{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:54:27Z","timestamp":1785304467232,"version":"3.55.0"},"reference-count":45,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,9,18]],"date-time":"2017-09-18T00:00:00Z","timestamp":1505692800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2017,11]]},"abstract":"Abstract<\/jats:title>Purpose<\/jats:title>Evaluation of dose degradation by anatomic changes for head\u2010and\u2010neck cancer (HNC<\/jats:styled-content>) intensity\u2010modulated proton therapy (IMPT<\/jats:styled-content>) relative to intensity\u2010modulated photon therapy (IMRT<\/jats:styled-content>) and identification of potential indicators for IMPT<\/jats:styled-content> treatment plan adaptation.<\/jats:p><\/jats:sec>Methods<\/jats:title>For 31 advanced HNC<\/jats:styled-content> datasets, IMPT<\/jats:styled-content> and IMRT<\/jats:styled-content> plans were recalculated on a computed tomography scan (CT<\/jats:styled-content>) taken after about 4 weeks of therapy. Dose parameter changes were determined for the organs at risk (OAR<\/jats:styled-content>s) spinal cord, brain stem, parotid glands, brachial plexus, and mandible, for the clinical target volume (CTV<\/jats:styled-content>) and the healthy tissue outside planning target volume (PTV<\/jats:styled-content>). Correlation of dose degradation with target volume changes and quality of rigid CT<\/jats:styled-content> matching was investigated.<\/jats:p><\/jats:sec>Results<\/jats:title>Recalculated IMPT<\/jats:styled-content> dose distributions showed stronger degradation than the IMRT<\/jats:styled-content> doses. OAR<\/jats:styled-content> analysis revealed significant changes in parotid median dose (IMPT<\/jats:styled-content>) and near maximum dose (D<\/jats:italic>1ml<\/jats:sub>) of spinal cord (IMPT<\/jats:styled-content>, IMRT<\/jats:styled-content>) and mandible (IMPT<\/jats:styled-content>). OAR<\/jats:styled-content> dose parameters remained lower in IMPT<\/jats:styled-content> cases. CTV<\/jats:styled-content> coverage (V<\/jats:italic>95%<\/jats:sub>) and overdose (V<\/jats:italic>107%<\/jats:sub>) deteriorated for IMPT<\/jats:styled-content> plans to (93.4 \u00b1 5.4)% and (10.6 \u00b1 12.5)%, while those for IMRT<\/jats:styled-content> plans remained acceptable. Recalculated plans showed similarly decreased PTV<\/jats:styled-content> conformity, but considerable hotspots, also outside the PTV<\/jats:styled-content>, emerged in IMPT<\/jats:styled-content> cases. Lower CT<\/jats:styled-content> matching quality was significantly correlated with loss of PTV<\/jats:styled-content> conformity (IMPT<\/jats:styled-content>, IMRT<\/jats:styled-content>), CTV<\/jats:styled-content> homogeneity and coverage (IMPT<\/jats:styled-content>). Target shrinkage correlated with increased dose in brachial plexus (IMRT<\/jats:styled-content>, IMPT<\/jats:styled-content>), hotspot generation outside the PTV<\/jats:styled-content> (IMPT<\/jats:styled-content>) and lower PTV<\/jats:styled-content> conformity (IMRT<\/jats:styled-content>).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The study underlines the necessity of precise positioning and monitoring of anatomy changes, especially in IMPT<\/jats:styled-content> which might require adaptation more often. Since OAR<\/jats:styled-content> doses remained typically below constraints, IMPT<\/jats:styled-content> plan adaptation will be indicated by target dose degradations.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.12189","type":"journal-article","created":{"date-parts":[[2017,9,18]],"date-time":"2017-09-18T14:50:20Z","timestamp":1505746220000},"page":"104-113","source":"Crossref","is-referenced-by-count":40,"title":["Potential proton and photon dose degradation in advanced head and neck cancer patients by intratherapy changes"],"prefix":"10.1002","volume":"18","author":[{"given":"Kristin","family":"St\u00fctzer","sequence":"first","affiliation":[{"name":"OncoRay \u2013 National Center for Radiation Research in Oncology Faculty of Medicine and University Hospital Carl Gustav Carus Technische Universit\u00e4t Dresden Helmholtz\u2010Zentrum Dresden \u2010 Rossendorf, Fetscherstr. 74, PF 41 01307 Dresden Germany"},{"name":"Helmholtz\u2010Zentrum Dresden \u2010 Rossendorf Institute of 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