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Comparing the Robustness of Intensity-modulated Proton Therapy and Proton-arc Therapy Against Interplay Effects of 4D Robust-optimised Plans for Lung Stereotactic Body Radiotherapy

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机构： [1]Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China [2]Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China [3]Department of Radiotherapy & Oncology, The First Affiliated Hospital of Soochow University, Institute of Radiotherapy & Oncology, Soochow University, Suzhou 215006, China [4]Department of Medical Physics, Brown University, Providence, RI 02912, USA

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关键词： Dose uncertainty hypofractionation treatment proton therapy robust optimisation

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To assess the robustness of 4D-optimised IMPT and PAT plans against interplay effects in non-small cell lung cancer (NSCLC) patients with respiratory motion over 10 mm, and to provide insights into the use of proton-based stereotactic body radiotherapy (SBRT) for lung cancer with significant tumour movement.Fourteen patients with early-stage NSCLC and tumour motion >10 mm were selected. Three hypofraction regimens were generated using 4D robust optimisation with the IMPT and PAT techniques. The nominal plan qualities for both techniques were compared, and their robustness against setup and range uncertainties was evaluated. 4D dynamic dose and the 4D static dose were generated to calculate ΔIMR(%) for interplay effects.PAT plans demonstrated superior target metrics such as D95 and D2, and offered enhanced protection for organs at risk (OARs), particularly in lung metrics, across multiple fractionation schemes (p < 0.05). The robustness of target coverage against setup and range uncertainties was better in PAT plans than IMPT, with average pass rates of 97.8% and 95.4%, respectively (p < 0.01). The interplay effect significantly affected target metrics in single-fraction plans, decreasing with more fractions, while its effect on OAR metrics was minimal. Median values for single-fraction plans were: ΔID98GTV was -3% for IMPT and -0.7% for PAT (p < 0.01); ΔID95GTV was -2.4% for IMPT and -0.6% for PAT (p < 0.01); ΔID2GTV was 3.2% for IMPT and 0.9% for PAT (p < 0.05). The interplay effects resulted in median homogeneity index deviations of 9.1% and 2% for the IMPT and PAT plans, respectively (p < 0.01). Different starting phases affected IMPT more significantly than PAT.PAT demonstrated greater robustness to interplay effects than IMPT for hypofractionated treatments of early-stage NSCLC, particularly in single-fraction schemes. Additionally, PAT showed good resilience to variations in different starting phases.Copyright © 2025 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

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大类 | 3 区医学

小类 | 3 区肿瘤学

第一作者：

第一作者机构： [1]Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China [2]Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China

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通讯机构： [1]Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China [2]Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China

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Comparing the Robustness of Intensity-modulated Proton Therapy and Proton-arc Therapy Against Interplay Effects of 4D Robust-optimised Plans for Lung Stereotactic Body Radiotherapy

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