A method to individualize adaptive planning target volumes for deformable targets.

We have investigated a method to individualize the planning target volume (PTV) for deformable targets in radiotherapy by combining a computer tomography (CT) scan with multiple cone beam (CB)CT scans. All combinations of the CT and up to five initial CBCTs were considered. To exclude translational motion, the clinical target volumes (CTVs) in the CBCTs were matched to the CTV in the CT. PTVs investigated were the unions, the intersections and all other structures defined by a volume with a constant CTV location frequency. The method was investigated for three bladder cancer patients with a CT and 20-27 CBCTs. Reliable alternatives to a standard PTV required use of at least four scans for planning. The CTV unions of four or five scans gave similar results when considering the fraction of individual repeat scan CTVs they volumetrically covered to at least 99%. For patient 1, 64% of the repeat scan CTVs were covered by these unions and for patient 2, 86% were covered. Further, the PTVs defined by the volume occupied by the CTV in all except one of the four or five planning scans seemed clinically feasible. On average, 52% of the repeat CBCT CTVs for patient 1 and 64% for patient 2 were covered to minimum 99% of their total volume. For patient 3, the method failed due to poor volume control of the bladder. The suggested PTVs could, with considerably improved conformity, complement the standard PTV.