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.