias. Despite being specific to a preclinical line, the results presented here can be transposed to other types of proton preclinical facilities, and thus allow us to effectively compare them to one another. Proton therapy (PRT) is an irradiation technique that aims at limiting normal tissue damage while maintaining the tumor response. To study its specificities, the ARRONAX cyclotron is currently developing a preclinical structure compatible with biological experiments. A prerequisite is to identify and control uncertainties on the ARRONAX beamline, which can lead to significant biases in the observed biological results and dose–response relationships, as for any facility. This paper summarizes and quantifies the impact of uncertainty on proton range, absorbed dose, and dose homogeneity in a preclinical context of cell or small animal irradiation on the Bragg curve, using Monte Carlo simulations. All possible sources of uncertainty were investigated and discussed independently. Those with a significant impact were identified, and protocols were established to reduce their consequences. Overall, the uncertainties evaluated were similar to those from clinical practice and are considered compatible with the performance of radiobiological experiments, as well as the study of dose–response relationships on this proton beam. Another conclusion of this study is that Monte Carlo simulations can be used to help build preclinical lines in other setups.
Highlights
Radiation therapy consists in delivering ionizing radiation to the tumor while preserving surrounding normal tissues
Examples of dose calculations computed on mouse cone beam computed tomography (CBCT) images for the ARRONAX proton beam are provided for lung, brain, and intestinal irradiation in the Bragg curve (Figure 1)
We estimated the impact of various sources of uncertainty specific to our proton beam line, as recommended by the American Association of Physics in Medicine (AAPM) report 202 [4]
Summary
Radiation therapy consists in delivering ionizing radiation to the tumor while preserving surrounding normal tissues. The dose–response curves for tumor control and normal tissue complications help define a therapeutic window, to deliver a sufficient dose of radiation to the tumor with acceptable side effects [1]. In this attempt to limit toxicity, proton therapy is an option for some tumor locations, as this irradiation technique spares most of normal tissues. Protons and light ions stop depositing energy at a given depth, with relatively low straggling, leading to a significant reduction in radiation dose to surrounding normal tissues. The proton beam delivery system allows high-precision radiation deposition in the three dimensions of the tumor [2]
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