SU‐E‐T‐527: Is CTV‐Based Robust Optimized IMPT in Non‐Small‐Cell Lung Cancer Robust Against Respiratory Motion?

Purpose: To determine which proton planning technique on average-CT is more vulnerable to respiratory motion induced density changes and interplay effect among (a) IMPT of CTV-based minimax robust optimization with 5mm set-up error considered, (b, c) IMPT/SFUD of 5mm-expanded PTV optimization. Methods: Three planning techniques were optimized in Raystation with a prescription of 60/25 (Gy/fractions) and almost the same OAR constraints/objectives for each of 10 NSCLC patients. 4D dose without/with interplay effect was recalculated on eight 4D-CT phases and accumulated after deforming the dose of each phase to a reference (exhalation phase). The change of D98% of each CTV caused by density changes and interplay was determined. In addition, evaluation of the DVH information vector (D99%, D98%, D95%, Dave, D50%, D2%, D1%) which compares the whole DVH by η score = (cosine similarity × Pearson correlation coefficient − 0.9) × 1000 quantified the degree of DVH change: score below 100 indicates changed DVH. Results: Three 3D plans of each technique satisfied our clinical goals. D98% shift mean±SD (Gy) due to density changes was largest in (c): −0.78±1.1 while (a): −0.11±0.65 and (b): − 0.59±0.93. Also the shift due to interplay effect most was (c): −.54±0.70 whereas (a): −0.25±0.93 and (b): −0.12±0.13. Moreover lowest η score caused by density change was also (c): 69, while (a) and (b) kept around 90. η score also indicated less effect of interplay than density changes. Note that generally the changed DVH were still acceptable clinically. Paired T-tests showed a significantly smaller density change effect in (a) (p<0.05) than in (b) or (c) and no significant difference in interplay effect. Conclusion: CTV-based robust optimized IMPT was more robust against respiratory motion induced density changes than PTV-based IMPT and SFUD. The interplay effect was smaller than the effect of density changes and similar among the three techniques. The JSPS Core-to-Core Program (No. 23003), Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research (No. 23390300), Grant-in-Aid for Young Scientists (B) (No. 21791194) and Grant-in-Aid for Cancer Research (H22-3rd Term Cancer Control-General-043)