Comparing cone-beam CT intensity correction methods for dose recalculation in adaptive intensity-modulated photon and proton therapy for head and neck cancer

<div><p>ABSTRACT</p><p><b>Background.</b> Adaptive intensity-modulated photon and proton radiotherapy (IMRT and IMPT) of head and neck (H&N) cancer requires frequent three-dimensional (3D) dose calculation. We compared two approaches for dose recalculation on the basis of intensity-corrected cone-beam (CB) x-ray computed tomography (CT) images.</p><p><b>Material and methods.</b> For nine H&N tumor patients, virtual CTs (vCT) were generated by deformable image registration of the planning CT (pCT) to the CBCT. The second intensity correction approach used population-based lookup tables for scaling CBCT intensities to the pCT HU range (CBCT<sub>LUT</sub>). IMRT and IMPT plans were generated with a commercial treatment planning system. Dose recalculations on vCT and CBCT<sub>LUT</sub> were analyzed using a (3%, 3 mm) gamma-index analysis and comparison of normal tissue and tumor dose/volume parameters. A replanning CT (rpCT) acquired within three days of the CBCT served as reference. Single field uniform dose (SFUD) proton plans were created and recalculated on vCT and CBCT<sub>LUT</sub> for proton range comparison.</p><p><b>Results.</b> Dose/volume parameters showed minor differences between rpCT, vCT and CBCT<sub>LUT</sub> in IMRT, but clinically relevant deviations between CBCT<sub>LUT</sub> and rpCT in the spinal cord for IMPT. Gamma-index pass-rates were found increased for vCT with respect to CBCT<sub>LUT</sub> in IMPT (by up to 21 percentage points) and IMRT (by up to 9 percentage points) for most cases. The SFUD-based proton range assessment showed improved agreement of vCT and rpCT, with 88–99% of the depth dose profiles in beam's eye view agreeing within 3 mm. For CBCT<sub>LUT</sub>, only 80–94% of the profiles fulfilled this criterion.</p><p><b>Conclusion.</b> vCT and CBCT<sub>LUT</sub> are suitable options for dose recalculation in adaptive IMRT. In the scope of IMPT, the vCT approach is preferable.</p></div>