An ESTRO-EPTN Delphi consensus on robustness evaluation in proton therapy
Physics and Imaging in Radiation Oncology, vol. 37, pp. 100900
Abstract
Background and purpose: Robustness evaluation (RE) is vital for proton treatment planning, but lacks international consensus or guidelines, with clinics using varied, self-developed methods focused on selected uncertainties. This ESTRO project surveys expert opinions on clinical RE methods to inform future treatment planning system (TPS) development. Materials and methods: A study within the European Particle Therapy Network (EPTN) involved 24 European proton therapy centres, with one radiation oncologist and one medical physicist per centre. The goal was to reach a consensus on transitioning from Planning Target Volume (PTV)-based planning to robustly optimized planning, including uncertainties, methods, and reporting of robustness evaluations. An internal committee drafted 39 statements, reviewed by an independent committee. Following a two-round Delphi procedure, consensus was set at a 75% agreement threshold. Results: Twenty of 24 contacted centers (83.0%) responded to both questionnaire rounds. Consensus was reached on 26 of 39 statements (66.7%), with 5 being high-priority. Strong agreement emerged regarding which uncertainties to include in RE (range, setup, intra-fraction, anatomy changes), methodologies (e.g., for moving targets, combining setup and range), and how to report RE results clinically. Disagreement was found on using the PTV for both planning and dose reporting. The results also offer important implications for TPS vendors and future software development. Conclusions: The ESTRO Delphi consensus may serve as practical guidance on points where a clear consensus was achieved. For remaining points, the development of guidelines is recommended to standardize methodologies and reporting. Furthermore, TPS vendors are encouraged to align their developments with the community's articulated requirements.
Authors 42
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Francesco Fracchiolla corresponding
Affiliation as printed
UO Fisica Sanitaria, APSS, Trento, Italy
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Affiliation as printed
Center for Proton Therapy, Paul Scherrer Institut, Forschungsstrasse 111, Villigen 5232, Switzerland
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University of Pavia · National Center for Oncological Hadrontherapy
Affiliation as printed
Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Italy
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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The Christie Hospital · The Christie NHS Foundation Trust
Affiliation as printed
Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
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Affiliation as printed
Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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Erasmus MC · Erasmus MC Cancer Institute · Holland Particle Therapy Center
Affiliation as printed
Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, the Netherlands
Holland Proton Therapy Center, Delft, the Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Université Paris Sciences et Lettres · Institut Curie
Affiliation as printed
Institut Curie, PSL Research University, Department of Radiation Oncology, Orsay Protontherapy Center, F-91400 Orsay, France
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Holland Particle Therapy Center
Affiliation as printed
Holland Proton Therapy Center, Delft, the Netherlands
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IDCQ Hospitales y Sanidad, S.L.U.
Affiliation as printed
Centro de Protonterapia Quironsalud, Madrid, Spain
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Maastricht University Medical Centre · Maastro Clinic
Affiliation as printed
Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Institute of Nuclear Physics, Polish Academy of Sciences
Affiliation as printed
Cyclotron Centre Bronowice, Institute of Nuclear Physics Polish Academy of Sciences, ul. Radzikowskiego 152, 31-342 Krakow, Poland
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Affiliation as printed
UO Protonterapia, APSS, Trento, Italy
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IDCQ Hospitales y Sanidad, S.L.U.
Affiliation as printed
Centro de Protonterapia Quironsalud, Madrid, Spain
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National Center for Oncological Hadrontherapy
Affiliation as printed
Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Italy
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Affiliation as printed
Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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Affiliation as printed
Center for Proton Therapy, Paul Scherrer Institut, Forschungsstrasse 111, Villigen 5232, Switzerland
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University College London Hospitals NHS Foundation Trust
Affiliation as printed
Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
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University Hospital Heidelberg
Affiliation as printed
Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 450, 69120 Heidelberg, Germany
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Affiliation as printed
The Skandion Clinic, Uppsala, Sweden
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European Institute of Oncology
Affiliation as printed
Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
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Affiliation as printed
Department of Oncology, Oslo University Hospital, Oslo, Norway
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Université Paris Sciences et Lettres · Institut Curie
Affiliation as printed
Institut Curie, PSL Research University, Department of Radiation Oncology, Orsay Protontherapy Center, F-91400 Orsay, France
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Maastricht University Medical Centre · Maastro Clinic
Affiliation as printed
Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Université Côte d'Azur · Centre Antoine Lacassagne
Affiliation as printed
Department of Radiation Therapy, Antoine Lacassagne Cancer Center, University of Côte d'Azur, Nice, France
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Affiliation as printed
Cancer Clinic, Haukeland University Hospital Bergen, Norway
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Affiliation as printed
Department of Diagnostics and Intervention, Oncology, Umeå University, Umeå, Sweden
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The Maria Sklodowska-Curie National Research Institute of Oncology
Affiliation as printed
Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, Kraków, Poland
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Affiliation as printed
Department of Medical Physics, Oslo University Hospital, Oslo, Norway
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Universitair Ziekenhuis Leuven
Affiliation as printed
Department of Radiotherapy-Oncology, Leuvens Kanker Instituut, Universitair Ziekenhuis Leuven, Leuven, Belgium
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Affiliation as printed
Cancer Clinic, Haukeland University Hospital Bergen, Norway
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University Hospital Carl Gustav Carus · Technische Universität Dresden
Affiliation as printed
Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
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Affiliation as printed
Institut Méditerranéen de Protonthérapie - Centre Antoine Lacassagne, Nice, France
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The Christie Hospital · The Christie NHS Foundation Trust
Affiliation as printed
Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
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OncoRay · University Hospital Carl Gustav Carus · Technische Universität Dresden
Affiliation as printed
Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine, Dresden, Germany
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University College London Hospitals NHS Foundation Trust · University College London
Affiliation as printed
Department of Medical Physics and Biomedical Engineering, University College London, UK
Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
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European Institute of Oncology
Affiliation as printed
Unit of Medical Physics, European Institute of Oncology (IEO) IRCCS, Milano, Italy
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Leiden University Medical Center · Holland Particle Therapy Center
Affiliation as printed
Holland Proton Therapy Center, Delft, the Netherlands
Leiden University Medical Center, Department of Radiotherapy, Leiden, the Netherlands
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University Hospital Heidelberg
Affiliation as printed
Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 450, 69120 Heidelberg, Germany
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Affiliation as printed
KU Leuven, Department of Oncology, Experimental Radiotherapy Lab, Leuven, Belgium
Particle Therapy Interuniversity Center Leuven - PARTICLE, Leuven, Belgium
UCLouvain, Institution de Recherche Expérimentale et Clinique, Center of Molecular Imaging Radiotherapy and Oncology (MIRO), Brussels, Belgium
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Affiliation as printed
UO Fisica Sanitaria, APSS, Trento, Italy
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