SU‐F‐BRD‐02: Incorporating Uncertainty Analysis in Plan Comparison of VMAT, Double Scattering Proton Plan and IMPT for Lung Irradiation

Abstract

Purpose:We investigate the effect of residual setup and motion errors in lung irradiation for VMAT, double scattering (DS) proton beams and spot scanning (IMPT) in a case study.Methods:The CT image and contour sets of a lung patient treated with 6 MV VMAT is re‐planned with DS as well as IMPT subject to the same constraints; V20(lung), V10(lung) and V5(lung)< 15%, 20% and 25% respectively, V20(heart)<25% and V100%(PTV)≥95%. In addition, uncertainty analysis in the form of isocenter shifts (±1–3mm) was incorporated in the DVH calculations to assess the plan robustness.Results:Only the IMPT plan satisfies all the specified constraints. The 3D‐conformal DS proton plan is able to achieve better sparing of the lung and heart dose compared to VMAT. For the lung, V20, V10 and V5 are 13%, 19% and 25% respectively for IMPT, 18%, 23% and 30% respectively for DS, and 20%, 30% and 42% respectively for VMAT. For heart: 0.6% for IMPT, 2.4% for DS and 30% for VMAT. When incorporating isocenter shifts in DVH calculations, the maximum changes in V20, V10 and V5 for lung are 14%, 21% and 28% respectively for IMPT. The corresponding max changes are19%, 24% and 32% respectively for DS, and 22%, 32% and 44% respectively for VMAT. The largest change occurs in the PTV coverage. For IMPT, V100%(PTV) varies between 88–96%, while V100%(PTV) for VMAT suffers a larger change compared to DS (Δ=5.5% vs 3.3%).Conclusion:While only IMPT satisfies the stringent dose‐volume constraints for the lung irradiation, it is not as robust as the 3D conformal DS plan. DS also has better sparing in lung and heart compared to VMAT and similar PTV coverage. By including isocenter shifts in dose‐volume calculations in treatment planning of lung, DS appears to be more robust than VMAT.