[Robust treatment planning in proton therapy].

Area of Science:

• Medical Physics
• Radiation Oncology

Background:

• Proton therapy utilizes the Bragg peak for precise dose delivery in external radiotherapy.
• Proton range uncertainties, stemming from ballistic errors and inaccurate physical quantity estimations, can compromise treatment efficacy and increase toxicity.
• Conventional X-ray radiotherapy has established methods for managing uncertainties, but these are less applicable to proton therapy due to its sensitivity.

Purpose of the Study:

• To propose a framework for managing uncertainties in proton therapy.
• To build upon existing formalisms used in X-ray radiotherapy.
• To outline necessary developments for consistent application to proton therapy.

Main Methods:

• Review and summarize established uncertainty management formalisms for X-ray radiotherapy.
• Analyze the specific challenges and origins of uncertainties in proton therapy.
• Discuss adaptations and new strategies required for proton therapy.

Main Results:

• X-ray radiotherapy dose distributions are less sensitive to uncertainties than proton therapy.
• Existing safety margin formalisms for X-rays have restrictive validity conditions for protons.
• Development of new tools and adapted strategies is crucial for accurate uncertainty management in proton therapy.

Conclusions:

• Proton therapy's Bragg peak advantage is challenged by range uncertainties.
• A continuity of approach from X-ray to proton therapy formalisms is necessary.
• Adapted strategies and new tools are essential for safe and effective proton therapy.