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Radiother Oncol. 2017 Nov;125(2):344-350. doi: 10.1016/j.radonc.2017.09.002. Epub 2017 Oct 12.

Dose to mass for evaluation and optimization of lung cancer radiation therapy.

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University of Virginia, Department of Radiation Oncology, Charlottesville, United States. Electronic address:
Johns Hopkins University, Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, United States.
Virginia Commonwealth University, Department of Radiation Oncology, Richmond, United States.
University of Virginia, Department of Radiation Oncology, Charlottesville, United States.



To evaluate potential organ at risk dose-sparing by using dose-mass-histogram (DMH) objective functions compared with dose-volume-histogram (DVH) objective functions.


Treatment plans were retrospectively optimized for 10 locally advanced non-small cell lung cancer patients based on DVH and DMH objectives. DMH-objectives were the same as DVH objectives, but with mass replacing volume. Plans were normalized to dose to 95% of the PTV volume (PTV-D95v) or mass (PTV-D95m). For a given optimized dose, DVH and DMH were intercompared to ascertain dose-to-volume vs. dose-to-mass differences. Additionally, the optimized doses were intercompared using DVH and DMH metrics to ascertain differences in optimized plans. Mean dose to volume, Dv‾, mean dose to mass, DM‾, and fluence maps were intercompared.


For a given dose distribution, DVH and DMH differ by >5% in heterogeneous structures. In homogeneous structures including heart and spinal cord, DVH and DMH are nearly equivalent. At fixed PTV-D95v, DMH-optimization did not significantly reduce dose to OARs but reduced PTV-Dv‾ by 0.20±0.2Gy (p=0.02) and PTV-DM‾ by 0.23±0.3Gy (p=0.02). Plans normalized to PTV-D95m also result in minor PTV dose reductions and esophageal dose sparing (Dv‾ reduced 0.45±0.5Gy, p=0.02 and DM‾ reduced 0.44±0.5Gy, p=0.02) compared to DVH-optimized plans. Optimized fluence map comparisons indicate that DMH optimization reduces dose in the periphery of lung PTVs.


DVH- and DMH-dose indices differ by >5% in lung and lung target volumes for fixed dose distributions, but optimizing DMH did not reduce dose to OARs. The primary difference observed in DVH- and DMH-optimized plans were variations in fluence to the periphery of lung target PTVs, where low density lung surrounds tumor.


DMH optimization; Lung cancer radiation therapy; Mass optimization; Radiation therapy optimization

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