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Radiobiologically equivalent deformable dose mapping for re-irradiation planning: Implementation, robustness, and
Juan A García-Alvarez1, Eric Paulson1, Kristofer Kainz1
1Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
This study introduces a new radiotherapy re-irradiation planning workflow. The bias-dose guided plans (BDGPs) improve organ at risk sparing and target coverage compared to manual plans.
Area of Science:
- Radiation Oncology
- Medical Physics
- Radiotherapy Planning
Background:
- Re-irradiation in radiotherapy requires specialized tools for optimal re-treatment planning.
- Complexities include managing fractionation size, anatomical changes, and cumulative doses.
Purpose of the Study:
- To present a robust workflow for radiotherapy re-irradiation planning.
- To improve organ at risk (OAR) sparing and target coverage in re-treatment scenarios.
Main Methods:
- Developed an automated workflow using MIM® Software and Elekta® Monaco® treatment planning system.
- Deformably mapped prior doses, converted to equivalent dose in 2 Gy fractions (EQD2), and accumulated.
- Created MIM extensions for dose mapping uncertainty estimation and EQD2 conversion for bias optimization.
Main Results:
- Bias-dose guided plans (BDGPs) showed a median reduction in OAR cumulative EQD2 of 240 cGy (p=0.002).
- BDGPs enabled higher target coverage compared to manually optimized plans (MOPs) that de-escalated dose.
- Dose mapping uncertainties led to OAR cumulative EQD2 increments of 10-730 cGy.
Conclusions:
- Introduced an efficient re-irradiation planning workflow using commercial software.
- Voxel-level bias dose guidance enhances OAR sparing and maximizes target dose coverage.
- Workflow tools support informed clinical decision-making in re-irradiation.
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