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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

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Improving Plan Quality in Adaptive Proton Therapy Using an Interactive Dose Modification Tool.

Lisa Stefanie Fankhauser¹, Francesca Albertini², Antony John Lomax²

¹Center for Proton Therapy, Paul Scherrer Institute, Forschungsstrasse 111, Villigen, AG, 5232, Switzerland.

Physics in Medicine and Biology

|July 2, 2026

Summary

This summary is machine-generated.

An interactive dose modification tool significantly improves proton therapy plan quality by efficiently restoring unmet clinical objectives after daily re-optimization. This approach enhances adaptive proton therapy workflows.

Keywords:

adaptive radiotherapy anatomical changes interactive dose modification online workflow proton therapy

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Area of Science:

Medical Physics
Radiation Oncology
Image-Guided Therapy

Background:

Anatomical changes during proton therapy (PT) necessitate plan adaptation for optimal outcomes.
Online adaptation aims to improve efficiency but may compromise plan quality.
Interactive dose modification (IDM) tools offer potential for localized adjustments.

Purpose of the Study:

To assess the feasibility of an IDM tool for enhancing daily re-optimized proton therapy plans.
To evaluate the IDM tool's effectiveness in meeting unmet clinical objectives.
To quantify improvements in plan quality and time efficiency.

Main Methods:

A retrospective study of four proton therapy cases with anatomical changes.
Comparison of three plan adaptation strategies: re-calculation, re-optimization, and re-optimization with IDM.
Evaluation of clinical endpoint fulfillment, dose deviations, and modification time.

Main Results:

IDM reduced unmet clinical endpoints from 34 to 3, with dose deviations minimized to ≤0.5 Gy(RBE).
Target coverage remained within 2.5 Gy(RBE) of the original plan after IDM.
Average IDM modification time was only 2 minutes, demonstrating high efficiency.

Conclusions:

The IDM tool efficiently improves plan quality in adaptive proton therapy.
Its speed, ease of use, and effectiveness support integration into online adaptive workflows.
IDM facilitates the restoration of clinical goals in daily adaptive PT.