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• W3093515811 abstract "Daily anatomical changes are an important concern for patients receiving Intensity-Modulated Proton Therapy (IMPT) in the head and neck region, as these can impact both target coverage and organs at risk (OAR) sparing over the course of treatment. Typically, the dosimetric impact of such anatomical changes is mitigated by increasing the plan robustness a priori, or adapting the plan throughout delivery. The purpose of this study is to evaluate which of these two strategies can achieve the best treatment quality in the context of head and neck IMPT. A representative cohort of five head and neck patients with daily CBCT images treated for tumors located in the oropharynx, larynx, and tonsil are evaluated in this retrospective study. For each patient, three IMPT plans are created: 1) a classical robust optimization (cRO) to clinical target volumes (CTVs) and main OARs using a 3 mm setup uncertainty, 2) an anatomical robust optimization (aRO) using the same criteria as cRO, but optimized simultaneously on the planning CT and the first fraction’s CBCT to include variability in patient positioning and 3) a plan optimized without robustness constraints, but online adapted daily based on CBCT (DA). All plans are optimized using the same objectives, constraints and beam angles. The daily adaptation is achieved using an in-house online adaptation workflow employing GPU accelerated Monte Carlo dose calculation and a novel deep-learning based fast scatter correction of CBCT images. Dose tracking using deformable image registration of the scatter-corrected CBCT images to the planning CT is performed to compare the cumulative and fraction dose associated with each strategy. A total of 411 clinical scenarios are evaluated. For all patients, aRO is shown to achieve a better target coverage for the overall treatment than cRO, but less than DA. Mean values for D95 to the CTV of 95.41%, 96.03% and 99.61% of the prescription dose are obtained for cRO, aRO and DA respectively. DA is also shown to noticeably reduce the integral dose for all patients, while providing equivalent or superior coverage than aRO. Finally, the mean dose to the parotid glands and the oral cavity is reduced to 21.4 / 19.4 Gy respectively with DA compared to 23.6 / 26.0 Gy and 23.0 / 24.2 Gy for aRO and cRO respectively. This study suggests the superiority of online adaptive IMPT for the treatment of head and neck cancers over two previously validated robust optimization approaches. The online adaptive workflow used in this study provided superior target coverage and lower integral dose than both robust optimization methods, this within clinically acceptable time." @default.
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• W3093515811 date "2020-11-01" @default.
• W3093515811 modified "2023-09-25" @default.
• W3093515811 title "Anatomic Changes in Head and Neck Intensity-modulated Proton Therapy: Comparison between Robust Optimization and Daily Adaptation" @default.
• W3093515811 doi "https://doi.org/10.1016/j.ijrobp.2020.07.2227" @default.
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