Experimental evaluation of a robust optimization method for IMRT of moving targets.

Internal organ motion during radiation therapy, if not considered appropriately in the planning process, has been shown to reduce target coverage and increase the dose to healthy tissues. Standard planning approaches, which use safety margins to handle intrafractional movement of the tumor, are typically designed based on the maximum amplitude of motion, and are often overly conservative. Comparable coverage and reduced dose to healthy organs appear achievable with robust motion-adaptive treatment planning, which considers the expected probability distribution of the average target position and the uncertainty of its realization during treatment delivery. A dosimetric test of a robust optimization method for IMRT was performed, using patient breathing data. External marker motion data acquired from respiratory-gated radiotherapy patients were used to build and test the framework for robust optimization. The motion trajectories recorded during radiation treatment itself are not strictly necessary to generate the initial version of a robust treatment plan, but can be used to adapt the plan during the course of treatment. Single-field IMRT plans were optimized to deliver a uniform dose to a rectangular area. During delivery on a linear accelerator, a computer-driven motion phantom reproduced the patients' breathing patterns and a two-dimensional ionization detector array measured the dose delivered. The dose distributions from robust-optimized plans were compared to those from standard plans, which used a margin expansion. Dosimetric tests confirmed the improved sparing of the non-target area with robust planning, which was achieved without compromising the target coverage. The maximum dose in robust plans did not exceed 110% of the prescription, while the minimum target doses were comparable in standard and robust plans. In test courses, optimized for a simplified target geometry, and delivered to a phantom that moved in one dimension with an average amplitude of 17 mm, the robust treatment design produced a reduction of more than 12% of the integral dose to non-target areas, compared to the standard plan using 10 mm margin expansion.