Managing treatment-related uncertainties in proton beam radiotherapy for gastrointestinal cancers

Erik J. Tryggestad, Wei Liu, Mark D. Pepin, Christopher L. Hallemeier, Terence T. Sio

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


In recent years, there has been rapid adaption of proton beam radiotherapy (RT) for treatment of various malignancies in the gastrointestinal (GI) tract, with increasing number of institutions implementing intensity modulated proton therapy (IMPT). We review the progress and existing literature regarding the technical aspects of RT planning for IMPT, and the existing tools that can help with the management of uncertainties which may impact the daily delivery of proton therapy. We provide an in-depth discussion regarding range uncertainties, dose calculations, image guidance requirements, organ and body cavity filling consideration, implanted devices and hardware, use of fiducials, breathing motion evaluations and both active and passive motion management methods, interplay effect, general IMPT treatment planning considerations including robustness plan evaluation and optimization, and finally plan monitoring and adaptation. These advances have improved confidence in delivery of IMPT for patients with GI malignancies under various scenarios.

Original languageEnglish (US)
Pages (from-to)212-224
Number of pages13
JournalJournal of Gastrointestinal Oncology
Issue number1
StatePublished - Feb 1 2020


  • GI cancer
  • Intensity modulated proton therapy (IMPT)
  • Motion management
  • Proton therapy
  • Uncertainties

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology


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