Multiple-CT optimization of intensity-modulated proton therapy – Is it possible to eliminate adaptive planning?

Xianliang Wang, Heng Li, Xiaorong Ronald Zhu, Qing Hou, Li Liao, Bo Jiang, Yupeng Li, Pei Wang, Jinyi Lang, Xiaodong Zhang

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background and purpose: We hypothesized that a plan's robustness to anatomical changes can be improved by optimizing with multiple CT scans of a patient. The purpose of this study was to determine whether an intensity modulated proton therapy (IMPT) plan could be developed to meet dose criteria on both planning and adaptive CT plans. Material and methods: Eight lung cancer patients who underwent adaptive IMPT were retrospectively selected. Each patient had two CTs: a primary planning CT (PCT) and an adaptive planning CT (ACT), and IMPT plans associated with the scans. PCT and ACT were then used in combination to optimize one plan (MCT plan). The doses to the target and organs at risk from the PCT plan, ACT plan, P-ACT plan (PCT plan calculated on ACT data), and MCT plans calculated on both CTs were compared. Results: The MCT plan maintained the D95% on both CTs (mean, 65.99 Gy on PCT and 66.02 Gy on ACT). Target dose coverage on ACT was significantly better with the MCT plan than with the P-ACT plan (p = 0.01). MCT plans had slightly higher lung V20 (0.6%, p = 0.02) than did PCT plans. The various plans showed no statistically significant difference in heart and spinal cord dose. Conclusions: The results of this study indicate that an IMPT plan can meet the dose criteria on both PCT and ACT, and that MCT optimization can improve the plan's robustness to anatomical change.

Original languageEnglish (US)
Pages (from-to)167-173
Number of pages7
JournalRadiotherapy and Oncology
Issue number1
StatePublished - Jul 2018
Externally publishedYes


  • Adaptive planning
  • Intensity-modulated proton therapy
  • Multiple CT optimization
  • Robust optimization

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging


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