TY - JOUR
T1 - An online adaptive plan library approach for intensity modulated proton therapy for head and neck cancer
AU - Oud, Michelle
AU - Breedveld, Sebastiaan
AU - Giżyńska, Marta
AU - Kroesen, Michiel
AU - Hutschemaekers, Stefan
AU - Habraken, Steven
AU - Petit, Steven
AU - Perkó, Zoltán
AU - Heijmen, Ben
AU - Hoogeman, Mischa
N1 - Disclosures
This study was partly funded by a research grant of Varian, a Siemens Healthineers Company. The Erasmus MC Cancer Institute
also has research collaborations with Elekta AB, Stockholm, Sweden, and Accuray Inc, Sunnyvale, USA.
Publisher Copyright: © 2022 The Authors
PY - 2022/11
Y1 - 2022/11
N2 - Background and purpose: In intensity modulated proton therapy (IMPT), the impact of setup errors and anatomical changes is commonly mitigated by robust optimization with population-based setup robustness (SR) settings and offline replanning. In this study we propose and evaluate an alternative approach based on daily plan selection from patient-specific pre-treatment established plan libraries (PLs). Clinical implementation of the PL strategy would be rather straightforward compared to daily online re-planning. Materials and methods: For 15 head-and-neck cancer patients, the planning CT was used to generate a PL with 5 plans, robustly optimized for increasing SR: 0, 1, 2, 3, 5 mm, and 3% range robustness. Repeat CTs (rCTs) and realistic setup and range uncertainty distributions were used for simulation of treatment courses for the PL approach, treatments with fixed SR (fSR3) and a trigger-based offline adaptive schedule for 3 mm SR (fSR3OfA). Daily plan selection in the PL approach was based only on recomputed dose to the CTV on the rCT. Results: Compared to using fSR3 and fSR3OfA, the risk of xerostomia grade ≥ II & III and dysphagia ≥ grade III were significantly reduced with the PL. For 6/15 patients the risk of xerostomia and/or dysphagia ≥ grade II could be reduced by > 2% by using PL. For the other patients, adherence to target coverage constraints was often improved. fSR3OfA resulted in significantly improved coverage compared to PL for selected patients. Conclusion: The proposed PL approach resulted in overall reduced NTCPs compared to fSR3 and fSR3OfA at limited cost in target coverage.
AB - Background and purpose: In intensity modulated proton therapy (IMPT), the impact of setup errors and anatomical changes is commonly mitigated by robust optimization with population-based setup robustness (SR) settings and offline replanning. In this study we propose and evaluate an alternative approach based on daily plan selection from patient-specific pre-treatment established plan libraries (PLs). Clinical implementation of the PL strategy would be rather straightforward compared to daily online re-planning. Materials and methods: For 15 head-and-neck cancer patients, the planning CT was used to generate a PL with 5 plans, robustly optimized for increasing SR: 0, 1, 2, 3, 5 mm, and 3% range robustness. Repeat CTs (rCTs) and realistic setup and range uncertainty distributions were used for simulation of treatment courses for the PL approach, treatments with fixed SR (fSR3) and a trigger-based offline adaptive schedule for 3 mm SR (fSR3OfA). Daily plan selection in the PL approach was based only on recomputed dose to the CTV on the rCT. Results: Compared to using fSR3 and fSR3OfA, the risk of xerostomia grade ≥ II & III and dysphagia ≥ grade III were significantly reduced with the PL. For 6/15 patients the risk of xerostomia and/or dysphagia ≥ grade II could be reduced by > 2% by using PL. For the other patients, adherence to target coverage constraints was often improved. fSR3OfA resulted in significantly improved coverage compared to PL for selected patients. Conclusion: The proposed PL approach resulted in overall reduced NTCPs compared to fSR3 and fSR3OfA at limited cost in target coverage.
UR - http://www.scopus.com/inward/record.url?scp=85139050259&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2022.09.011
DO - 10.1016/j.radonc.2022.09.011
M3 - Article
C2 - 36150418
AN - SCOPUS:85139050259
SN - 0167-8140
VL - 176
SP - 68
EP - 75
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -
