The dirty and clean dose concept: towards creating proton therapy treatment plans with a photon-like dose response

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dc.contributor.authorHeuchel, Lena
dc.contributor.authorHahn, Christian
dc.contributor.authorÖdén, Jakob
dc.contributor.authorTraneus, Erik
dc.contributor.authorWulff, Jörg
dc.contributor.authorTimmermann, Beate
dc.contributor.authorBäumer, Christian
dc.contributor.authorLühr, Armin
dc.date.accessioned2024-08-29T07:25:42Z
dc.date.available2024-08-29T07:25:42Z
dc.date.issued2023-10-25
dc.description.abstractBackground: Applying tolerance doses for organs at risk (OAR) from photon therapy introduces uncertainties in proton therapy when assuming a constant relative biological effectiveness (RBE) of 1.1. Purpose: This work introduces the novel dirty and clean dose concept, which allows for creating treatment plans with a more photon-like dose response for OAR and, thus, less uncertainties when applying photon-based tolerance doses. Methods: The concept divides the 1.1-weighted dose distribution into two parts: the clean and the dirty dose. The clean and dirty dose are deposited by protons with a linear energy transfer (LET) below and above a set LET threshold, respectively. For the former, a photon-like dose response is assumed, while for the latter, the RBE might exceed 1.1. To reduce the dirty dose in OAR, a MaxDirtyDose objective was added in treatment plan optimization. It requires setting two parameters: LET threshold and max dirty dose level. A simple geometry consisting of one target volume and one OAR in water was used to study the reduction in dirty dose in the OAR depending on the choice of the two MaxDirtyDose objective parameters during plan optimization. The best performing parameter combinations were used to create multiple dirty dose optimized (DDopt) treatment plans for two cranial patient cases. For each DDopt plan, 1.1-weighted dose, variable RBE-weighted dose using the Wedenberg RBE model and dose-average LETd distributions as well as resulting normal tissue complication probability (NTCP) values were calculated and compared to the reference plan (RefPlan) without MaxDirtyDose objectives. Results: In the water phantom studies, LET thresholds between 1.5 and 2.5 keV/µm yielded the best plans and were subsequently used. For the patient cases, nearly all DDopt plans led to a reduced Wedenberg dose in critical OAR. This reduction resulted from an LET reduction and translated into an NTCP reduction of up to 19 percentage points compared to the RefPlan. The 1.1-weighted dose in the OARs was slightly increased (patient 1: 0.45 Gy(RBE), patient 2: 0.08 Gy(RBE)), but never exceeded clinical tolerance doses. Additionally, slightly increased 1.1-weighted dose in healthy brain tissue was observed (patient 1: 0.81 Gy(RBE), patient 2: 0.53 Gy(RBE)). The variation of NTCP values due to variation of α/β from 2 to 3 Gy was much smaller for DDopt (2 percentage points (pp)) than for RefPlans (5 pp). Conclusions: The novel dirty and clean dose concept allows for creating biologically more robust proton treatment plans with a more photon-like dose response. The reduced uncertainties in RBE can, therefore, mitigate uncertainties introduced by using photon-based tolerance doses for OAR.en
dc.identifier.urihttp://hdl.handle.net/2003/42660
dc.identifier.urihttp://dx.doi.org/10.17877/DE290R-24496
dc.language.isoende
dc.relation.ispartofseriesMedical physics;51(1)
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/de
dc.subjectclean doseen
dc.subjectdirty doseen
dc.subjectlinear energy transfer (LET)en
dc.subjectproton therapy treatment plan optimizationen
dc.subjectrelative biological effectiveness (RBE)en
dc.subject.ddc530
dc.titleThe dirty and clean dose concept: towards creating proton therapy treatment plans with a photon-like dose responseen
dc.typeTextde
dc.type.publicationtypeResearchArticlede
dcterms.accessRightsopen access
eldorado.secondarypublicationtruede
eldorado.secondarypublication.primarycitationHeuchel L, Hahn C, Ödén J, et al. The dirty and clean dose concept: Towards creating proton therapy treatment plans with a photon-like dose response. Med Phys. 2024; 51: 622–636. https://doi.org/10.1002/mp.16809de
eldorado.secondarypublication.primaryidentifierhttps://doi.org/10.1002/mp.16809de

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