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@ARTICLE{Burigo:142252,
      author       = {L. N. Burigo$^*$ and J. Ramos-Méndez and M. Bangert$^*$
                      and R. W. Schulte and B. Faddegon},
      title        = {{S}imultaneous optimization of {RBE}-weighted dose and
                      nanometric ionization distributions in treatment planning
                      with carbon ions.},
      journal      = {Physics in medicine and biology},
      volume       = {64},
      number       = {1},
      issn         = {1361-6560},
      address      = {Bristol},
      publisher    = {IOP Publ.},
      reportid     = {DKFZ-2019-00055},
      pages        = {015015},
      year         = {2019},
      abstract     = {Inverse treatment planning in intensity modulated particle
                      therapy (IMPT) with scanned carbon-ion beams is currently
                      based on the optimization of RBE-weighted dose to satisfy
                      requirements of target coverage and limited toxicity to
                      organs-at-risk (OARs) and healthy tissues. There are many
                      feasible IMPT plans that meet these requirements, which
                      allows the introduction of further criteria to narrow the
                      selection of a biologically optimal treatment plan. We
                      propose a novel treatment planning strategy based on the
                      simultaneous optimization of RBE-weighted dose and
                      nanometric ionization details (ID) as a new physical
                      characteristic of the delivered plan beyond LET. In
                      particular, we focus on the distribution of large ionization
                      clusters (more than 3 ionizations) to enhance the biological
                      effect across the target volume while minimizing biological
                      effect in normal tissues. Carbon-ion treatment plans for
                      different patient geometries and beam configurations
                      generated with the simultaneous optimization strategy were
                      compared against reference plans obtained with RBE-weighted
                      dose optimization alone. Quality indicators, inhomogeneity
                      index and planning volume histograms of RBE-weighted dose
                      and large ionization clusters were used to evaluate the
                      treatment plans. We show that with simultaneous
                      optimization, ID distributions can be optimized in
                      carbon-ion radiotherapy without compromising the
                      RBE-weighted dose distributions. This strategy can
                      potentially be used to account for optimization of endpoints
                      closely related to radiation quality to achieve better tumor
                      control and reduce risks of complications.},
      cin          = {E040},
      ddc          = {530},
      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:30523890},
      doi          = {10.1088/1361-6560/aaf400},
      url          = {https://inrepo02.dkfz.de/record/142252},
}