{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T20:23:12Z","timestamp":1773001392367,"version":"3.50.1"},"reference-count":36,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Sparing pharyngeal constrictor muscles (PCMs) during radiotherapy improves patient\u2010reported swallowing function. This study aimed to explore the feasibility of integrating knowledge\u2010based planning (KBP) with multicriteria optimization (MCO) in Eclipse v18.0 to selectively spare PCM, quantify the required trade\u2010off in prophylactic planning target volume (PTV54) coverage, and to evaluate MCO performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      Ten patients previously planned with KBP for oropharyngeal cancer (65, 60, and 54\u00a0Gy in 30 fractions) were retrospectively re\u2010planned. Clinical plans were further optimized using trade\u2010off exploration in MCO, with a priority order: spinal cord and brainstem sparing, high\u2010dose and intermediate\u2010dose target coverage, PCM sparing, low\u2010dose target coverage, parotids sparing, remaining organs at risk (OAR). Plans were evaluated based on planning target volumes dose metrics (D\n                      <jats:sub>50%<\/jats:sub>\n                      , D\n                      <jats:sub>98%<\/jats:sub>\n                      , and D\n                      <jats:sub>2%<\/jats:sub>\n                      ), homogeneity index (HI), conformity index (CI), and maximum and mean doses to OARs, and paired\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests were performed. Differences between navigated and deliverable plans were analyzed. One patient underwent 10 identical repeat plan generations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      MCO reduced the average mean dose to the superior and middle PCM, inferior PCM, contralateral parotid, and larynx by 2.0, 3.4, 2.6, and 3.9\u00a0Gy, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05) but at the expense of HI and CI. No difference was observed in average PTV54 D\n                      <jats:sub>98%<\/jats:sub>\n                      between techniques; however, all clinical plans and seven MCO plans achieved D\n                      <jats:sub>98%<\/jats:sub>\n                      \u2265 95%, with three MCO plans modestly compromised (D\n                      <jats:sub>98%<\/jats:sub>\n                      93.7%\u201394.6%). Dose metrics between navigated and deliverable plans differed by \u22640.7\u00a0Gy for mean doses and \u22641.8\u00a0Gy for maximum doses. Pareto surface generation was not repeatable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MCO effectively balances the trade\u2010off between PCM sparing and low\u2010dose target coverage. It may be a valuable tool in the context of personalized care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70112","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T05:55:44Z","timestamp":1749102944000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Advantages and limitations of navigation\u2010based multicriteria optimization (MCO) in selectively sparing pharyngeal constrictor muscles in head and neck radiotherapy treatment planning"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1440-2904","authenticated-orcid":false,"given":"Laura K.","family":"Howard","sequence":"first","affiliation":[{"name":"Medical Physics Department Clatterbridge Cancer Centre NHS Foundation Trust  Liverpool UK"},{"name":"Department of Physics University of Liverpool  Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon J. 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