부산대학교 도서관

Simple Summary: The manuscript discusses the administration of proton therapy to the first 13 pediatric patients in the prospective SJWT21 clinical trial to assess the efficacy of proton therapy in treating children with stage III-V Wilms' tumor. The group of 13 patients received abdominal irradiation after undergoing a nephrectomy or partial nephrectomy. A key aspect of the study highlighted in the manuscript is the rigorous daily monitoring of changes in bowel gas and analyzing how these changes affect the quality of the treatment plan. Additionally, the manuscript investigates the potential inaccuracies in the proton range caused by varying gantry beam angles. It aims to pinpoint the most advantageous gantry angles that would reduce deviations from the intended treatment plan, thereby improving the safety and effectiveness of proton therapy for these young patients. (1) Background: Proton therapy, a precise form of radiation treatment, can be significantly affected by variations in bowel content. The purpose was to identify the most beneficial gantry angles that minimize deviations from the treatment plan quality, thus enhancing the safety and efficacy of proton therapy for Wilms' tumor patients. (2) Methods: Thirteen patients with Wilms' tumor, enrolled in the SJWT21 clinical trial, underwent proton therapy. The variations in bowel gas were systematically monitored using daily Cone Beam Computed Tomography (CBCT) imaging. Air cavities identified in daily CBCT images were analyzed to construct daily verification plans and measure water equivalent path length (WEPL) changes. A worst-case scenario simulation was conducted to identify the safest beam angles. (3) Results: The study revealed a maximum decrease in target dose (ΔD100%) of 8.0%, which corresponded to a WEPL variation (ΔWEPL) of 11.3 mm. The average reduction in target dose, denoted as mean ΔD100%, was found to be 2.8%, with a standard deviation (SD) of 3.2%. The mean ΔWEPL was observed as 3.3 mm, with an SD of 2.7 mm. The worst-case scenario analysis suggested that gantry beam angles oriented toward the patient's right and posterior aspects from 110° to 310° were associated with minimized WEPL discrepancies. (4) Conclusions: This study comprehensively evaluated the influence of bowel gas variability on treatment plan accuracy and proton range uncertainties in pediatric proton therapy for Wilms' tumor. [ABSTRACT FROM AUTHOR]