Evaluating the technical feasibility of biology-guided dose painting in proton therapy

Abstract

Biology-guided voxel-level inverse prescription mapping for dose painting (DP) using diffusion-weighted magnetic resonance imaging was evaluated for technical feasibility in proton therapy for 10 skull-base chordoma patients. Patient-specific DP prescriptions were generated from tumour cellularity and implemented in a clinical treatment planning system. Compared with uniform plans, DP achieved lower conformity (although >97 %), improved target dose metrics, reduced doses to most organs at risk, and increased tumour control probability without exceeding clinical constraints. DP proton therapy is technically feasible and may enhance treatment effectiveness.