title: Probabilistic evaluation of target dose deterioration in dose painting by numbers for stage II/III lung cancer.
abstract: OBJECTIVE
  Non-small cell lung cancer is typically irradiated with 60-66 Gy in 2-Gy fractions. Local control could be improved by increasing dose to the more radiation-resistant areas (eg, based on the standardized uptake values of a pretreatment [(18)F]fluoro-deoxyglucose positron emission tomography scan). Such dose painting approaches, however, are poorly suited for a conventional planning target volume margin expansion; therefore, typically no margins are used. This study investigates dose deterioration of a dose painting by numbers (DPBN) approach resulting from geometrical uncertainties.
  
  
  METHODS
  For 9 DPBN plans of stage II/III non-small cell lung cancer patients, the boost dose was escalated up to 130 Gy (in 33 fractions) or until a dose-limiting constraint was reached. Then, using Monte Carlo methods, a probabilistic evaluation of dose endpoints for 99%, 98%, and 2% of gross tumor volume at a 90% confidence level was performed considering 8 different combinations of systematic (∑) and random (σ) geometric error distributions.
  
  
  RESULTS
  Important underdosages, because of geometric uncertainties, of up to 38 Gy with minimal image guidance occur, reducing to 8 Gy with the highest level of image guidance, for a patient where a maximum dose of 119 Gy could be achieved. The evaluation showed that systematic errors had the largest influence. The effects of the uncertainties are most evident where the dose or its gradient is high.
  
  
  CONCLUSIONS
  Probabilistic evaluation showed that the geometric uncertainties have a large effect and should be evaluated before approving DPBN plans.
authors: Philips Research, Oncology Solutions, Eindhoven, The Netherlands; Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: davide.fontanarosa@philips.com.
authors: Davide
authors: D
authors: Fontanarosa
authors: Department of Radiation Oncology, Netherlands Cancer Institute and Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors: Marnix
authors: M
authors: Witte
authors: Department of Radiotherapy, University Medical Center, Utrecht, The Netherlands.
authors: Gert
authors: G
authors: Meijer
authors: Philips Technologie GmbH Innovative Technologies, Research Laboratories, Aachen, Germany.
authors: Georgy
authors: G
authors: Shakirin
authors: Department of Radiotherapy, Catharina Hospital, Eindhoven, the Netherlands.
authors: Jacco
authors: J
authors: Steenhuijsen
authors: Department of Radiotherapy, Catharina Hospital, Eindhoven, the Netherlands.
authors: Danny
authors: D
authors: Schuring
authors: Department of Radiation Oncology, Netherlands Cancer Institute and Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors: Marcel
authors: M
authors: van Herk
authors: Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors: Philippe
authors: P
authors: Lambin
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D015331:Cohort Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*