Treatment planning for heavy-ion radiotherapy: biological optimization of multiple beam ports

A crucial task in radiotherapy is dose conformation to the prescribed target volume whilst sparing the surrounding healthy tissue around as much as possible. One of the best approaches so far is active dose shaping in three dimensions using scanned beams of charged particles, like carbon ions. Besides their inverse dose profile and minimal lateral scattering, carbon ions have the advantage that their RBEs increase towards the end of their range. An active beam-delivery system for intensity-modulated carbon-ion beams has been operational at GSI since December, 1997. In order to ensure dose conformation, inverse treatment planning with respect to the biologically effective dose distribution must be applied. A typical patient irradiation comprises two singly optimized opposing fields. This paper discusses the superposition of biologically effective dose distributions for radiotherapy with 12C ions, which is non-trivial due to the nonlinear nature of the dose response of biological systems. Sum rules for the nonlinear addition of singly optimized fields are derived. This method is being used clinically, and has been successfully applied to more than 50 patients.