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Pre‐treatment analysis of non‐rigid variations can assist robust intensity‐modulated proton therapy plan selection for head and neck patients

PURPOSE: To incorporate small non‐rigid variations of head and neck patients into the robust evaluation of intensity‐modulated proton therapy (IMPT) for the selection of robust treatment plans. METHODS: A cohort of 20 nasopharynx cancer patients with weekly kilovoltage CT (kVCT) and 15 oropharynx ca...

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Autores principales: Zhang, Ying, Alshaikhi, Jailan, Amos, Richard A., Tan, Wenyong, Anaya, Virginia Marin, Pang, Yaru, Royle, Gary, Bär, Esther
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092578/
https://www.ncbi.nlm.nih.gov/pubmed/36083223
http://dx.doi.org/10.1002/mp.15971
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author Zhang, Ying
Alshaikhi, Jailan
Amos, Richard A.
Tan, Wenyong
Anaya, Virginia Marin
Pang, Yaru
Royle, Gary
Bär, Esther
author_facet Zhang, Ying
Alshaikhi, Jailan
Amos, Richard A.
Tan, Wenyong
Anaya, Virginia Marin
Pang, Yaru
Royle, Gary
Bär, Esther
author_sort Zhang, Ying
collection PubMed
description PURPOSE: To incorporate small non‐rigid variations of head and neck patients into the robust evaluation of intensity‐modulated proton therapy (IMPT) for the selection of robust treatment plans. METHODS: A cohort of 20 nasopharynx cancer patients with weekly kilovoltage CT (kVCT) and 15 oropharynx cancer patients with weekly cone‐beam CT (CBCT) were retrospectively included. Anatomical variations between week 0/week 1 of treatment were acquired using deformable image registration (DIR) for all 35 patients and then applied to the planning CT of four patients who have kVCT scanned each week to simulate potential small non‐rigid variations (sNRVs). The robust evaluations were conducted on IMPT plans with: (1) different number of beam fields from 3‐field to 5‐field; (2) different beam angles. The robust evaluation before treatment, including the sNRVs and setup uncertainty, referred to as sNRV+R evaluation was compared with the conventional evaluation (without sNRVs) in terms of robustness consistency with the gold standard evaluation based on weekly CT. RESULTS: Among four patients (490 scenarios), we observed a maximum difference in the sNRV+R evaluation to the nominal dose of: 9.37% dose degradation on D (95) of clinical target volumes (CTVs), increase in mean dose (D [Formula: see text]) of parotid 11.87 Gy, increase in max dose (D [Formula: see text]) of brainstem 20.82 Gy. In contrast, in conventional evaluation, we observed a maximum difference to the nominal dose of: 7.58% dose degradation on D (95) of the CTVs, increase in parotid D [Formula: see text] by 4.88 Gy, increase in brainstem D [Formula: see text] by 13.5 Gy. In the measurement of the robustness ranking consistency with the gold standard evaluation, the sNRV+R evaluation was better or equal to the conventional evaluation in 77% of cases, particularly, better on spinal cord, parotid glands, and low‐risk CTV. CONCLUSION: This study demonstrated the additional dose discrepancy that sNRVs can make. The inclusion of sNRVs can be beneficial to robust evaluation, providing information on clinical uncertainties additional to the conventional rigid isocenter shift.
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spelling pubmed-100925782023-04-13 Pre‐treatment analysis of non‐rigid variations can assist robust intensity‐modulated proton therapy plan selection for head and neck patients Zhang, Ying Alshaikhi, Jailan Amos, Richard A. Tan, Wenyong Anaya, Virginia Marin Pang, Yaru Royle, Gary Bär, Esther Med Phys EMERGING IMAGING AND THERAPY MODALITIES PURPOSE: To incorporate small non‐rigid variations of head and neck patients into the robust evaluation of intensity‐modulated proton therapy (IMPT) for the selection of robust treatment plans. METHODS: A cohort of 20 nasopharynx cancer patients with weekly kilovoltage CT (kVCT) and 15 oropharynx cancer patients with weekly cone‐beam CT (CBCT) were retrospectively included. Anatomical variations between week 0/week 1 of treatment were acquired using deformable image registration (DIR) for all 35 patients and then applied to the planning CT of four patients who have kVCT scanned each week to simulate potential small non‐rigid variations (sNRVs). The robust evaluations were conducted on IMPT plans with: (1) different number of beam fields from 3‐field to 5‐field; (2) different beam angles. The robust evaluation before treatment, including the sNRVs and setup uncertainty, referred to as sNRV+R evaluation was compared with the conventional evaluation (without sNRVs) in terms of robustness consistency with the gold standard evaluation based on weekly CT. RESULTS: Among four patients (490 scenarios), we observed a maximum difference in the sNRV+R evaluation to the nominal dose of: 9.37% dose degradation on D (95) of clinical target volumes (CTVs), increase in mean dose (D [Formula: see text]) of parotid 11.87 Gy, increase in max dose (D [Formula: see text]) of brainstem 20.82 Gy. In contrast, in conventional evaluation, we observed a maximum difference to the nominal dose of: 7.58% dose degradation on D (95) of the CTVs, increase in parotid D [Formula: see text] by 4.88 Gy, increase in brainstem D [Formula: see text] by 13.5 Gy. In the measurement of the robustness ranking consistency with the gold standard evaluation, the sNRV+R evaluation was better or equal to the conventional evaluation in 77% of cases, particularly, better on spinal cord, parotid glands, and low‐risk CTV. CONCLUSION: This study demonstrated the additional dose discrepancy that sNRVs can make. The inclusion of sNRVs can be beneficial to robust evaluation, providing information on clinical uncertainties additional to the conventional rigid isocenter shift. John Wiley and Sons Inc. 2022-10-06 2022-12 /pmc/articles/PMC10092578/ /pubmed/36083223 http://dx.doi.org/10.1002/mp.15971 Text en © 2022 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle EMERGING IMAGING AND THERAPY MODALITIES
Zhang, Ying
Alshaikhi, Jailan
Amos, Richard A.
Tan, Wenyong
Anaya, Virginia Marin
Pang, Yaru
Royle, Gary
Bär, Esther
Pre‐treatment analysis of non‐rigid variations can assist robust intensity‐modulated proton therapy plan selection for head and neck patients
title Pre‐treatment analysis of non‐rigid variations can assist robust intensity‐modulated proton therapy plan selection for head and neck patients
title_full Pre‐treatment analysis of non‐rigid variations can assist robust intensity‐modulated proton therapy plan selection for head and neck patients
title_fullStr Pre‐treatment analysis of non‐rigid variations can assist robust intensity‐modulated proton therapy plan selection for head and neck patients
title_full_unstemmed Pre‐treatment analysis of non‐rigid variations can assist robust intensity‐modulated proton therapy plan selection for head and neck patients
title_short Pre‐treatment analysis of non‐rigid variations can assist robust intensity‐modulated proton therapy plan selection for head and neck patients
title_sort pre‐treatment analysis of non‐rigid variations can assist robust intensity‐modulated proton therapy plan selection for head and neck patients
topic EMERGING IMAGING AND THERAPY MODALITIES
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092578/
https://www.ncbi.nlm.nih.gov/pubmed/36083223
http://dx.doi.org/10.1002/mp.15971
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