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

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Lena Heuchel - , Dortmund University of Technology (Author)
  • Christian Hahn - , Department of Radiotherapy and Radiooncology, OncoRay - National Center for Radiation Research in Oncology, Dortmund University of Technology, University Hospital Carl Gustav Carus Dresden (Author)
  • Jakob Ödén - , RaySearch Laboratories AB (Author)
  • Erik Traneus - , RaySearch Laboratories AB (Author)
  • Jörg Wulff - , University of Duisburg-Essen (Author)
  • Beate Timmermann - , University of Duisburg-Essen, German Cancer Research Center (DKFZ) (Author)
  • Christian Bäumer - , Dortmund University of Technology, University of Duisburg-Essen, German Cancer Research Center (DKFZ) (Author)
  • Armin Lühr - , Dortmund University of Technology (Author)

Abstract

Background: 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.

Details

Original languageEnglish
Pages (from-to)622-636
Number of pages15
JournalMedical physics
Volume51(2024)
Issue number1
Publication statusPublished - Jan 2024
Peer-reviewedYes

External IDs

PubMed 37877574

Keywords

Keywords

  • clean dose, dirty dose, linear energy transfer (LET), proton therapy treatment plan optimization, relative biological effectiveness (RBE)