Sebastian Tattenberg1,2, Thomas M Madden2, Bram L Gorissen3, Thomas Bortfeld2, Katia Parodi1, Joost Verburg2. 1. Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, 85748, Garching, Germany. 2. Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, MA, USA. 3. Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, 02142, MA, USA.
Abstract
PURPOSE: Proton therapy allows for more conformal dose distributions and lower organ at risk and healthy tissue doses than conventional photon-based radiotherapy, but uncertainties in the proton range currently prevent proton therapy from making full use of these advantages. Numerous developments therefore aim to reduce such range uncertainties. In this work, we quantify the benefits of reductions in range uncertainty for treatments of skull base tumors. METHODS: The study encompassed 10 skull base patients with clival tumors. For every patient, six treatment plans robust to set-up errors of 2 mm and range errors from 0% to 5% were created. The determined metrics included the brainstem and optic chiasm normal tissue complication probability (NTCP) with the endpoints of necrosis and blindness, respectively, as well as the healthy tissue volume receiving at least 70% of the prescription dose. RESULTS: A range uncertainty reduction from the current level of 4% to a potentially achievable level of 1% reduced the probability of brainstem necrosis by up to 1.3 percentage points in the nominal scenario in which neither set-up nor range errors occur and by up to 2.9 percentage points in the worst-case scenario. Such a range uncertainty reduction also reduced the optic chiasm NTCP with the endpoint of blindness by up to 0.9 percentage points in the nominal scenario and by up to 2.2 percentage points in the worst-case scenario. The decrease in the healthy tissue volume receiving at least 70% of the prescription dose ranged from -7.8 cc to 24.1 cc in the nominal scenario and from -3.4 cc to 38.4 cc in the worst-case scenario. CONCLUSION: The benefits quantified as part of this study serve as a guideline of the OAR and healthy tissue dose benefits that range monitoring techniques may be able to achieve. Benefits were observed between all levels of range uncertainty. Even smaller range uncertainty reductions may therefore be beneficial. This article is protected by copyright. All rights reserved.
PURPOSE: Proton therapy allows for more conformal dose distributions and lower organ at risk and healthy tissue doses than conventional photon-based radiotherapy, but uncertainties in the proton range currently prevent proton therapy from making full use of these advantages. Numerous developments therefore aim to reduce such range uncertainties. In this work, we quantify the benefits of reductions in range uncertainty for treatments of skull base tumors. METHODS: The study encompassed 10 skull base patients with clival tumors. For every patient, six treatment plans robust to set-up errors of 2 mm and range errors from 0% to 5% were created. The determined metrics included the brainstem and optic chiasm normal tissue complication probability (NTCP) with the endpoints of necrosis and blindness, respectively, as well as the healthy tissue volume receiving at least 70% of the prescription dose. RESULTS: A range uncertainty reduction from the current level of 4% to a potentially achievable level of 1% reduced the probability of brainstem necrosis by up to 1.3 percentage points in the nominal scenario in which neither set-up nor range errors occur and by up to 2.9 percentage points in the worst-case scenario. Such a range uncertainty reduction also reduced the optic chiasm NTCP with the endpoint of blindness by up to 0.9 percentage points in the nominal scenario and by up to 2.2 percentage points in the worst-case scenario. The decrease in the healthy tissue volume receiving at least 70% of the prescription dose ranged from -7.8 cc to 24.1 cc in the nominal scenario and from -3.4 cc to 38.4 cc in the worst-case scenario. CONCLUSION: The benefits quantified as part of this study serve as a guideline of the OAR and healthy tissue dose benefits that range monitoring techniques may be able to achieve. Benefits were observed between all levels of range uncertainty. Even smaller range uncertainty reductions may therefore be beneficial. This article is protected by copyright. All rights reserved.
Entities:
Keywords:
IMPT; proton therapy; range uncertainty; robust optimization
Authors: Daria Boscolo; Daria Kostyleva; Mohammad Javad Safari; Vasiliki Anagnostatou; Juha Äystö; Soumya Bagchi; Tim Binder; Georgios Dedes; Peter Dendooven; Timo Dickel; Vasyl Drozd; Bernhard Franczack; Hans Geissel; Chiara Gianoli; Christian Graeff; Tuomas Grahn; Florian Greiner; Emma Haettner; Roghieh Haghani; Muhsin N Harakeh; Felix Horst; Christine Hornung; Jan-Paul Hucka; Nasser Kalantar-Nayestanaki; Erika Kazantseva; Birgit Kindler; Ronja Knöbel; Natalia Kuzminchuk-Feuerstein; Bettina Lommel; Ivan Mukha; Chiara Nociforo; Shunki Ishikawa; Giulio Lovatti; Munetaka Nitta; Ikechi Ozoemelam; Stephane Pietri; Wolfgang R Plaß; Andrej Prochazka; Sivaji Purushothaman; Claire-Anne Reidel; Heidi Roesch; Fabio Schirru; Christoph Schuy; Olga Sokol; Timo Steinsberger; Yoshiki K Tanaka; Isao Tanihata; Peter Thirolf; Walter Tinganelli; Bernd Voss; Uli Weber; Helmut Weick; John S Winfield; Martin Winkler; Jianwei Zhao; Christoph Scheidenberger; Katia Parodi; Marco Durante Journal: Front Oncol Date: 2021-08-19 Impact factor: 5.738
Authors: Friderike K Longarino; Antonia Kowalewski; Thomas Tessonnier; Stewart Mein; Benjamin Ackermann; Jürgen Debus; Andrea Mairani; Wolfram Stiller Journal: Front Oncol Date: 2022-04-20 Impact factor: 5.738
Authors: Jan Hofmaier; Franziska Walter; Indrawati Hadi; Maya Rottler; Rieke von Bestenbostel; George Dedes; Katia Parodi; Maximilian Niyazi; Claus Belka; Florian Kamp Journal: Phys Imaging Radiat Oncol Date: 2021-12-02
Authors: Friderike K Longarino; Thomas Tessonnier; Stewart Mein; Semi B Harrabi; Jürgen Debus; Wolfram Stiller; Andrea Mairani Journal: J Appl Clin Med Phys Date: 2021-11-01 Impact factor: 2.102