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Site-specific range margins in proton therapy can reduce uncertainties for liver, prostate, and whole brain treatments. Complex geometries may require patient-specific adjustments and Monte Carlo simulations for accurate proton range predictions.

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Computational Biology

Background:

  • Proton therapy utilizes generic range margins, potentially leading to suboptimal dose delivery.
  • Complex patient geometries can impact the accuracy of analytical dose calculations in proton therapy.
  • Monte Carlo (MC) simulations offer high accuracy but are computationally intensive.

Purpose of the Study:

  • To evaluate the feasibility of site-specific range margins in proton therapy.
  • To assess the potential for margin reduction using current analytical dose calculation methods.
  • To investigate the impact of complex geometries on proton range prediction accuracy.

Main Methods:

  • Compared analytical pencil-beam algorithm dose distributions with Monte Carlo (MC) simulations (TOPAS).
  • Analyzed 508 passively scattered treatment fields across seven disease sites.
  • Performed voxel-by-voxel comparisons of distal dose surfaces to assess range differences (R90, R50) and dose falloff (R80-R20).

Main Results:

  • Reduced margins are feasible for liver, prostate, and whole brain treatments (2.8% + 1.2 mm and 3.1% + 1.2 mm, respectively) without MC.
  • Current generic margins are insufficient for some breast, lung, and head and neck patients.
  • A generic margin of 6.3% + 1.2 mm may be needed for breast, lung, and head and neck treatments without adjustments.

Conclusions:

  • Proton therapy range uncertainty margins should be site-specific, not generic.
  • Complex geometries necessitate field-specific margin adjustments.
  • Routine MC simulations are recommended for verifying treatment plans in patients with heterogeneous geometries.