ArticleAdvances in radiation oncology
Optimization of Field Design in the Treatment of Rectal Cancer with Intensity Modulated Proton Beam Radiation Therapy: How Many Fields Are Needed to Account for Rectal Distension Uncertainty?
Article in Advances in radiation oncology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed, 6 citations in OpenAlex.
- Radiotherapy boost to the primary tumour in locally advanced rectal cancer: Systematic review of practices andClinical and translational radiation oncology · 2025Review
- An In Silico Feasibility Study of Dose-Escalated Hypofractionated Proton Therapy for Rectal Cancer.Cancers · 2025Article
- Comparison of dosimetries of carbon-ion pencil beam scanning, proton pencil beam scanning and volumetric modulated arc therapy for locally recurrent rectal cancer.Journal of radiation research · 2023Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposePreoperative chemoradiation represents the standard of care in patients with locally advanced rectal cancer. Robustness is often compromised in the setting of proton beam therapy owing to the sensitivity of proton particles to tissue heterogeneity, such as with intestinal gas. The ideal beam arrangement to mitigate the anatomic uncertainty caused by intestinal gas is not well defined. METHODS AND MATERIALS: We developed pencil beam scanning plans using (1) 1-beam posteroanterior (PA) plans, (2) 2-beam with right and left posterior oblique (RPO and LPO) plans, (3) 3-beam with PA and opposed lateral plans, and (4) 5-beam with PA, RPO, LPO, and opposed lateral plans. We created 12 plans with robustness optimization and ran a total of 60 plan evaluations for varying degrees of intestinal gas distension to evaluate which plans would maintain clinical goals to the greatest degree.
resultsA single PA beam resulted in considerable loss of target coverage to the clinical target volume prescribed 50 Gy (volume receiving 100% of the prescribed dose [V
conclusionsA single PA beam should be avoided when using proton beam therapy for rectal cancer. RPO/LPO and PA/opposed lateral arrangements may both be considered; RPO/LPO is favored to reduce integral dose and avoid beams traversing the hips. In patients for whom the plan CT has rectal distension of ≥3 cm, resimulation or strategies to reduce intestinal gas should be strongly considered.
Identifiers
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Registered trials
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