Partial adaptation for online-adaptive proton therapy triggered by during-delivery treatment verification: Feasibility study on prostate cancer treatments

Abstract

Background and Purpose

Online treatment verification during proton therapy delivery may detect deviations due to anatomical changes occurring along the treatment course and trigger immediate intervention, if necessary. We investigated the potential of partial plan adaptation in two-field prostate cancer treatments as a solution for online-adaptive proton therapy (OAPT) after the detection of relevant treatment deviations during the first field delivery.

Materials and Methods

In a retrospective study, ten fractions from eight prostate cancer patients with prompt gamma imaging (PGI) detected treatment deviations, which were confirmed on respective in-room control computed tomography (cCT) scans, were considered. For each cCT, a dose-mimicking-based robust partial adaptation reoptimized the second field by considering the suboptimal dose delivery of the first non-adapted, PGI-monitored field. The results were compared to the non-adapted scenario and upfront full adaptation (both fields) in terms of achievable target coverage (prescription: 48 Gy/60 Gy to low-risk/high-risk target) and organ-at-risk (OAR) sparing.

Results

Partially adapted plans showed comparable target coverage (median D_98%: 99.9%/98.0% for low-/high-risk target) to fully adapted plans (100.3%/98.7%) and were superior to non-adapted plans (98.7%/94.5%). Achievable OAR sparing was patient-specific depending on the proximity to the target region, but within clinical goals for the partially and fully adapted plans.

Conclusions

Partial adaptation triggered mid-delivery of a fraction can still generate plans of comparable conformity to full adaptation, even in the case of plans with only two, opposing fields. A verification-triggered OAPT may therefore become an alternative to upfront OAPT, saving time and imaging dose in fractions without relevant anatomy changes.