Comparison of cone beam computed tomography post-processing methods for online adaptive proton therapy of prostate cancer

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Mislav Bobić - , ETH Zurich, Massachusetts General Hospital (Author)
  • Daniel H. Bushe - , Massachusetts General Hospital (Author)
  • Hoyeon Lee - , Massachusetts General Hospital (Author)
  • Brian A. Winey - , Massachusetts General Hospital (Author)
  • Jason A. Efstathiou - , Massachusetts General Hospital (Author)
  • Harald Paganetti - , Massachusetts General Hospital (Author)
  • Jennifer Pursley - , Massachusetts General Hospital (Author)
  • Nils Peters - , Massachusetts General Hospital, University of Washington (Author)
  • Lena Nenoff - , Massachusetts General Hospital, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), OncoRay - National Centre for Radiation Research in Oncology (Author)

Abstract

Background and purpose: Although cone beam computed tomography (CBCT) enables online adaptive radiotherapy, its CT number accuracy may be insufficient for online adaptive proton therapy (OAPT). We compared proton dose distributions calculated directly on CBCT with calculations using additional CBCT image-processing methods in prostate cancer. Materials and methods: Retrospective proton plans were created for 10 prostate patients originally treated with 5-fraction online adaptive photon radiotherapy using CBCT. These plans were forward-calculated on each CBCT with four different approaches: (1) the clinical CBCT with a dedicated CT number calibration, (2) CBCT with histogram correction, (3) CT deformed to the CBCT, and (4) deformed CT with an air-cavity correction. Additionally, adaptive treatment using an OAPT workflow was simulated for each fraction and compared among the four CBCT-based methods. Dose-volume histograms (DVH) and related parameters were compared between the four methods for both non-adaptive and online adaptive treatment simulations. Results: Proton dose distributions were comparable across all CBCT-based strategies, with median differences of up to 1% for all DVH metrics compared to a reference method. Larger differences were observed for doses calculated directly on the CBCT for patient geometries deviating from the CBCT-specific calibration. Despite these differences, all four methods indicated the dosimetric benefits of OAPT over non-adaptive treatment. Conclusion: An advanced CBCT system enables proton dose calculations performed directly on the CBCT, demonstrating sufficient accuracy for integration into an OAPT workflow. Additional CBCT-based post-processing techniques are recommended to maximize the dosimetric benefit of plan adaptation in all patient populations.

Details

Original languageEnglish
Article number100858
JournalPhysics and imaging in radiation oncology
Volume36
Publication statusPublished - Oct 2025
Peer-reviewedYes

Keywords

Sustainable Development Goals

Keywords

  • Adaptive proton therapy, CBCT, Prostate cancer, Proton dose calculation, Proton therapy