概率评估指导具有现实设置和范围不确定性的IMPT计划改善了神经肿瘤患者OAR保留和目标覆盖之间的权衡。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-27 DOI:10.1016/j.radonc.2025.111171

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

摘要

目的：基于场景的质子治疗评估通常依赖于少量的错误场景，导致对不确定性和次优权衡下DVH值的了解有限。在这项研究中，我们调查了基于概率评估的再优化是否改善了神经肿瘤患者的声腔保留和靶覆盖之间的权衡。材料与方法：纳入22例神经肿瘤患者。18个国家实现了其最初的目标（A组），而4个国家的目标覆盖率受到损害，以避免桨叶（B组）。CTV的概率目标被校准为与基于ptv的光子计划一致，得到D99.8%,CTV = 0.95Dpres，置信水平为90 %。设置概率OAR约束以满足临床约束，置信水平为95% %。对两组临床计划进行重新优化，保持临床目标和约束条件，但降低了CTV目标（A组）满足概率目标或剂量限制性OAR目标（B组）不超过约束条件的稳健性。对于原方案和重新优化后的方案，采用多项式混沌展开方法模拟10000个分步处理，得到相关DVH参数的概率分布。结果：对于A组，重新优化导致总体OAR DVH值中位数下降8.2（范围：0.4-20.8）Gy RBE。对于B组，重新优化导致D99.8% CTV的人群中位数增加2.7（范围：1.3-6.8）Gy RBE。人群中位数V95%，CTV从97.4% %提高到99.1% %。结论：我们证明了概率评估指导的IMPT规划可以使OAR保留或目标覆盖增强。

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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

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 D_99.8%,CTV = 0.95D_pres 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 D_99.8%,CTV. The population median V_95%,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.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

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.