Probabilistic evaluation guided IMPT planning with realistic setup and range uncertainties improves the trade-off between OAR sparing and target coverage in neuro-oncological patients
Jenneke I. de Jong , Steven J.M. Habraken , Jesús Rojo-Santiago , Danny Lathouwers , Zoltán Perkó , Sebastiaan Breedveld , Mischa S. Hoogeman
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引用次数: 0
Abstract
Objective
Scenario-based evaluation in proton therapy often relies on a small number of error scenarios, leading to limited insight into the DVH values under uncertainty and suboptimal trade-offs. In this study, we investigated if re-optimization based on probabilistic evaluation improves the trade-off between OAR sparing and target coverage in neuro-oncological patients.
Materials and methods
22 neuro-oncological patients were included. 18 met their original target goals (group A), while in 4, target coverage was compromised to spare OARs (group B).
The probabilistic goal for the CTV was calibrated to be consistent with PTV-based photon plans, resulting in D99.8%,CTV = 0.95Dpres with a 90 % confidence level. The probabilistic OAR constraints were set to meet the clinical constraints with a 95 % confidence level.
For both groups, the clinical plans were re-optimized, keeping the clinical objectives and constraints, but reducing robustness for the CTV objective (group A) to meet the probabilistic goal, or for the dose-limiting OAR objectives (group B) without exceeding the constraints.
For the original and re-optimized plans, polynomial chaos expansion was applied to simulate 10,000 fractionated treatments, deriving probability distributions for relevant DVH parameters.
Results
For group A, re-optimization resulted in a population median decrease of 8.2 (range: 0.4–20.8) Gy RBE in the total OAR-related clinical goal values.
For group B, re-optimization resulted in a population median increase of 2.7 (range: 1.3–6.8) Gy RBE in the D99.8%,CTV. The population median V95%,CTV improved from 97.4 % to 99.1 %.
Conclusion
We demonstrated that probabilistic evaluation guided IMPT planning enables either OAR sparing or target coverage enhancement.
期刊介绍:
Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.