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Treatment Planning: comparing techniques and standards

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Abstract

Purpose

To highlight merits and pitfalls of treatment plan comparison between photon-based conventional radiation therapy (XRT) and particle-based (proton and carbon ions) therapy (PT).

Methods

The physical and dosimetric rationales for the use of PT will be explored looking at their advantages and disadvantages with a specific focus on sensitivity to range and biological uncertainties. Next, the analysis will focus on linear energy transfer (LET) and its correlation with relative biological effectiveness (RBE), particularly within the context of plan optimization and evaluation phases in proton therapy. This examination aims to address the impact of the LET/RBE interplay on radiobiological uncertainties.

Results

There is a wide literature of planning studies comparing PT and the most advanced XRT techniques. Purely dosimetric advantages are translated into normal tissue complication probability (NTCP) variation to drive patient optimal allocation, but the impact of range uncertainty needs to be accounted for, together with the consequent need for plan adaptation and organ motion management. RBE modelling and entailed clinical effects are currently central in PT research, while new degrees of freedom are being introduced with LET-based plan optimization and evaluation.

Conclusions

PT shows many dosimetric advantages but emphasizes challenges like range uncertainty. RBE modelling plays a crucial role, and LET-based optimization introduces new possibilities. Addressing uncertainties and embracing innovation are vital for enhancing PT’s efficacy.

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Data availability

The data supporting the findings of this study can be accessed from the corresponding author upon a reasonable request. However, please note that restrictions may apply due to the potential inclusion of information that could compromise the privacy of participants.

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Acknowledgements

This work has been partly founded by the European Union’s Horizon 2020 research and innovation program under grant agreement No. 101008548 (HITRIplus).

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The authors declare that no funds, grants, or any other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy

    Silvia Molinelli, Alfredo Mirandola, Giuseppe Magro, Stefania Russo, Alessandro Vai, Eleonora Rossi, Alessia Bazani, Luca Trombetta, Matteo Bagnalasta, Ester Orlandi & Mario Ciocca

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  1. Silvia Molinelli
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SM, GM and AV. The first draft of the manuscript was written by SM and all authors commented on previous versions of the manuscript. Further revisions have been managed by GM. All authors read and approved the final manuscript.

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Correspondence to Giuseppe Magro.

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Molinelli, S., Mirandola, A., Magro, G. et al. Treatment Planning: comparing techniques and standards. Health Technol. (2024). https://doi.org/10.1007/s12553-024-00845-8

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