Treatment planning for proton therapy: what is needed in the next 10 years?

Abstract

Treatment planning is the process where the prescription of the radiation oncologist is translated into a deliverable treatment. With the complexity of contemporary radiotherapy, treatment planning cannot be performed without a computerized treatment planning system. Proton therapy (PT) enables highly conformal treatment plans with a minimum of dose to tissues outside the target volume, but to obtain the most optimal plan for the treatment, there are a multitude of parameters that need to be addressed. In this review areas of ongoing improvements and research in the field of PT treatment planning are identified and discussed. The main focus is on issues of immediate clinical and practical relevance to the PT community highlighting the needs for the near future but also in a longer perspective. We anticipate that the manual tasks performed by treatment planners in the future will involve a high degree of computational thinking, as many issues can be solved much better by e.g. scripting. More accurate and faster dose calculation algorithms are needed, automation for contouring and planning is required and practical tools to handle the variable biological efficiency in PT is urgently demanded just to mention a few of the expected improvements over the coming 10 years.

Radiotherapy Treatment plannINg study Guidelines (RATING): A framework for setting up and reporting on scientific treatment planning studies

“…The evolution of computer hard-and software allowed implementation of advanced algorithms for dose calculation and optimisation, and facilitated the introduction of many complex treatment techniques [3][4][5][6]. Radiotherapy treatment planning is currently in an exciting era with novel developments in, for example, automated planning, robust planning, online adaptive radio-therapy, knowledge-based planning and plan quality assessment methods [7][8][9][10][11].…”

Influence of Target Location, Size, and Patient Age on Normal Tissue Sparing- Proton and Photon Therapy in Paediatric Brain Tumour Patient-Specific Approach

“…As long-term follow-ups and prospective studies are difficult to conduct in PT due to practical reasons, more consideration is given to retrospective and prospective planning comparative studies and modelling. In lieu of long-term clinical data, model-based approaches provide justification for adopting a new technology that has not yet produced adequate patient outcome data [16]. Although initial clinical results are promising, it is not well understood if PT should be the only RT modality to treat paediatric brain tumour patients.…”

RBE for proton radiation therapy – a Nordic view in the international perspective

“…For the purpose of plan evaluation and comparison, treatment planning systems need to produce and store information about the distributions of measurable physical quantities like dose and LET and also to incorporate several RBE models that could be used for effect predictions and treatment plan evaluation [39]. Scripting options for the user can offer additional flexibility to test future models.…”