Exploratory Study of 4D versus 3D Robust Optimization in Intensity Modulated Proton Therapy for Lung Cancer

Liu, Wei; Schild, Steven E.; Chang, Joe Y.; Liao, Zhongxing; Chang, Yu Hui; Wen, Zhifei; Shen, Jiajian; Stoker, J.; Ding, Xiaoning; Hu, Yanle; Sahoo, Narayan; Herman, Michael; Vargas, Carlos; Keole, Sameer R.; Wong, William W.; Bues, Martin

doi:10.1016/j.ijrobp.2015.11.002

Cited by 114 publications

(175 citation statements)

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“…Chen et al have implemented a robust optimization in a multi-criteria optimization as well [Chen et al, 2012]. Furthermore, in a recent treatment planning study by Liu et al [Liu et al, 2016b] showing the necessity of making treatment plans robust against motion uncertainties, especially in the hypo-fractionated regiment. Furthermore, OAR doses that are under the limits after optimization, may exceed them after calculating the 4D dose.…”

Section: Summary and Discussionmentioning

confidence: 99%

“…The robust optimization, however, can substantially improve the treatment plans [Chen et al, 2012]. Furthermore, the robustness optimization is now computationally possible even for a 4D optimization [Liu et al, 2016b], bringing treatment of lung cancer patients with PT closer to reality. Future studies on treating lung cancer with PT should definitely include a robust 4D dose optimization.…”

Section: Discussionmentioning

confidence: 99%

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In silico comparison of photons versus carbon ions in single fraction therapy of lung cancer

et al. 2016

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Stereotactic body image guided radiation therapy (SBRT) shows excellent results for the local control of early stage lung cancer. However, not all patients are eligible for SBRT, and advanced stage treatment is less successful and often associated with severe side effects. Scanned carbon ion therapy (PT) can deliver more conformal dose likely benefiting these patient groups.Therefore an in silico trial was conducted on early and advanced stage patients to identify potential advantages of PT. The patients were treated with SBRT at Champalimaud Center for the Unknown, Lisbon (Portugal). PT plans were simulated on 4DCTs, and rescanning was investigated for motion mitigation in 4D-dose calculations. A dedicated strategy for 4D intensity modulated particle therapy (IMPT) was developed and applied for advanced stage patients with multiple lesions. For clinically valid and reliable results the deformable image registrationnecessary for 4D-dose calculation -a quality assurance tool was developed and applied in the study.The results showed that target coverage was comparable in SBRT and PT, while PT delivered significantly lower doses to most critical structures, especially the heart, lungs, and esophagus.A highly complex case of advanced stage lung cancer could be treated in a single fraction of 24 Gy with PT, while SBRT could not deliver the full ablative dose treatment due to an excessive heart dose. The mean heart dose was reduced from 10 Gy to 0.8 Gy with PT for this specific patient.

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Section: Summary and Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In silico comparison of photons versus carbon ions in single fraction therapy of lung cancer

et al. 2016

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“…Several methods are available to mitigate these uncertainties: robust beam angle selection utilizing waterequivalent thickness optimization, 4DCT-based robust optimization, layer or volumetric "repainting" delivery, spotsequence delivery optimization, increased fractionation, spot-size modulation, mini-ridge filter utilization, and respiratory gating or breath-hold-based treatment, to name a few (105,(110)(111)(112)(113)(114). Unfortunately, most of these methods require additional treatment planning software and devices or increase time and logistical burden on planning, quality assurance, and treatment delivery.…”

Section: Modalitiesmentioning

confidence: 99%

Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy

Diwanji¹,

Mohindra²,

Vyfhuis³

et al. 2017

Transl. Lung Cancer Res.

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Abstract:The 21st century has seen several paradigm shifts in the treatment of non-small cell lung cancer (NSCLC) in early-stage inoperable disease, definitive locally advanced disease, and the postoperative setting.A key driver in improvement of local disease control has been the significant evolution of radiation therapy techniques in the last three decades, allowing for delivery of definitive radiation doses while limiting exposure of normal tissues. For patients with locally-advanced NSCLC, the advent of volumetric imaging techniques has allowed a shift from 2-dimensional approaches to 3-dimensional conformal radiation therapy (3DCRT).The next generation of 3DCRT, intensity-modulated radiation therapy and volumetric-modulated arc therapy (VMAT), have enabled even more conformal radiation delivery. Clinical evidence has shown that this can improve the quality of life for patients undergoing definitive management of lung cancer. In the earlystage setting, conventional fractionation led to poor outcomes. Evaluation of altered dose fractionation with the previously noted technology advances led to advent of stereotactic body radiation therapy (SBRT). This technique has dramatically improved local control and expanded treatment options for inoperable, earlystage patients. The recent development of proton therapy has opened new avenues for improving conformity and the therapeutic ratio. Evolution of newer proton therapy techniques, such as pencil-beam scanning (PBS), could improve tolerability and possibly allow reexamination of dose escalation. These new progresses, along with significant advances in systemic therapies, have improved survival for lung cancer patients across the spectrum of non-metastatic disease. They have also brought to light new challenges and avenues for further research and improvement.

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“…Proton therapy is unique because of the sharp falloff of dose deposition beyond the Bragg peak. Intensity‐modulated proton therapy (IMPT) is an advanced form of proton therapy that can achieve highly conformal tumor dose coverage and superior sparing of organs at risk (OARs) . Proton therapy highly depends on the quality of treatment planning, which involves solving multiple optimization problems and determining important delivery parameters, such as beam angles, proton energies, and beamlet intensities.…”

Section: Introductionmentioning

confidence: 99%

Robust treatment planning with conditional value at risk chance constraints in intensity‐modulated proton therapy

Liang

Schild

et al. 2017

Medical Physics

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Background and purpose Intensity-modulated proton therapy (IMPT) is highly sensitive to range uncertainties and uncertainties caused by setup variation. The conventional inverse treatment planning of IMPT based on the planning target volume (PTV) is not often sufficient to ensure robustness of treatment plans. We applied a probabilistic framework (chance-constrained optimization) in IMPT planning to hedge against the influence of uncertainties. Material and methods We retrospectively selected one patient with lung cancer, one patient with head and neck (H&N) cancer, and one with prostate cancer for this analysis. Using their original images and prescriptions, we created new IMPT plans using two methods: (1) a robust chance-constrained treatment planning method with the clinical target volume (CTV) as the target; (2) the margin-based method with PTV as the target, which was solved by commercial software, CPLEX, using linear programming. For the first method, we reformulated the model into a tractable mixed-integer programming problem and sped up the calculation using Benders decomposition. The dose-volume histograms (DVHs) from the nominal and perturbed dose distributions were used to assess and compare plan quality. DVHs for all uncertain scenarios along with the nominal DVH were plotted. The width of the “bands” of DVHs was used to quantify the plan sensitivity to uncertainty. The newly developed Benders decomposition method was compared with a commercial solution to demonstrate its computational efficiency. The trade-off between nominal plan quality and plan robustness was investigated. Results Our chance-constrained model outperformed the PTV method in terms of tumor coverage, tumor dose homogeneity, and plan robustness. Our model was shown to produce IMPT plans to meet the dose-volume constraints of organs at risk (OARs) and had better sparing of OARs than the PTV method in the three clinical cases included in this study. The chance-constrained model provided a flexible tool for users to balance between plan robustness and plan quality. In addition, our in-house developed method was found to be much faster than the commercial solution. Conclusion With explicit control of plan robustness, the chance-constrained robust optimization model generated superior IMPT plans compared to the PTV-based method.

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Exploratory Study of 4D versus 3D Robust Optimization in Intensity Modulated Proton Therapy for Lung Cancer

Cited by 114 publications

References 68 publications

In silico comparison of photons versus carbon ions in single fraction therapy of lung cancer

In silico comparison of photons versus carbon ions in single fraction therapy of lung cancer

Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy

Robust treatment planning with conditional value at risk chance constraints in intensity‐modulated proton therapy

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