4D Proton treatment planning strategy for mobile lung tumors.
OBJECTIVE
To investigate strategies for designing compensator-based 3D proton treatment plans for mobile lung tumors using four-dimensional computed tomography (4DCT) images.


METHODS
Four-dimensional CT sets for 10 lung cancer patients were used in this study. The internal gross tumor volume (IGTV) was obtained by combining the tumor volumes at different phases of the respiratory cycle. For each patient, we evaluated four planning strategies based on the following dose calculations: (1) the average (AVE) CT; (2) the free-breathing (FB) CT; (3) the maximum intensity projection (MIP) CT; and (4) the AVE CT in which the CT voxel values inside the IGTV were replaced by a constant density (AVE_RIGTV). For each strategy, the resulting cumulative dose distribution in a respiratory cycle was determined using a deformable image registration method.


RESULTS
There were dosimetric differences between the apparent dose distribution, calculated on a single CT dataset, and the motion-corrected 4D dose distribution, calculated by combining dose distributions delivered to each phase of the 4DCT. The AVE_RIGTV plan using a 1-cm smearing parameter had the best overall target coverage and critical structure sparing. The MIP plan approach resulted in an unnecessarily large treatment volume. The AVE and FB plans using 1-cm smearing did not provide adequate 4D target coverage in all patients. By using a larger smearing value, adequate 4D target coverage could be achieved; however, critical organ doses were increased.


CONCLUSIONS
The AVE_RIGTV approach is an effective strategy for designing proton treatment plans for mobile lung tumors.
Kang
Yixiu
Y
Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
Zhang
Xiaodong
X
Chang
Joe Y
JY
Wang
He
H
Wei
Xiong
X
Liao
Zhongxing
Z
Komaki
Ritsuko
R
Cox
James D
JD
Balter
Peter A
PA
Liu
Helen
H
Zhu
X Ronald
XR
Mohan
Radhe
R
Dong
Lei
L
D006801:Humans; D007091:Image Processing, Computer-Assisted; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D009068:Movement; D061766:Proton Therapy; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D011522:Protons
D011522:Protons