title: Evaluation of Robustness to Setup and Range Uncertainties for Head and Neck Patients Treated With Pencil Beam Scanning Proton Therapy.
abstract: OBJECTIVE
  To evaluate the robustness of head and neck plans for treatment with intensity modulated proton therapy to range and setup errors, and to establish robustness parameters for the planning of future head and neck treatments.
  
  
  METHODS
  Ten patients previously treated were evaluated in terms of robustness to range and setup errors. Error bar dose distributions were generated for each plan, from which several metrics were extracted and used to define a robustness database of acceptable parameters over all analyzed plans. The patients were treated in sequentially delivered series, and plans were evaluated for both the first series and for the combined error over the whole treatment. To demonstrate the application of such a database in the head and neck, for 1 patient, an alternative treatment plan was generated using a simultaneous integrated boost (SIB) approach and plans of differing numbers of fields.
  
  
  RESULTS
  The robustness database for the treatment of head and neck patients is presented. In an example case, comparison of single and multiple field plans against the database show clear improvements in robustness by using multiple fields. A comparison of sequentially delivered series and an SIB approach for this patient show both to be of comparable robustness, although the SIB approach shows a slightly greater sensitivity to uncertainties.
  
  
  CONCLUSIONS
  A robustness database was created for the treatment of head and neck patients with intensity modulated proton therapy based on previous clinical experience. This will allow the identification of future plans that may benefit from alternative planning approaches to improve robustness.
authors.affiliation: Centre for Proton Radiotherapy, PSI, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Malyapa
authors.affiliation: Manchester Academic Health Science Centre, Faculty of Medical and Human Sciences, University of Manchester, UK; Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lowe
authors.affiliation: Centre for Proton Radiotherapy, PSI, Switzerland.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bolsi
authors.affiliation: Centre for Proton Radiotherapy, PSI, Switzerland.
authors.forename: Antony J
authors.initials: AJ
authors.lastname: Lomax
authors.affiliation: University of Zürich, Zürich, Switzerland.
authors.forename: Damien C
authors.initials: DC
authors.lastname: Weber
authors.affiliation: Centre for Proton Radiotherapy, PSI, Switzerland. Electronic address: francesca.albertini@psi.ch.
authors.forename: Francesca
authors.initials: F
authors.lastname: Albertini
mesh_terms: D000328:Adult; D001933:Brain Stem; D002648:Child; D016208:Databases, Factual; D019583:Dose Fractionation, Radiation; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D009897:Optic Chiasm; D009900:Optic Nerve; D058958:Organs at Risk / Q000528:radiation effects; D061766:Proton Therapy / Q000379:methods*; D011859:Radiography; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D061106:Radiotherapy Setup Errors; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012062:Relative Biological Effectiveness; D013116:Spinal Cord; D035501:Uncertainty