A fundamental challenge in the treatment planning process of multi-fractional external-beam radiation therapy (EBRT) is the tradeoff between tumor control and normal tissue sparing in the presence of geometric uncertainties (GUs). To accommodate GUs, the conventional way is to use an empirical planning treatment volume (PTV) margin on the treatment target. However, it is difficult to determine a near-optimal PTV margin to ensure specified target coverage with as much normal tissue protection as achievable. Coverage optimized planning (COP) avoids this problem by optimizing dose in possible virtual treatment courses with GU models directly incorporated. A near-optimal dosimetric margin generated by COP was reported to savvily accommodate setup errors of target and normal tissues for prostate cancer treatment. This work further develops COP to account for (1) deformable organ motion and (2) delineation uncertainties for high-risk prostate cancer patients. The clinical value of COP is investigated by comparing with two margin-based planning techniques: (i) optimized margin (OM) technique that iteratively modifies PTV margins according to the evaluated target coverage probability and (ii) fixed margin (FM) technique that uses empirically selected constant PTV margins. Without patient-specific coverage probability estimation, FM plans are always less immune to the degraded effect of the modeled GUs than the COP plans or the OM plans. Empirical PTV margins face more risks of undesirable target coverage probability and/or excessive dose to surrounding OAR. The value of COP relative to OM varies with different GUs. As implemented for deformable organ motions, COP has limited clinical benefit. Due to optimization tradeoffs, COP often results in target coverage probability below the prescribed value while OM achieves better target coverage with comparable normal tissue dose. For delineation uncertainties, the clinical value of COP is potentially significant. Compared to OM, COP successfully maintains acceptable target coverage probability by exploiting the slack of normal tissue dose in low dose regions and maximally limiting high dose to normal tissue within tolerance.
| Identifer | oai:union.ndltd.org:vcu.edu/oai:scholarscompass.vcu.edu:etd-4060 |
| Date | 12 April 2013 |
| Creators | Xu, Huijun |
| Publisher | VCU Scholars Compass |
| Source Sets | Virginia Commonwealth University |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | Theses and Dissertations |
| Rights | © The Author |
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