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Analytical modeling of depth-dose degradation in heterogeneous lung tissue for intensity-modulated proton therapy planning.
Phys. Imag. Radiat. Oncology 14, 32-38 (2020)
Background and purpose: Proton therapy may be promising for treating non-small-cell lung cancer due to lower doses to the lung and heart, as compared to photon therapy. A reported challenge is degradation, i.e., a smoothing of the depth-dose distribution due to heterogeneous lung tissue. For pencil beams, this causes a distal falloff widening and a peak-to-plateau ratio decrease, not considered in clinical treatment planning systems. Materials and methods: We present a degradation model implemented into an analytical dose calculation, fully integrated into a treatment planning workflow. Degradation effects were investigated on target dose, distal dose falloffs, and mean lung dose for ten patient cases with varying anatomical characteristics. Results: For patients with pronounced range straggling (in our study large tumors, or lesions close to the mediastinum), degradation effects were restricted to a maximum decrease in target coverage (D95 of the planning target volume) of 1.4%. The median broadening of the distal 80–20% dose falloffs was 0.5 mm at the maximum. For small target volumes deep inside lung tissue, however, the target underdose increased considerably by up to 26%. The mean lung dose was not negatively affected by degradation in any of the investigated cases. Conclusion: For most cases, dose degradation due to heterogeneous lung tissue did not yield critical organ at risk overdosing or overall target underdosing. However, for small and deep-seated tumors which can only be reached by penetrating lung tissue, we have seen substantial local underdose, which deserves further investigation, also considering other prevalent sources of uncertainty.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
Bragg Peak Degradation ; Depth-dose Degradation ; Heterogeneous Lung Tissue ; Non-small-cell Lung Carcinoma ; Proton Therapy ; Radiotherapy Planning
ISSN (print) / ISBN
2405-6316
e-ISSN
2405-6316
Quellenangaben
Volume: 14,
Pages: 32-38
Publisher
Elsevier
Non-patent literature
Publications
Reviewing status
Peer reviewed
Institute(s)
Institute of Radiation Medicine (IRM)