Probabilistic evaluation of target dose deterioration in dose painting by numbers for stage II/III lung cancer

Davide Fontanarosa*, Marnix Witte, Gert Meijer, Georgy Shakirin, Jacco Steenhuijsen, Danny Schuring, Marcel van Herk, Philippe Lambin

*Corresponding author for this work

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Abstract

Purpose: Non-small cell lung cancer is typically irradiated with 60-66 Gy in 2-Gy fractions. Local control could be improved by increasing dose to the more radiation-resistant areas (eg, based on the standardized uptake values of a pretreatment [18F]fluoro-deoxyglucose positron emission tomography scan). Such dose painting approaches, however, are poorly suited for a conventional planning target volume margin expansion; therefore, typically no margins are used. This study investigates dose deterioration of a dose painting by numbers (DPBN) approach resulting from geometrical uncertainties. Methods and materials: For 9 DPBN plans of stage II/III non-small cell lung cancer patients, the boost dose was escalated up to 130 Gy (in 33 fractions) or until a dose-limiting constraint was reached. Then, using Monte Carlo methods, a probabilistic evaluation of dose endpoints for 99%, 98%, and 2% of gross tumor volume at a 90% confidence level was performed considering 8 different combinations of systematic (∑) and random (σ) geometric error distributions. Results: Important underdosages, because of geometric uncertainties, of up to 38 Gy with minimal image guidance occur, reducing to 8 Gy with the highest level of image guidance, for a patient where a maximum dose of 119 Gy could be achieved. The evaluation showed that systematic errors had the largest influence. The effects of the uncertainties are most evident where the dose or its gradient is high. Conclusions: Probabilistic evaluation showed that the geometric uncertainties have a large effect and should be evaluated before approving DPBN plans.
Original languageEnglish
Pages (from-to)e375-e382
JournalPractical radiation oncology
Volume5
Issue number4
DOIs
Publication statusPublished - 2015

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