ArticleJournal of applied clinical medical physics2026
Omission of lateral isocenter shifts in robust optimization of proton therapy treatment plans for prostate cancer.
Article in Journal of applied clinical medical physics, 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
backgroundProton therapy is routinely used to treat prostate cancer using bilaterally opposed beams and can achieve lower dose to nearby organs-at-risk (OARs) such as the bladder and rectum. Pencil beam scanning (PBS) proton therapy offers the most conformal treatment plans to best spare healthy tissue. Robust optimization is often utilized in planning PBS treatment to account for uncertainties in treatment delivery, such as misalignment of the isocenter, by evaluating the dose in perturbation scenarios in which the isocenter is translated. This process is effective but resource intensive and time consuming. PURPOSE: To assess the feasibility of omitting lateral translations of the isocenter in robust optimization of pencil-beam scanning (PBS) proton therapy treatment plans for prostate cancer patients, utilizing parallel opposed lateral beams.
methodsThe impact of isocenter shifts in the beam direction was studied systematically in a series of cube plans of varying field size and depth in water. In addition, the impact of omitting lateral isocenter shifts in robust optimization was analyzed retrospectively across sixteen clinical treatment plans, including plans with pelvic lymph nodes (LN) and a simultaneous integrated boost (SIB) delivered to the dominant intraprostatic lesion (DIL) or PET avid LNs. The impact on key dose-volume metrics for several OARs, as well as the results of robust evaluation and the difference in optimization time were recorded.
resultsThe plan comparison shows no significant difference in dose to any OAR or robust target coverage for any of the plans considered. The time required for a single optimization with fixed settings reduced by 24 min (22%) on average, with a maximum reduction of 129 min (43.1%).
conclusionsLateral isocenter shifts can be safely omitted in robust optimization of PBS proton therapy treatment plans for prostate patients, utilizing parallel opposed lateral beams, to achieve a significant reduction in optimization time, without increasing dose to OARs or sacrificing robust target coverage.
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