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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Multiple Computed Tomography Robust Optimization to Account for Random Anatomic Density Variations During Intensity

Mingyao Zhu1, Adeel Kaiser1, Mark V Mishra1

  • 1Department of Radiation Oncology, Maryland Proton Treatment Center, University of Maryland School of Medicine, Baltimore, Maryland.

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This study introduces a pseudomultiple-CT robust optimization (pMCT-RO) method for intensity modulated proton therapy (IMPT) to reduce dose errors from anatomical changes. The pMCT-RO method significantly lowers normal tissue dose compared to non-robust methods.

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Image-Guided Therapy

Background:

  • Anatomical variations during Intensity Modulated Proton Therapy (IMPT) can cause dosimetric degradation.
  • Non-robustly optimized (non-RO) plans are susceptible to dose errors from changes in bowel density.
  • Prostate cancer patients treated with IMPT experienced dose degradation due to unoptimized plans.

Purpose of the Study:

  • To propose and evaluate a novel robust optimization (RO) method for IMPT plans.
  • To mitigate dosimetric degradation caused by random anatomic variations during pelvic treatment.
  • To develop a method that does not require additional patient CT scans.

Main Methods:

  • A pseudomultiple-CT RO (pMCT-RO) method was developed using 3 CT images (native, air, tissue assignments for bowel).
  • RO settings included 5 mm setup and 3.5% range uncertainty across 3 CTs.
  • Compared pMCT-RO with single-CT RO (SCT-RO) and non-RO plans using QACTs and nominal CT data.

Main Results:

  • All methods achieved sufficient target coverage (D95%, V95%) on QACTs.
  • pMCT-RO plans showed significantly lower normal tissue Dmax (109.1%) compared to non-RO (144.4%) and SCT-RO (116.9%).
  • pMCT-RO and SCT-RO plans reduced the volume of normal tissue receiving prescription dose or higher compared to non-RO plans.

Conclusions:

  • A robust optimization method (pMCT-RO) was developed to minimize dose heterogeneity in pelvic IMPT.
  • This method effectively addresses anatomical changes without needing extra patient CT scans.
  • The pMCT-RO planning method has been clinically implemented since 2017.