PTV-based VMAT vs. robust IMPT for head-and-neck cancer:A probabilistic uncertainty analysis of clinical plan evaluation with the Dutch model-based selection

Background and purpose: In the Netherlands, head-and-neck cancer (HNC) patients are referred for proton therapy (PT) through model-based selection (MBS). However, treatment errors may compromise adequate CTV dose. Our aims are: (i) to derive probabilistic plan evaluation metrics on the CTV consistent with clinical metrics; (ii) to evaluate plan consistency between photon (VMAT) and proton (IMPT) planning in terms of CTV dose iso-effectiveness and (iii) to assess the robustness of the OAR doses and of the risk toxicities involved in the MBS. Materials and methods: Sixty HNC plans (30 IMPT/30 VM... Mehr ...