Incorporating range uncertainty into proton therapy treatment planning

This dissertation addresses the issue of robustness in proton therapy treatment planning for cancer treatment. Proton therapy is considered to be advantageous in treating most childhood cancers and certain adult cancers, including those of the skull base, spine and head and neck. Protons, unlike X-rays, have a finite range highly dependent on the electron density of the material they are traversing, resulting in a steep dose gradient at the distal edge of the Bragg peak. These characteristics, together with advancements in computation and technology have led to the ability to plan and deliver treatments with greater conformality, sparing normal tissue and organs at risk. Radiotherapy treatment plans aim to meet set dosimetric constraints, and meet them at every fraction. Plan robustness is a measure of deviation between the delivered dose distribution and the planned dose distribution. Due to the same characteristics that make protons advantageous, conventional means of using margins to create a Planning Target Volume (PTV) to ensure plan robustness are inadequate. Additional to this, without a PTV, a new method of analysing plan quality is required in proton therapy. My original contribution to the knowledge in this area is the demonstration of how site- and centre- specific robustness constraints can be established. Robustness constraints can be used both for proton plan analysis and to identify patients that require plans of greater individualisation. I have also used the daily volumetric imaging from patients previously treated with conventional radiotherapy to quantify range uncertainty from inter- and intra-fraction motion. These new methods of both quantifying and analysing the change in proton range in the patient can aid in the choice of beam directions, provide input into a multi- criteria optimisation algorithm or can be used as criteria to determine when adaptive planning may be required. This greater understanding in range uncertainty better informs the planner on how best to balance the trade-off between plan conformality and robustness in proton therapy. This research is directly relevant to furthering the knowledge base in light of HM Government pledging £250 million to build two proton centres in England, to treat NHS patients from 2018. Use of methods described in this dissertation will aid in the establishment of clear and pre-defined protocols for treating patients in the future.

Name dc:type.qualificationname

Doctor of Philosophy (PhD)

Level dc:type.qualificationlevel

Doctoral

Grantor dc:publisher.institution

University of Cambridge

Year dc:date.issued

2015

Author dc:creator

• McGowan, Stacey Elizabeth

• Proton Therapy
• Radiotherapy
• Optimisation
• Range Uncertainty
• NHS
• Cancer

Licence

• https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/0a9d62f6-a7a8-4861-b46b-20e185194d3c/download
• https://www.rioxx.net/licenses/all-rights-reserved/

Language dc:language

en

DOI dc:identifier.doi

https://doi.org/10.17863/CAM.16185

OAI identifier oai:identifier

oai:www.repository.cam.ac.uk:1810/248787