Anatomic changes in head and neck intensity-modulated proton therapy: Comparison between robust optimization and online adaptation

Lalonde, Arthur; Bobić, Mislav; Winey, Brian; Verburg, J; Sharp, Gregory C.; Paganetti, Harald

doi:10.1016/j.radonc.2021.03.008

Cited by 37 publications

(68 citation statements)

References 44 publications

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“…For this retrospective study, we used the same patient cohort and treatment planning approach as for the work reported in [ 9 , 30 ]. The dataset included 10 H&N patients with tumors located in the oral cavity, oropharynx, and larynx.…”

Section: Methodsmentioning

confidence: 99%

CT-on-Rails Versus In-Room CBCT for Online Daily Adaptive Proton Therapy of Head-and-Neck Cancers

Nesteruk

Bobić

Lalonde

et al. 2021

Cancers

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Purpose: To compare the efficacy of CT-on-rails versus in-room CBCT for daily adaptive proton therapy. Methods: We analyzed a cohort of ten head-and-neck patients with daily CBCT and corresponding virtual CT images. The necessity of moving the patient after a CT scan is the most significant difference in the adaptation workflow, leading to an increased treatment execution uncertainty σ. It is a combination of the isocenter-matching σi and random patient movements induced by the couch motion σm. The former is assumed to never exceed 1 mm. For the latter, we studied three different scenarios with σm = 1, 2, and 3 mm. Accordingly, to mimic the adaptation workflow with CT-on-rails, we introduced random offsets after Monte-Carlo-based adaptation but before delivery of the adapted plan. Results: There were no significant differences in accumulated dose-volume histograms and dose distributions for σm = 1 and 2 mm. Offsets with σm = 3 mm resulted in underdosage to CTV and hot spots of considerable volume. Conclusion: Since σm typically does not exceed 2 mm for in-room CT, there is no clinically significant dosimetric difference between the two modalities for online adaptive therapy of head-and-neck patients. Therefore, in-room CT-on-rails can be considered a good alternative to CBCT for adaptive proton therapy.

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Section: Methodsmentioning

confidence: 99%

CT-on-Rails Versus In-Room CBCT for Online Daily Adaptive Proton Therapy of Head-and-Neck Cancers

Nesteruk

Bobić

Lalonde

et al. 2021

Cancers

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“…In the work by Yang et al investigating the role of multiple-CT optimisation to mitigate the impact of anatomical changes, they report that approximately 40% of all clinical HN patients treated at their institute with IMPT required at least one plan adaptation [20]. Other in-silico, small cohort studies investigating the impact of anatomical changes in robustly optimised HN IMPT have reported inadequate target coverage in 25% to 60% of cases [21,23]. The differences in the reported rates of plan adaptation highlight that experiences with IMPT in HN are variable and likely to be influenced by institutional protocols, planning approaches, treatment site and patient cohort characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…This, however, does not guarantee robustness to tissue deformations, non-rigid positioning issues or anatomical changes, all of which may occur over the treatment course. Methods of mitigating these additional sources of uncertainty are currently being investigated, such as the use of multiple-CT robust optimisation [19][20][21] or on-line plan adaptation [19,[22][23], however these are not yet routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of robustly optimised intensity modulated proton therapy for nasopharyngeal carcinoma

Scandurra

Meijer

Free

et al. 2022

Radiotherapy and Oncology

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“…For such approaches the simplified optimization technique should be thoroughly compared to the original optimizer, as was done in our study by comparing RPM to 2p∊c. Another technique, described in [28,29], uses deformable image registration to obtain daily delineations. The method first calculates the dose for each pencil-beam on the new anatomy, and then performs a restoration by re-optimizing the intensity of a subset of spots using the planning objectives of the intended plan.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of alternative parameter settings for dose restoration and full plan adaptation in IMPT for prostate cancer

2021

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Anatomic changes in head and neck intensity-modulated proton therapy: Comparison between robust optimization and online adaptation

Cited by 37 publications

References 44 publications

CT-on-Rails Versus In-Room CBCT for Online Daily Adaptive Proton Therapy of Head-and-Neck Cancers

CT-on-Rails Versus In-Room CBCT for Online Daily Adaptive Proton Therapy of Head-and-Neck Cancers

Evaluation of robustly optimised intensity modulated proton therapy for nasopharyngeal carcinoma

Evaluation of alternative parameter settings for dose restoration and full plan adaptation in IMPT for prostate cancer

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