Harmonization of proton treatment planning for head and neck cancer using pencil beam scanning: first report of the IPACS collaboration group

Markus Stock, Joanna Gora, Ana Perpar, Petra Georg, Alexander Lehde, Gabriele Kragl, Eugen Hug, Vladimir Vondracek, Jiri Kubes, Zuzana Poulova, Carlo Algranati, Marco Cianchetti, Marco Schwarz, Maurizio Amichetti, Tomasz Kajdrowicz, Renata Kopeć, Gabriela Mierzwińska, Paweł Olko, Katarzyna Skowrońska, Urszula SowaEleonora Góra, Kamil Kisielewicz, Beata Sas-Korczyńska, Tomasz Skóra, Anna Bäck, Magnus Gustafsson, Maret Sooaru, Petra Witt Nyström, Jan Nyman, Thomas Björk Eriksson

Research output: Journal article (peer-reviewed)Journal article

4 Citations (Scopus)


Background and purpose: A collaborative network between proton therapy (PT) centres in Trento in Italy, Poland, Austria, Czech Republic and Sweden (IPACS) was founded to implement trials and harmonize PT. This is the first report of IPACS with the aim to show the level of harmonization that can be achieved for proton therapy planning of head and neck (sino-nasal) cancer.Methods: CT-data sets of five patients were included. During several face-to-face and online meetings, a common treatment planning protocol was developed. Each centre used its own treatment planning system (TPS) and planning approach with some restrictions specified in the treatment planning protocol. In addition, volumetric modulated arc therapy (VMAT) photon plans were created.Results: For CTV1, the average Dmedian was 59.3 ± 2.4 Gy(RBE) for protons and 58.8 ± 2.0 Gy(RBE) for VMAT (aim was 56 Gy(RBE)). For CTV2, the average Dmedian was 71.2 ± 1.0 Gy(RBE) for protons and 70.6 ± 0.4 Gy(RBE) for VMAT (aim was 70 Gy(RBE)). The average D2% for the spinal cord was 25.1 ± 8.5 Gy(RBE) for protons and 47.6 ± 1.4 Gy(RBE) for VMAT. The average D2% for chiasm was 46.5 ± 4.4 Gy(RBE) for protons and 50.8 ± 1.4 Gy(RBE) for VMAT, respectively. Robust evaluation was performed and showed the least robust plans for plans with a low number of beams.Discussion: In conclusion, several influences on harmonization were identified: adherence/interpretation to/of the protocol, available technology, experience in treatment planning and use of different beam arrangements. In future, all OARs that should be included in the optimization need to be specified in order to further harmonize treatment planning.

Original languageEnglish
Pages (from-to)1720-1730
Number of pages11
JournalActa Oncologica
Issue number12
Publication statusPublished - 02 Dec 2019
Externally publishedYes


  • Brain Stem/radiation effects
  • Cochlea/radiation effects
  • Europe
  • Head and Neck Neoplasms/diagnostic imaging
  • Humans
  • International Cooperation
  • Larynx/radiation effects
  • Nose Neoplasms/diagnostic imaging
  • Optic Nerve/radiation effects
  • Organs at Risk/radiation effects
  • Paranasal Sinus Neoplasms/diagnostic imaging
  • Parotid Gland/radiation effects
  • Photons/therapeutic use
  • Proton Therapy/methods
  • Radiotherapy Planning, Computer-Assisted/methods
  • Radiotherapy, Intensity-Modulated/methods
  • Tomography, X-Ray Computed
  • Tumor Burden


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