International journal of particle therapy · 2025
Comprehensive Robustness Evaluation of Proton and Carbon-Ion Plans in Thoracic Cancer Treatment.
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Sheng Yinxiangzi, Volz Lennart, Mao Jingfang, Chen Jian, Steinsberger Timo, Wang Weiwei, Sun Jiayao, Han RongCheng, Durante Marco, Graeff Christian
Аннотация
PURPOSE: To evaluate the impact of setup errors, range uncertainty, and respiratory motion on dose distributions for clinically delivered pencil beam scanning proton and carbon-ion plans.
MATERIALS AND METHODS: A retrospective analysis was conducted on 23 lung cancer and trachea adenoid cystic carcinoma patients who received treatment at our center. Plans were generated using Syngo with planning target volume-based optimization. Dose reconstruction was performed using TReatment planning for Particles 4D. The plans robustness evaluation was performed using two methods: a worst scenarios conventional evaluation (WSCE) with 21 scenarios and a worst scenarios statistical evaluation (WSSE) with 100 randomly sampled scenarios. On top of the 3D evaluation considering setup error and range error, a 4D evaluation was performed considering motion-induced error.
RESULTS: The overall target dose ΔD95% was -2.37% ± 1.55% (mean ± standard deviation [SD]) of the prescribed dose (PD) and -2.62% ± 2.08% for 3DWSSE and 4DWSSE, respectively. The WSCE method often underestimated the dose by approximately 5% for ΔD95%. The induced uncertainties had limited impact on mean doses for Lungs-iGTV and heart. However, a ΔD1cc greater than 5% of PD was observed for the esophagus and trachea.
CONCLUSION: Conventional robustness evaluation showed significantly reduced target coverage, yet it considers highly improbable worst-case scenarios. Comprehensive WSSE enables the identification of critical patients without compromising plan quality by avoiding overestimation and compensating for unrealistic error scenarios.
MATERIALS AND METHODS: A retrospective analysis was conducted on 23 lung cancer and trachea adenoid cystic carcinoma patients who received treatment at our center. Plans were generated using Syngo with planning target volume-based optimization. Dose reconstruction was performed using TReatment planning for Particles 4D. The plans robustness evaluation was performed using two methods: a worst scenarios conventional evaluation (WSCE) with 21 scenarios and a worst scenarios statistical evaluation (WSSE) with 100 randomly sampled scenarios. On top of the 3D evaluation considering setup error and range error, a 4D evaluation was performed considering motion-induced error.
RESULTS: The overall target dose ΔD95% was -2.37% ± 1.55% (mean ± standard deviation [SD]) of the prescribed dose (PD) and -2.62% ± 2.08% for 3DWSSE and 4DWSSE, respectively. The WSCE method often underestimated the dose by approximately 5% for ΔD95%. The induced uncertainties had limited impact on mean doses for Lungs-iGTV and heart. However, a ΔD1cc greater than 5% of PD was observed for the esophagus and trachea.
CONCLUSION: Conventional robustness evaluation showed significantly reduced target coverage, yet it considers highly improbable worst-case scenarios. Comprehensive WSSE enables the identification of critical patients without compromising plan quality by avoiding overestimation and compensating for unrealistic error scenarios.