ArticlePhysical and engineering sciences in medicine2026
Optimizing allocation of limited proton fractions via NTCP-optimized combined proton-photon radiotherapy.
Article in Physical and engineering sciences in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Compared to photon radiotherapy (RT), proton RT is less widely available and more costly. To maximize the normal-tissue complication probability (NTCP) benefit of limited proton resources at a population level, this work introduces a novel NTCP-optimized combined proton-photon treatment (NTCP-CPPT) approach that can achieve the OAR-sparing benefits in terms of reaching desired NTCP thresholds with the minimal proton fraction. NTCP-optimized intensity-modulated proton therapy (NTCP-IMPT) and NTCP-optimized intensity-modulated radiation therapy (NTCP-IMRT) plans are generated via the NTCP-optimized treatment planning based on physical dose and NTCP objectives. For each patient, a minimal proton fraction is determined for the NTCP-CPPT plan as a combination of NTCP-IMPT and NTCP-IMRT plans, while still retaining the sum-NTCP threshold for the patient to be justified for the proton access. For comparison, conventional CPPT (CONV-CPPT) plans are obtained by a combination of conventional IMRT (CONV-IMRT) and conventional IMPT (CONV-IMPT) plans that are solely optimized based on physical dose optimization. Compared to CONV-CPPT, NTCP-CPPT reduced the average proton fractions from 18 to 3 without compromising physical dose objectives, while both NTCP-CPPT and CONV-CPPT plans maintained a sum-NTCP below 20% relative to CONV-IMRT. Additionally, NTCP-CPPT, using an average of 22 proton fractions out of 35, maintained the same sum-NTCP as CONV-IMPT required 35 proton fractions. To increase patient access to proton RT, a novel combined proton-photon treatment called NTCP-CPPT is proposed that can provide a minimal number of proton fractions while still retaining sufficient OAR-sparing benefits to justify the proton access.
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