An online adaptive plan library approach for intensity modulated proton therapy for head and neck cancer

An online adaptive plan library approach for intensity modulated proton therapy for head and neck cancer

Oud, Michelle (Erasmus MC)
Breedveld, Sebastiaan (Erasmus MC)
Giżyńska, Marta (Holland Particle Therapy Centre)
Kroesen, Michiel (Erasmus MC; Holland Particle Therapy Centre)
Hutschemaekers, Stefan (Holland Particle Therapy Centre)
Habraken, S.J.M. (Erasmus MC; Holland Particle Therapy Centre)
Petit, Steven (Erasmus MC)
Perko, Z. (TU Delft RST/Reactor Physics and Nuclear Materials)
Heijmen, Ben (Erasmus MC)
Hoogeman, M.S. (Erasmus MC; Holland Particle Therapy Centre)

2022

Background and purpose: In intensity modulated proton therapy (IMPT), the impact of setup errors and anatomical changes is commonly mitigated by robust optimization with population-based setup robustness (SR) settings and offline replanning. In this study we propose and evaluate an alternative approach based on daily plan selection from patient-specific pre-treatment established plan libraries (PLs). Clinical implementation of the PL strategy would be rather straightforward compared to daily online re-planning. Materials and methods: For 15 head-and-neck cancer patients, the planning CT was used to generate a PL with 5 plans, robustly optimized for increasing SR: 0, 1, 2, 3, 5 mm, and 3% range robustness. Repeat CTs (rCTs) and realistic setup and range uncertainty distributions were used for simulation of treatment courses for the PL approach, treatments with fixed SR (fSR₃) and a trigger-based offline adaptive schedule for 3 mm SR (fSR₃OfA). Daily plan selection in the PL approach was based only on recomputed dose to the CTV on the rCT. Results: Compared to using fSR₃ and fSR₃OfA, the risk of xerostomia grade ≥ II & III and dysphagia ≥ grade III were significantly reduced with the PL. For 6/15 patients the risk of xerostomia and/or dysphagia ≥ grade II could be reduced by > 2% by using PL. For the other patients, adherence to target coverage constraints was often improved. fSR₃OfA resulted in significantly improved coverage compared to PL for selected patients. Conclusion: The proposed PL approach resulted in overall reduced NTCPs compared to fSR₃ and fSR₃OfA at limited cost in target coverage.

Daily adaptive radiotherapy
Head and neck cancer
Intensity modulated proton therapy
Inter-fraction motion
Plan library
Proton therapy

http://resolver.tudelft.nl/uuid:66b4e176-235e-4abb-80ed-a930a4f8c312

https://doi.org/10.1016/j.radonc.2022.09.011

0167-8140

Radiotherapy & Oncology, 176, 68-75

Institutional Repository

journal article

© 2022 Michelle Oud, Sebastiaan Breedveld, Marta Giżyńska, Michiel Kroesen, Stefan Hutschemaekers, S.J.M. Habraken, Steven Petit, Z. Perko, Ben Heijmen, M.S. Hoogeman