Fractionation in radiation treatment planning

Radiotherapy treatment is often delivered in a fractionated manner over a period of time. Emerging delivery devices are able to determine the actual dose that has been delivered at each stage facilitating the use of adaptive treatment plans that compensate for errors in delivery. We formulate a model of the day-to-day planning problem as a stochastic program and exhibit the gains that can be achieved by incorporating uncertainty about errors during treatment into the planning process. Due to size and time restrictions, the model becomes intractable for realistic instances. We show how heuristics and neuro-dynamic programming can be used to approximate the stochastic solution, and derive results from our models for realistic time periods. These results allow us to generate practical rules of thumb that can be immediately implemented in current planning technologies.