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Target miss using PTV-based IMRT compared to robust optimization via coverage probability concept in prostate cancer.

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Coverage probability (CovP) offers more robust prostate radiotherapy planning than conventional planning target volume (PTV) margins. This approach improves target coverage and organ at risk (OAR) sparing in intensity-modulated radiation therapy (IMRT).

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Oncology

Background:

  • Prostate Intensity-Guided Radiation Therapy (IGRT) planning target volume (PTV) margins significantly impact cure and toxicity rates.
  • Optimizing PTV margins is crucial for dose-escalated prostate radiotherapy to balance target coverage and organ at risk (OAR) sparing.
  • Conventional PTV-based IMRT may not adequately account for prostate motion and deformation, potentially compromising treatment efficacy and safety.

Purpose of the Study:

  • To evaluate the efficacy of the coverage probability (CovP) concept for robust plan optimization in dose-escalated prostate radiotherapy.
  • To compare CovP-based IMRT with conventional PTV-based IMRT regarding OAR sparing and compensation for prostate motion.
  • To assess the feasibility of probabilistic dose-escalated IMRT in a prospective study.

Main Methods:

  • A prospective study involving 27 intermediate-risk prostate cancer patients treated with 78 Gy/39 fractions.
  • CovP-plans were evaluated using three separate CT scans to capture organ motion and deformation.
  • CovP-dose distribution was optimized considering probabilities of systematic organ displacement, compared to conventional PTV-based IMRT plans.

Main Results:

  • CovP-concept demonstrated superior robustness in target volume coverage compared to PTV-based IMRT.
  • PTV-based IMRT frequently resulted in target misses and cold spots, whereas CovP-concept mitigated these issues.
  • While dose escalation was comparable at certain levels, PTV-based IMRT led to increased OAR doses, particularly in high-dose regions.

Conclusions:

  • Probabilistic dose-escalated IMRT using the CovP-concept is feasible and offers significant advantages over conventional PTV-based IMRT.
  • The CovP-concept provides superior target coverage and enhanced OAR sparing by implementing a robust optimization strategy for organ motion and deformation.
  • CovP-based IMRT represents a promising approach towards adaptive IGRT, potentially reducing the need for daily re-planning.