Background: To evaluate the robustness of
head and neck treatment using proton pencil beam scanning (PBS) technique with
respect to range uncertainty (RU) and setup errors (SE), and to establish a
robust PBS planning strategy for future
treatment. Methods and Materials: Ten consecutive patients were planned
with a novel proton field geometry (combination of two posterior oblique fields
and one anterior field with gradient dose match) using single-field uniform
dose (SFUD) planning technique and the proton plans were dosimetrically
compared to two coplanar arc VMAT plans. Robustness of the plans, with
respect to range uncertainties (RU = ± 3% for proton) and setup errors (SE =
2.25 mm for proton and VMAT), in terms of deviations to target coverage (CTV
D98%) and OAR doses (max/mean), were evaluated and compared for each patient
under worst case scenarios. Results: Dosimetrically,PBS plans
provided better sparing to larynx (p = 0.005), oral cavity (p < 0.001) and
contralateral parotid (p = 0.004) when compared to VMAT. CTV D98% variations
were higher from SE than from RU for proton plans (-1.1% ±
1.3 % vs -0.4% ± 0.7% for nodal CTV and -
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