ArticlePhysics and imaging in radiation oncology2023
Comparison of 3D and 4D robustly optimized proton treatment plans for non-small cell lung cancer patients with tumour motion amplitudes larger than 5 mm.
Article in Physics and imaging in radiation oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Interplay effect evaluation on lung and esophageal cancer patients treated with compact proton system in free breathing.Physics and imaging in radiation oncology · 2026Article
- Feasibility of in-vivo 4D prompt-gamma treatment verification in proton therapy for pancreatic cancer.Physics and imaging in radiation oncology · 2026Article
- Impact of four-dimensional computed tomography phase number on target coverage of four-dimensional robustly optimized lung stereotactic body radiotherapy.Scientific reports · 2025Article
- New guidelines and recommendations to advance treatment planning in proton therapy.Physics and imaging in radiation oncology · 2025Article
- Comparing different boost concepts and beam configurations for proton therapy of pancreatic cancer.Physics and imaging in radiation oncology · 2024Article
- The role of 4D particle therapy in daily patient care and research.Physics and imaging in radiation oncology · 2024Article
- A review of the clinical introduction of 4D particle therapy research concepts.Physics and imaging in radiation oncology · 2024Review
- Review and recommendations on deformable image registration uncertainties for radiotherapy applications.Physics in medicine and biology · 2023Review
- Parameter based 4D dose calculations for proton therapy.Physics and imaging in radiation oncology · 2023Article
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7 authors.
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Abstract
Background and purpose: There is no consensus about an ideal robust optimization (RO) strategy for proton therapy of targets with large intrafractional motion. We investigated the plan robustness of 3D and different 4D RO strategies. Materials and methods: For eight non-small cell lung cancer patients with clinical target volume (CTV) motion >5 mm, different RO approaches were investigated: 3DRO considering the average CT (AvgCT) with a target density override, 4DRO considering three/all 4DCT phases, and 4DRO considering the AvgCT and three/all 4DCT phases. Robustness against setup/range errors, interplay effects based on breathing and machine log file data for deliveries with/without rescanning, and interfractional anatomical changes were analyzed for target coverage and OAR sparing. Results: All nominal plans fulfilled the clinical requirements with individual CTV coverage differences <2pp; 4DRO without AvgCT generated the most conformal dose distributions. Robustness against setup/range errors was best for 4DRO with AvgCT (18% more passed error scenarios than 3DRO). Interplay effects caused fraction-wise median CTV coverage loss of 3pp and missed maximum dose constraints for heart and esophagus in 18% of scenarios. CTV coverage and OAR sparing fulfilled requirements in all cases when accumulating four interplay scenarios. Interfractional changes caused less target misses for RO with AvgCT compared to 4DRO without AvgCT (≤42%/33% vs. ≥56%/44% failed single/accumulated scenarios). Conclusions: All RO strategies provided acceptable plans with equally low robustness against interplay effects demanding other mitigation than rescanning to ensure fraction-wise target coverage. 4DRO considering three phases and the AvgCT provided best compromise on planning effort and robustness.
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