SU-C-BRB-01: Automated Dose Deformation for Re-Irradiation




An objective of retreatment planning is to minimize dose to previously irradiated tissues. Conventional retreatment planning is based largely on best-guess superposition of the previous treatment's isodose lines. In this study, we report a rigorous, automated retreatment planning process to minimize dose to previously irradiated organs at risk (OAR).


Data for representative patients previously treated using helical tomotherapy and later retreated in the vicinity of the original disease site were retrospectively analyzed in an automated fashion using a prototype treatment planning system equipped with a retreatment planning module (Accuray, Inc.). The initial plan's CT, structures, and planned dose were input along with the retreatment CT and structure set. Using a deformable registration algorithm implemented in the module, the initially planned dose and structures were warped onto the retreatment CT. An integrated third-party sourced software (MIM, Inc.) was used to evaluate registration quality and to contour overlapping regions between isodose lines and OARs, providing additional constraints during retreatment planning. The resulting plan and the conventionally generated retreatment plan were compared.


Jacobian maps showed good quality registration between the initial plan and retreatment CTs. For a right orbit case, the dose deformation facilitated delineating the regions of the eyes and optic chiasm originally receiving 13 to 42 Gy. Using these regions as dose constraints, the new retreatment plan resulted in V50 reduction of 28% for the right eye and 8% for the optic chiasm, relative to the conventional plan. Meanwhile, differences in the PTV dose coverage were clinically insignificant.


Automated retreatment planning with dose deformation and definition of previously-irradiated regions allowed for additional planning constraints to be defined to minimize re-irradiation of OARs. For serial organs that do not recover from radiation damage, this method provides a more precise and quantitative means to limit cumulative dose.

This research is partially supported by Accuray, Inc