Multi-IMPT: a biologically equivalent approach to proton ARC therapy

Proton spot-scanning arc therapy (ARC) is an emerging modality that can improve the high-dose conformity to targets compared with standard intensity-modulated proton therapy (IMPT). However, the efficient treatment delivery of ARC is challenging due to the required frequent energy changes during the continuous gantry rotation. This work proposes a novel method that delivers a multiple IMPT (multi-IMPT) plan that is equivalent to ARC in terms of biologically effective dose (BED).

The proposed multi-IMPT method utilizes a different subset of limited number of beam angles in each fraction for dose delivery. Due to the different dose delivered to organs at risk (OAR) in each fraction, we optimize biologically effective dose (BED) for OAR and the physical dose delivered for target in each fraction. The BED-based multi-IMPT inverse optimization problem is solved via the iterative convex relaxation method and the alternating direction method of multipliers. The effectiveness of the proposed multi-IMPT method is evaluated in terms of dose objectives in comparison with ARC.

Multi-IMPT provided similar plan quality with ARC. For example, multi-IMPT provided better OAR sparing and slightly better target dose coverage for the prostate case; similar dose distribution for the lung case; slightly worse dose coverage for the brain case; better dose coverage but slightly higher BED in OAR for the head-and-neck case.

We have proposed a multi-IMPT approach to deliver ARC-equivalent plan quality.