The Perils of Adapting to Dose Errors in Radiation Therapy
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Misic-2015-The perils of adapti.pdf
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Author(s)
Chan, Timothy C. Y.
Misic, Velibor
Date Issued
May 2015
Journal
PLOS ONE
Publisher
Public Library of Science
Citation
Misic, Velibor V., and Timothy C. Y. Chan. “The Perils of Adapting to Dose Errors in Radiation Therapy.” Edited by Qinghui Zhang. PLOS ONE 10, no. 5 (May 5, 2015): e0125335.
Version
Final published version
Abstract
We consider adaptive robust methods for lung cancer that are also dose-reactive, wherein the treatment is modified after each treatment session to account for the dose delivered in prior treatment sessions. Such methods are of interest because they potentially allow for errors in the delivered dose to be corrected as the treatment progresses, thereby ensuring that the tumor receives a sufficient dose at the end of the treatment. We show through a computational study with real lung cancer patient data that while dose reaction is beneficial with respect to the final dose distribution, it may lead to exaggerated daily underdose and overdose relative to non-reactive methods that grows as the treatment progresses. However, by combining dose reaction with a mechanism for updating an estimate of the uncertainty, the magnitude of this growth can be mitigated substantially. The key finding of this paper is that reacting to dose errors – an adaptation strategy that is both simple and intuitively appealing – may backfire and lead to treatments that are clinically unacceptable.
MIT Department
Massachusetts Institute of Technology. Operations Research Center
Sloan School of Management
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DOI of Published Version
https://doi.org/10.1371/journal.pone.0125335
