Sebastian Hild1,2, Christian Graeff1, Antoni Rucinski3,4, Klemens Zink5,6, Gregor Habl3,7, Marco Durante1,8, Klaus Herfarth3, Christoph Bert9,10,11. 1. Department of Biophysics, GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany. 2. Department of Radiation Oncology, University Clinic Erlangen and Friedrich- Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany. 3. Heidelberg Ion-Beam Therapy Center (HIT) and Department of Radiation Oncology, University Clinic Heidelberg, Heidelberg, Germany. 4. INFN Sezione di Roma and Dipartimento di Scienze di Base e Applicate per Ingegneria, Sapienza Universit'a di Roma, Roma, Italy. 5. Institute for Medical Physics and Radiation Protection, University of Applied Sciences, Giessen, Germany. 6. Department of Radiotherapy and Radiooncology, University Medical Center Giessen-Marburg, Marburg, Germany. 7. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany. 8. Faculty of Physics, Technische Universität Darmstadt, Darmstadt, Germany. 9. Department of Biophysics, GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany. christoph.bert@uk-erlangen.de. 10. Department of Radiation Oncology, University Clinic Erlangen and Friedrich- Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany. christoph.bert@uk-erlangen.de. 11. Radiation Oncology, University Hospital Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany. christoph.bert@uk-erlangen.de.
Abstract
BACKGROUND AND PURPOSE: Intensity-modulated particle therapy (IMPT) for tumors showing interfraction motion is a topic of current research. The purpose of this work is to compare three treatment strategies for IMPT to determine potential advantages and disadvantages of ion prostate cancer therapy. MATERIALS AND METHODS: Simulations for three treatment strategies, conventional one-plan radiotherapy (ConvRT), image-guided radiotherapy (IGRT), and online adaptive radiotherapy (ART) were performed employing a dataset of 10 prostate cancer patients with six CT scans taken at one week intervals. The simulation results, using a geometric margin concept (7-2 mm) as well as patient-specific internal target volume definitions for IMPT were analyzed by target coverage and exposure of critical structures on single fraction dose distributions. RESULTS: All strategies led to clinically acceptable target coverage in patients exhibiting small prostate motion (mean displacement <4 mm), but IGRT and especially ART led to significant sparing of the rectum. In 20% of the patients, prostate motion exceeded 4 mm causing insufficient target coverage for ConvRT (V95mean = 0.86, range 0.63-0.99) and IGRT (V95mean = 0.91, range 0.68-1.00), while ART maintained acceptable target coverage. CONCLUSION: IMPT of prostate cancer demands consideration of rectal sparing and adaptive treatment replanning for patients exhibiting large prostate motion.
BACKGROUND AND PURPOSE: Intensity-modulated particle therapy (IMPT) for tumors showing interfraction motion is a topic of current research. The purpose of this work is to compare three treatment strategies for IMPT to determine potential advantages and disadvantages of ion prostate cancer therapy. MATERIALS AND METHODS: Simulations for three treatment strategies, conventional one-plan radiotherapy (ConvRT), image-guided radiotherapy (IGRT), and online adaptive radiotherapy (ART) were performed employing a dataset of 10 prostate cancerpatients with six CT scans taken at one week intervals. The simulation results, using a geometric margin concept (7-2 mm) as well as patient-specific internal target volume definitions for IMPT were analyzed by target coverage and exposure of critical structures on single fraction dose distributions. RESULTS: All strategies led to clinically acceptable target coverage in patients exhibiting small prostate motion (mean displacement <4 mm), but IGRT and especially ART led to significant sparing of the rectum. In 20% of the patients, prostate motion exceeded 4 mm causing insufficient target coverage for ConvRT (V95mean = 0.86, range 0.63-0.99) and IGRT (V95mean = 0.91, range 0.68-1.00), while ART maintained acceptable target coverage. CONCLUSION: IMPT of prostate cancer demands consideration of rectal sparing and adaptive treatment replanning for patients exhibiting large prostate motion.
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