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@ARTICLE{Spautz:277737,
      author       = {S. Spautz and L. Haase and M. Tschiche and S. Makocki and
                      C. Richter$^*$ and E. G. C. Troost$^*$ and K. Stützer},
      title        = {{C}omparison of 3{D} and 4{D} robustly optimized proton
                      treatment plans for non-small cell lung cancer patients with
                      tumour motion amplitudes larger than 5 mm.},
      journal      = {Physics $\&$ Imaging in Radiation Oncology},
      volume       = {27},
      issn         = {2405-6316},
      address      = {Amsterdam [u. a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2023-01454},
      pages        = {100465},
      year         = {2023},
      abstract     = {There is no consensus about an ideal robust optimization
                      (RO) strategy for proton therapy of targets with large
                      intrafractional motion. We investigated the plan robustness
                      of 3D and different 4D RO strategies.For eight non-small
                      cell lung cancer patients with clinical target volume (CTV)
                      motion >5 mm, different RO approaches were investigated:
                      3DRO considering the average CT (AvgCT) with a target
                      density override, 4DRO considering three/all 4DCT phases,
                      and 4DRO considering the AvgCT and three/all 4DCT phases.
                      Robustness against setup/range errors, interplay effects
                      based on breathing and machine log file data for deliveries
                      with/without rescanning, and interfractional anatomical
                      changes were analyzed for target coverage and OAR
                      sparing.All nominal plans fulfilled the clinical
                      requirements with individual CTV coverage differences <2pp;
                      4DRO without AvgCT generated the most conformal dose
                      distributions. Robustness against setup/range errors was
                      best for 4DRO with AvgCT $(18\%$ more passed error scenarios
                      than 3DRO). Interplay effects caused fraction-wise median
                      CTV coverage loss of 3pp and missed maximum dose constraints
                      for heart and esophagus in $18\%$ of scenarios. CTV coverage
                      and OAR sparing fulfilled requirements in all cases when
                      accumulating four interplay scenarios. Interfractional
                      changes caused less target misses for RO with AvgCT compared
                      to 4DRO without AvgCT $(≤42\%/33\%$ vs. $≥56\%/44\%$
                      failed single/accumulated scenarios).All RO strategies
                      provided acceptable plans with equally low robustness
                      against interplay effects demanding other mitigation than
                      rescanning to ensure fraction-wise target coverage. 4DRO
                      considering three phases and the AvgCT provided best
                      compromise on planning effort and robustness.},
      keywords     = {Interfraction changes (Other) / Large intrafraction motion
                      (Other) / Lung cancer (Other) / Proton therapy (Other) /
                      Robust optimization (Other)},
      cin          = {DD01},
      ddc          = {610},
      cid          = {I:(DE-He78)DD01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37449022},
      pmc          = {pmc:PMC10338142},
      doi          = {10.1016/j.phro.2023.100465},
      url          = {https://inrepo02.dkfz.de/record/277737},
}