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The Perils of Adapting to Dose Errors in Radiation Therapy

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  • Velibor V Mišić
  • Timothy C Y Chan

Abstract

We consider adaptive robust methods for lung cancer that are also dose-reactive, wherein the treatment is modified after each treatment session to account for the dose delivered in prior treatment sessions. Such methods are of interest because they potentially allow for errors in the delivered dose to be corrected as the treatment progresses, thereby ensuring that the tumor receives a sufficient dose at the end of the treatment. We show through a computational study with real lung cancer patient data that while dose reaction is beneficial with respect to the final dose distribution, it may lead to exaggerated daily underdose and overdose relative to non-reactive methods that grows as the treatment progresses. However, by combining dose reaction with a mechanism for updating an estimate of the uncertainty, the magnitude of this growth can be mitigated substantially. The key finding of this paper is that reacting to dose errors – an adaptation strategy that is both simple and intuitively appealing – may backfire and lead to treatments that are clinically unacceptable.

Suggested Citation

  • Velibor V Mišić & Timothy C Y Chan, 2015. "The Perils of Adapting to Dose Errors in Radiation Therapy," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-16, May.
    • Handle: RePEc:plo:pone00:0125335
    DOI: 10.1371/journal.pone.0125335
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    References listed on IDEAS

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    1. Thomas Bortfeld & Timothy C. Y. Chan & Alexei Trofimov & John N. Tsitsiklis, 2008. "Robust Management of Motion Uncertainty in Intensity-Modulated Radiation Therapy," Operations Research, INFORMS, vol. 56(6), pages 1461-1473, December.
    2. Chan, Timothy C.Y. & Mišić, Velibor V., 2013. "Adaptive and robust radiation therapy optimization for lung cancer," European Journal of Operational Research, Elsevier, vol. 231(3), pages 745-756.
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