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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Introduce a rotational robust optimization framework for spot-scanning proton arc (SPArc) therapy.

Sheng Chang1,2, Gang Liu2,3, Lewei Zhao2

  • 1Department of Radiation Oncology, Wuhan University, Renmin Hospital, Wuhan, 430060 Hubei Province, People's Republic of China.

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Summary

A new rotational robust optimization algorithm (SPArc_rot) significantly reduces proton therapy dose uncertainties caused by patient rotational setup errors. This improves target coverage and organ-at-risk sparing in image-guided radiotherapy.

Keywords:
SPArcoriginalSPArcrotdose perturbationrobust optimizationrotational error

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Planning

Background:

  • Patient setup errors, particularly in rotational directions, introduce dosimetric uncertainties in proton therapy.
  • Advanced image-guided radiotherapy techniques still face challenges in mitigating these rotational uncertainties.

Purpose of the Study:

  • To develop and evaluate a novel rotational robust optimization algorithm, SPArc_rot, for mitigating dosimetric impacts of rotational setup errors.
  • To assess the effectiveness of SPArc_rot in reducing target and organ-at-risk (OAR) dose uncertainties compared to the original SPArc algorithm.

Main Methods:

  • A new rotational robust optimization SPArc algorithm (SPArc_rot) was developed using a multi-CT robust optimization framework.
  • Simulated rotational setup errors (±5° roll) and recalculated plans with varying rotational errors (±1° to ±5°).
  • Evaluated dosimetric metrics including D98% of CTV and 3D gamma analysis (3%/3 mm) across five disease sites.

Main Results:

  • SPArc_rot significantly reduced dosimetric changes in targets and uncertainties in maximum OAR doses (e.g., brainstem, spinal cord) compared to SPArc.
  • Uncertainties in mean OAR doses (e.g., liver, parotid) were comparable between the two techniques.
  • Gamma passing rates for the clinical target volume (CTV) were significantly improved with SPArc_rot.

Conclusions:

  • Rotational setup errors are a significant source of dose perturbation in proton therapy.
  • The SPArc_rot planning approach effectively mitigates dose uncertainties for targets and OARs by accounting for rotational errors.
  • SPArc_rot offers improved precision and safety in image-guided proton radiotherapy.