title: Multifield optimization intensity-modulated proton therapy (MFO-IMPT) for prostate cancer: Robustness analysis through simulation of rotational and translational alignment errors.
abstract: To evaluate the dosimetric consequences of rotational and translational alignment errors in patients receiving intensity-modulated proton therapy with multifield optimization (MFO-IMPT) for prostate cancer. Ten control patients with localized prostate cancer underwent treatment planning for MFO-IMPT. Rotational and translation errors were simulated along each of 3 axes: anterior-posterior (A-P), superior-inferior (S-I), and left-right. Clinical target-volume (CTV) coverage remained high with all alignment errors simulated. Rotational errors did not result in significant rectum or bladder dose perturbations. Translational errors resulted in larger dose perturbations to the bladder and rectum. Perturbations in rectum and bladder doses were minimal for rotational errors and larger for translational errors. Rectum V45 and V70 increased most with A-P misalignment, whereas bladder V45 and V70 changed most with S-I misalignment. The bladder and rectum V45 and V70 remained acceptable even with extreme alignment errors. Even with S-I and A-P translational errors of up to 5mm, the dosimetric profile of MFO-IMPT remained favorable. MFO-IMPT for localized prostate cancer results in robust coverage of the CTV without clinically meaningful dose perturbations to normal tissue despite extreme rotational and translational alignment errors.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. tpugh@mdanderson.org
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Pugh
authors.forename: Richard A
authors.initials: RA
authors.lastname: Amos
authors.forename: Sandra
authors.initials: S
authors.lastname: John Baptiste
authors.forename: Seungtaek
authors.initials: S
authors.lastname: Choi
authors.forename: Quyhn
authors.initials: Q
authors.lastname: Nhu Nguyen
authors.forename: X
authors.initials: X
authors.lastname: Ronald Zhu
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Palmer
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Lee
mesh_terms: D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D061766:Proton Therapy; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012007:Rectum / Q000528:radiation effects; D012399:Rotation; D001743:Urinary Bladder / Q000528:radiation effects; D011522:Protons
chemical_list: D011522:Protons
keywords: IMPT; Prostate cancer; Proton therapy; Robustness