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

Oud, M.; Breedveld, S.; Gíżyńska, M.; Kroesen, Michiel; Hutschemaekers, S.; Habraken, S.; Петит, С.; Perkó, Zoltán; Heijmen, B.; Hoogeman, M.

doi:10.1016/j.radonc.2022.09.011

Cited by 21 publications

(10 citation statements)

References 48 publications

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“…For image-guidance, also here MR would be preferable, and developments on integration of MR are on-going ( 30 ). There is also work on going on fast and accurate plan adaptation in proton therapy, ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Inter- and intrafraction dose variations in robotic stereotactic body radiation therapy (SBRT) for perihilar cholangiocarcinoma in the prospective phase I STRONG trial

Paronetto

Toom²,

Milder³

et al. 2023

Front. Oncol.

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Using fiducial-marker-based robotic respiratory tumor tracking, we treated perihilar cholangiocarcinoma patients in the STRONG trial with 15 daily fractions of 4 Gy. For each of the included patients, in-room diagnostic-quality repeat CTs (rCT) were acquired pre- and post-dose delivery in 6 treatment fractions to analyze inter- and intrafraction dose variations. Planning CTs (pCTs) and rCTs were acquired in expiration breath-hold. Analogous to treatment, spine and fiducials were used to register rCTs with pCTs. In each rCT, all OARs were contoured, and the target was rigidly copied from the pCT based on grey values. The rCTs acquired were used to calculate the doses to be delivered through the treatment-unit settings. On average, target doses in rCTs and pCTs were similar. However, due to target displacements relative to the fiducials in rCTs, 10% of the rCTs showed PTV coverage losses of >10%. Although target coverages had been planned below desired values in order to protect OARs, many pre-rCTs contained OAR constraint violations: 44.4% for the 6 major constraints. Most OAR dose differences between pre- and post-rCTs were not statistically significant. The dose deviations observed in repeat CTs represent opportunities for more advanced adaptive approaches to enhancing SBRT treatment quality.

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Section: Discussionmentioning

confidence: 99%

Inter- and intrafraction dose variations in robotic stereotactic body radiation therapy (SBRT) for perihilar cholangiocarcinoma in the prospective phase I STRONG trial

Paronetto

Toom²,

Milder³

et al. 2023

Front. Oncol.

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“…This is particularly relevant for intensity modulated proton therapy (IMPT), where the delivered dose is substantially more sensitive to these variations. For head-and-neck (H&N) cancer patients, the large setup robustness settings required to achieve the desired target coverage in the absence of online plan adaptations can result in significantly increased toxicity risks (van de Water et al 2016, Oud et al 2022). Therefore, there have been continuous efforts to investigate the potential and feasibility of various online adaptation strategies.…”

Section: Introductionmentioning

confidence: 99%

“…(4) Plan library strategies do not adapt the original plans. Instead, a pre-treatment generated library of plans is employed with daily selection of the library plan that best fits the geometry-of-the-day (Oud et al 2022).…”

Section: Introductionmentioning

confidence: 99%

“…However, robustness evaluation was not performed and they exclusively included patients that needed an offline adaptation, not providing a representative sample of the patient population. In Oud et al (2022), our plan library strategy was compared in compliance with the two requirements. However, online dose restoration, re-optimization, and re-planning strategies can potentially further improve dosimetry.…”

Section: Introductionmentioning

confidence: 99%

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A fast and robust constraint-based online re-optimization approach for automated online adaptive intensity modulated proton therapy in head and neck cancer

Oud,

Breedveld,

Rojo-Santiago

et al. 2024

Phys. Med. Biol.

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Objective – In head-and-neck cancer intensity modulated proton therapy (IMPT), adaptive radiotherapy is currently restricted to offline re-planning, mitigating the effect of slow changes in patient anatomies. Daily online adaptations can potentially improve dosimetry. Here, a new, fully automated online re-optimization strategy is presented. In a retrospective study, this online re-optimization approach was compared to our trigger-based offline re-planning (offlineTB re-planning) schedule, including extensive robustness analyses.Approach – The online re-optimization method employs automated multi-criterial re-optimization, using robust optimization with 1 mm setup-robustness settings (in contrast to 3 mm for offlineTB re-planning). Hard planning constraints and spot addition are used to enforce adequate target coverage, avoid prohibitively large maximum doses and minimize organ-at-risk doses. For 67 repeat-CTs from 15 patients, fraction doses of the two strategies were compared for the CTVs and organs-at-risk. Per repeat-CT, 10.000 fractions with different setup and range robustness settings were simulated using Polynomial Chaos Expansion for fast and accurate dose calculations. Main results – For 14/67 repeat-CTs, offlineTB re-planning resulted in <50% probability of D98%≥95% of the prescribed dose (Dpres) in one or both CTVs, which never happened with online re-optimization. With offlineTB re-planning, eight repeat-CTs had zero probability of obtaining D98%≥95%Dpres for CTV7000, while the minimum probability with online re-optimization was 81%. Risks of xerostomia and dysphagia grade ≥ II were reduced by 3.5 ± 1.7 and 3.9 ± 2.8 percentage point [mean ± SD] (p<10-5 for both). In online re-optimization, adjustment of spot configuration followed by spot-intensity re-optimization took 3.4 minutes on average. Significance – The fast online re-optimization strategy always prevented substantial losses of target coverage caused by day-to-day anatomical variations, as opposed to the clinical trigger-based offline re-planning schedule. On top of this, online re-optimization could be performed with smaller setup robustness settings, contributing to improved organs-at-risk sparing.

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“…Several approaches to deviate from the Conventional single-plan convention have been proposed, with adaptive radiotherapy (ART) the most developed. The intention of ART is generally to adapt in each fraction the pre-treatment plan to the anatomy of the day or to compensate for problems in previous fractions (Sharfo et al 2016, Jagt et al 2018, 2019, Werensteijn-Honingh et al 2019, Sibolt et al 2021, Byrne et al 2022, Hoegen et al 2022, Kensen et al 2022, Mulder et al 2022, Oud et al 2022, Schiff et al 2022.…”

Section: Introductionmentioning

confidence: 99%

Per-fraction planning to enhance optimization degrees of freedom compared to the conventional single-plan approach

Rossi,

Breedveld,

Heijmen

2023

Phys. Med. Biol.

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Objective:In conventional radiotherapy, a single treatment plan is generated pre-treatment, and delivered in daily fractions. In this study, we propose to generate different treatment plans for all fractions (‘Per-fraction’ planning) to reduce cumulative OAR doses. Per-fraction planning was compared to the ‘Conventional’ single-plan approach for non-coplanar 4x9.5 Gy prostate SBRT.Approach:An in-house application for fully automated, non-coplanar multi-criterial treatment planning with integrated beam angle and fluence optimization was used for plan generations. For the Conventional approach, a single 12-beam non-coplanar IMRT plan with individualized beam angles was generated for each of the 20 included patients. In Per-fraction planning, four fraction plans were generated for each patient. For each fraction, a different set of patient-specific 12-beam configurations could be automatically selected. Per-fraction plans were sequentially generated by adding dose to already generated fraction plan(s). For each fraction, the cumulative- and fraction dose were simultaneously optimized, allowing some minor constraint violations in fraction doses, but not in cumulative.Main results:In the Per-fraction approach, on average 32.9 ± 3.1 [29;39] unique beams per patient were used. PTV doses in the separate Per-fraction plans were acceptable and highly similar to those in Conventional plans, while also fulfilling all OAR hard constraints. When comparing total cumulative doses, Per-fraction planning showed improved bladder sparing for all patients with reductions in Dmean of 22.6% (p=0.0001) and in D1cc of 2.0% (p=0.0001), reductions in patient volumes receiving 30% and 50% of the prescribed dose of 54.7% and 6.3%, respectively, and a 3.1% lower rectum Dmean (p=0.007). Rectum D1cc was 4.1 % higher (p=0.0001) and Urethra dose was similar. Significance:In this proof-of-concept paper, Per-fraction planning resulted in several dose improvements in healthy tissues compared to the Conventional single-plan approach, for similar PTV dose. By keeping the number of beams per fraction the same as in Conventional planning, reported dosimetric improvements could be obtained without increase in fraction durations. Further research is needed to explore the full potential of the Per-fraction planning approach.

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

Cited by 21 publications

References 48 publications

Inter- and intrafraction dose variations in robotic stereotactic body radiation therapy (SBRT) for perihilar cholangiocarcinoma in the prospective phase I STRONG trial

Inter- and intrafraction dose variations in robotic stereotactic body radiation therapy (SBRT) for perihilar cholangiocarcinoma in the prospective phase I STRONG trial

A fast and robust constraint-based online re-optimization approach for automated online adaptive intensity modulated proton therapy in head and neck cancer

Per-fraction planning to enhance optimization degrees of freedom compared to the conventional single-plan approach

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