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MO-FG-CAMPUS-TeP3-04: Deliverable Robust Optimization in IMPT Using Quadratic Objective Function.

PURPOSE
To find and evaluate the way of applying deliverable MU constraints into robust spot intensity optimization in Intensity-Modulated- Proton-Therapy (IMPT) to prevent plan quality and robustness from degrading due to machine deliverable MU-constraints.


METHODS
Currently, the influence of the deliverable MU-constraints is retrospectively evaluated by post-processing immediately following optimization. In this study, we propose a new method based on the quasi-Newton-like L-BFGS-B algorithm with which we turn deliverable MU-constraints on and off alternatively during optimization. Seven patients with two different machine settings (small and large spot size) were planned with both conventional and new methods. For each patient, three kinds of plans were generated - conventional non-deliverable plan (plan A), conventional deliverable plan with post-processing (plan B), and new deliverable plan (plan C). We performed this study with both realistic (small) and artificial (large) deliverable MU-constraints.


RESULTS
With small minimum MU-constraints considered, new method achieved a slightly better plan quality than conventional method (D95% CTV normalized to the prescription dose: 0.994[0.992∼0.996] (Plan C) vs 0.992[0.986∼0.996] (Plan B)). With large minimum MU constraints considered, results show that the new method maintains plan quality while plan quality from the conventional method is degraded greatly (D95% CTV normalized to the prescription dose: 0.987[0.978∼0.994] (Plan C) vs 0.797[0.641∼1.000] (Plan B)). Meanwhile, plan robustness of these two method's results is comparable. (For all 7 patients, CTV DVH band gap at D95% normalized to the prescription dose: 0.015[0.005∼0.043] (Plan C) vs 0.012[0.006∼0.038] (Plan B) with small MU-constraints and 0.019[0.009∼0.039] (Plan C) vs 0.030[0.015∼0.041] (Plan B) with large MU-constraints) CONCLUSION: Positive correlation has been found between plan quality degeneration and magnitude of deliverable minimal MU. Compared to conventional post-processing method, our new method of incorporating deliverable minimal MU-constraints directly into plan optimization, can produce machine-deliverable plans with better plan qualities and non-compromised plan robustness. This research was supported by the National Cancer Institute Career Developmental Award K25CA168984, by the Fraternal Order of Eagles Cancer Research Fund Career Development Award, by The Lawrence W. and Marilyn W. Matteson Fund for Cancer Research, by Mayo Arizona State University Seed Grant and by The Kemper Marley Foundation.