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@ARTICLE{Steitz:130601,
      author       = {J. Steitz$^*$ and P. Naumann and S. Ulrich$^*$ and M. F.
                      Haefner and F. Sterzing$^*$ and U. Oelfke and M.
                      Bangert$^*$},
      title        = {{W}orst case optimization for interfractional motion
                      mitigation in carbon ion therapy of pancreatic cancer.},
      journal      = {Radiation oncology},
      volume       = {11},
      number       = {1},
      issn         = {1748-717X},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DKFZ-2017-05679},
      pages        = {134},
      year         = {2016},
      abstract     = {The efficacy of radiation therapy treatments for pancreatic
                      cancer is compromised by abdominal motion which limits the
                      spatial accuracy for dose delivery - especially for
                      particles. In this work we investigate the potential of
                      worst case optimization for interfractional offline motion
                      mitigation in carbon ion treatments of pancreatic cancer.We
                      implement a worst case optimization algorithm that
                      explicitly models the relative biological effectiveness of
                      carbon ions during inverse planning. We perform a
                      comparative treatment planning study for seven pancreatic
                      cancer patients. Treatment plans that have been generated
                      using worst case optimization are compared against (1)
                      conventional intensity-modulated carbon ion therapy, (2)
                      single field uniform dose carbon ion therapy, and (3) an
                      ideal yet impractical scenario relying on daily re-planning.
                      The dosimetric quality and robustness of the resulting
                      treatment plans is evaluated using reconstructions of the
                      daily delivered dose distributions on fractional control
                      CTs.Idealized daily re-planning consistently gives the best
                      dosimetric results with regard to both target coverage and
                      organ at risk sparing. The absolute reduction of D 95 within
                      the gross tumor volume during fractional dose reconstruction
                      is most pronounced for conventional intensity-modulated
                      carbon ion therapy. Single field uniform dose optimization
                      exhibits no substantial reduction for six of seven patients
                      and values for D 95 for worst case optimization fall in
                      between. The treated volume (D>95 $\%$ prescription dose)
                      outside of the gross tumor volume is reduced by a factor of
                      two by worst case optimization compared to conventional
                      optimization and single field uniform dose optimization.
                      Single field uniform dose optimization comes at an increased
                      radiation exposure of normal tissues, e.g. ≈2 Gy (RBE) in
                      the mean dose in the kidneys compared to conventional and
                      worst case optimization and ≈4 Gy (RBE) in D 1 in the
                      spinal cord compared to worst case
                      optimization.Interfractional motion substantially
                      deteriorates dose distributions for carbon ion treatments of
                      pancreatic cancer patients. Single field uniform dose
                      optimization mitigates the negative influence of motion on
                      target coverage at an increased radiation exposure of normal
                      tissue. Worst case optimization enables an exploration of
                      the trade-off between robust target coverage and organ at
                      risk sparing during inverse treatment planning beyond margin
                      concepts.},
      keywords     = {Ions (NLM Chemicals) / Carbon (NLM Chemicals)},
      cin          = {E040},
      ddc          = {610},
      cid          = {I:(DE-He78)E040-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:27717378},
      pmc          = {pmc:PMC5055683},
      doi          = {10.1186/s13014-016-0705-8},
      url          = {https://inrepo02.dkfz.de/record/130601},
}