Considerations for study design in the DAHANCA 35 trial of protons versus photons for head and neck cancer.

Proton radiotherapy offers a dosimetric advantage compared to photon therapy in sparing normal tissue, but the clinical evidence for toxicity reductions in the treatment of head and neck cancer is limited. The Danish Head and Neck Cancer Group (DAHANCA) has initiated the DAHANCA 35 randomised trial to clarify the value of proton therapy (NCT04607694). The DAHANCA 35 trial is performed in an enriched population of patients selected by an anticipated benefit of proton therapy to reduce the risk of late dysphagia or xerostomia based on normal tissue complication probability (NTCP) modelling. We present our considerations on the trial design and a test of the selection procedure conducted before initiating the randomised study.

Determining the mechanical properties of a radiochromic silicone-based 3D dosimeter.

New treatment modalities in radiotherapy (RT) enable delivery of highly conformal dose distributions in patients. This creates a need for precise dose verification in three dimensions (3D). A radiochromic silicone-based 3D dosimetry system has recently been developed. Such a dosimeter can be used for dose verification in deformed geometries, which requires knowledge of the dosimeter's mechanical properties. In this study we have characterized the dosimeter's elastic behaviour under tensile and compressive stress. In addition, the dose response under strain was determined. It was found that the dosimeter behaved as an incompressible hyperelastic material with a non-linear stress/strain curve and with no observable hysteresis or plastic deformation even at high strains. The volume was found to be constant within a 2% margin at deformations up to 60%. Furthermore, it was observed that the dosimeter returned to its original geometry within a 2% margin when irradiated under stress, and that the change in optical density per centimeter was constant regardless of the strain during irradiation. In conclusion, we have shown that this radiochromic silicone-based dosimeter's mechanical properties make it a viable candidate for dose verification in deformable 3D geometries.

Eliminating the dose-rate effect in a radiochromic silicone-based 3D dosimeter.

Comprehensive dose verification, such as 3D dosimetry, may be required for safe introduction and use of advanced treatment modalities in radiotherapy. A radiochromic silicone-based 3D dosimetry system has recently been suggested, though its clinical use has so far been limited by a considerable dose-rate dependency of the dose response. In this study we have investigated the dose-rate dependency with respect to the chemical composition of the dosimeter. We found that this dependency was reduced with increasing dye concentration, and the dose response was observed to be identical for dosimeters irradiated with 2 and 6 Gy min(-1) at concentrations of 0.26% (w/w) dye and 1% (w/w) dye solvent. Furthermore, for the optimized dosimeter formulation, no dose-rate effect was observed due to the attenuation of the beam fluence with depth. However, the temporal stability of the dose response decreased with dye concentration; the response was reduced by (62 ± 1)% within approximately 20 h upon irradiation, at the optimal chemical composition and storage at room temperature. In conclusion, this study presents a chemical composition for a dose-rate independent silicone dosimeter which has considerably improved the clinical applicability of such dosimeters, but at the cost of a decreased stability.

FlexyDos3D: a deformable anthropomorphic 3D radiation dosimeter: radiation properties.

Three dimensional radiation dosimetry has received growing interest with the implementation of highly conformal radiotherapy treatments. The radiotherapy community faces new challenges with the commissioning of image guided and image gated radiotherapy treatments (IGRT) and deformable image registration software.A new three dimensional anthropomorphically shaped flexible dosimeter, further called 'FlexyDos3D', has been constructed and a new fast optical scanning method has been implemented that enables scanning of irregular shaped dosimeters. The FlexyDos3D phantom can be actuated and deformed during the actual treatment. FlexyDos3D offers the additional advantage that it is easy to fabricate, is non-toxic and can be molded in an arbitrary shape with high geometrical precision.The dosimeter formulation has been optimized in terms of dose sensitivity. The influence of the casting material and oxygen concentration has also been investigated. The radiophysical properties of this new dosimeter are discussed including stability, spatial integrity, temperature dependence of the dosimeter during radiation, readout and storage, dose rate dependence and tissue equivalence.