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. 2013 Aug;40(8):081709.
doi: 10.1118/1.4813900.

Preliminary evaluation of multifield and single-field optimization for the treatment planning of spot-scanning proton therapy of head and neck cancer

Enzhuo M Quan  1 , Wei Liu, Richard Wu, Yupeng Li, Steven J Frank, Xiaodong Zhang, X Ronald Zhu, Radhe Mohan
Affiliations

Preliminary evaluation of multifield and single-field optimization for the treatment planning of spot-scanning proton therapy of head and neck cancer

Enzhuo M Quan et al. Med Phys. 2013 Aug.

Abstract

Purpose: Spot-scanning proton therapy (SSPT) using multifield optimization (MFO) can generate highly conformal dose distributions, but it is more sensitive to setup and range uncertainties than SSPT using single-field optimization (SFO). The authors compared the two optimization methods for the treatment of head and neck cancer with bilateral targets and determined the superior method on the basis of both the plan quality and the plan robustness in the face of setup and range uncertainties.

Methods: Four patients with head and neck cancer with bilateral targets who received SSPT treatment in the authors' institution were studied. The patients had each been treated with a MFO plan using three fields. A three-field SFO plan (3F-SFO) and a two-field SFO plan (2F-SFO) with the use of a range shifter in the beam line were retrospectively generated for each patient. The authors compared the plan quality and robustness to uncertainties of the SFO plans with the MFO plans. Robustness analysis of each plan was performed to generate the two dose distributions consisting of the highest and the lowest possible doses (worst-case doses) from the spatial and range perturbations at every voxel. Dosimetric indices from the nominal and worst-case plans were compared.

Results: The 3F-SFO plans generally yielded D95 and D5 values in the targets that were similar to those of the MFO plans. 3F-SFO resulted in a lower dose to the oral cavity than MFO in all four patients by an average of 9.9 Gy, but the dose to the two parotids was on average 6.7 Gy higher for 3F-SFO than for MFO. 3F-SFO plans reduced the variations of dosimetric indices under uncertainties in the targets by 22.8% compared to the MFO plans. Variations of dosimetric indices under uncertainties in the organs at risk (OARs) varied between organs and between patients, although they were on average 9.2% less for the 3F-SFO plans than for the MFO plans. Compared with the MFO plans, the 2F-SFO plans showed a reduced dose to the parotids for both the nominal dose and in the worst-case scenario, but the plan robustness in the target of the 2F-SFO plans was not notably greater than that of the MFO plans.

Conclusions: Compared with MFO, 3F-SFO improves plan robustness in the targets but degrades dose sparing in the parotids in both the nominal and worst-case scenarios. Although 2F-SFO improves parotid sparing compared with MFO, it produces little improvement in plan robustness. Therefore, considering its tolerable target coverage and sparing of OARs in worst-case scenarios, the authors recommend MFO as the planning method for the treatment of head and neck cancer with bilateral targets.

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Figures

Figure 1
Figure 1
Dose distributions from the MFO (left), 3F-SFO (middle), and 2F-SFO (right) plans for patient 3. The arrows indicate the angles of the proton beams.
Figure 2
Figure 2
Banded DVHs of the 3F-MFO, 3F-SFO, and 2F-SFO plans for patient 3. The solid lines are DVHs for the nominal doses, and the shaded areas (the bands) are bounded by the DVHs for the cold and hot doses obtained from the robustness analysis.
Figure 3
Figure 3
Dosimetric indices in the targets (a) and the OARs (b) from the MFO, 3F-SFO, and 2F-SFO plans averaged over the four patients. The maximums and minimums of each error bar were taken from the hot and cold plans, respectively, calculated from the robustness analysis. Lt: Left; Rt: Right.
Figure 4
Figure 4
Length of the worst-case error bars in the targets displayed in Fig. 3. For D95, it is given by the minimum error, and for D5, the maximum error.
See this image and copyright information in PMC

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