Fast, Automated, Knowledge-Based Treatment Planning for Selecting Patients for Proton Therapy Based on Normal Tissue Complication Probabilities

• Published in: Advances in radiation oncology 2022-07, Vol.7 (4), p.100903-100903, Article 100903
• Main Authors: Hytönen, Roni, Vergeer, Marije R., Vanderstraeten, Reynald, Koponen, Timo K., Smith, Christel, Verbakel, Wilko F.A.R.
• Format: Article
• Language: English
• Subjects: Scientific
• ISSN: 2452-1094; 2452-1094
• DOI: 10.1016/j.adro.2022.100903

Selecting patients who will benefit from proton therapy is laborious and subjective. We demonstrate a novel automated solution for creating high-quality knowledge-based plans (KBPs) using proton and photon beams to identify patients for proton treatment based on their normal tissue complication probabilities (NTCP). Two previously validated RapidPlan PT models for locally advanced head and neck cancer were used in combination with scripting to automatically create proton and photon KBPs for 72 patients with recent oropharynx cancer. NTCPs were calculated for each patient based on the KBPs, and patient selection was simulated according to the current Dutch national protocol. The photon/proton KBP exhibited good correlation between predicted and achieved organ-at-risk mean doses, with a ≤5 Gy difference in 208/196 out of 215 structures relevant for the head and neck cancer NTCP model. The proton KBPs yielded on average 7.1/6.1/7.6 Gy lower dose to salivary/swallowing structures/oral cavity than the photon KBPs. This reduced average grade 2/3 dysphagia and xerostomia by 7.1/3.3 and 5.5/2.0 percentage points, resulting in 16 of 72 patients (22%) being indicated for proton treatment. The entire automated process took