{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T18:23:43Z","timestamp":1770575023451,"version":"3.49.0"},"reference-count":39,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T00:00:00Z","timestamp":1757808000000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"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":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose\/objectives<\/jats:title>\n                    <jats:p>Proton stereotactic body radiotherapy (SBRT) using the pencil beam scanning (PBS) technique is increasingly used for localized prostate cancer (PCa) due to its potential for superior normal tissue sparing. However, interfractional anatomical variations pose challenges for accurate dose delivery, especially in ultrahypofractionation. This study investigates the dosimetric impact of these variations in PCa patients treated with PBS\u2010SBRT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Forty\u2010two low\u2010 or intermediate\u2010risk PCa patients treated with PBS\u2010SBRT (36.25\/ 40\u00a0Gy in 5 fractions) were included. Delivered doses were calculated by applying the initial plans to HU and artifact\u2010corrected pre\u2010treatment cone\u2010beam computed tomography (CBCT) images. Dosimetric parameters were evaluated per fraction. Key anatomical features included clinical target volume (CTV) shifts in the superior\u2010inferior (SI) and anterior\u2010posterior (AP) directions, and volume changes in the bladder and rectum. These features were used to predict deviations in CTV D\n                      <jats:sub>99<\/jats:sub>\n                      and D\n                      <jats:sub>0.03cc<\/jats:sub>\n                      , as well as maximum bladder and rectum doses. Univariate and multivariate logistic regression models were developed to identify significant anatomical predictors of dosimetric deviations, with odds ratios (OR) and area under the curve (AUC) values reported for predictive performance evaluation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      CTV AP shifts and bladder\/rectum volume changes were significant predictors of dosimetric deviations. Univariate analyses indicated that bladder volume increases\u00a0&gt;\u00a0109.80 cc were strongly associated with deviations in CTV D\n                      <jats:sub>0.03cc<\/jats:sub>\n                      (mean deviation\u00a0=\u00a00.33\u00a0Gy, OR\u00a0=\u00a05.78,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.03). Rectum volume changes\u00a0&gt;\u00a09.22 cc were the strongest predictor of rectum D\n                      <jats:sub>0.03cc<\/jats:sub>\n                      deviations (mean deviation\u00a0=\u00a00.68\u00a0Gy, OR\u00a0=\u00a04.23,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.01). AP shifts\u00a0&gt;\u00a0\u22120.27\u00a0cm were also predictive of CTV D\n                      <jats:sub>0.03cc<\/jats:sub>\n                      deviations (OR\u00a0=\u00a00.35,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.01). Multivariate model predicting rectum D\n                      <jats:sub>0.03cc<\/jats:sub>\n                      achieved the highest AUC (0.73), followed by CTV D\n                      <jats:sub>0.03cc<\/jats:sub>\n                      (AUC\u00a0=\u00a00.68).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multivariate models incorporating bladder volume changes and CTV shifts accurately predict dosimetric deviations in PBS\u2010SBRT. These findings highlight the need for adaptive strategies during PBS\u2010SBRT to mitigate the impact of interfractional variations, optimize dose delivery precision, and reduce toxicity in high\u2010risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70223","type":"journal-article","created":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T12:59:58Z","timestamp":1757854798000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The effect of interfractional variation on delivered dose with ultrahypofractionated pencil beam scanning proton therapy for localized prostate cancer"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0886-655X","authenticated-orcid":false,"given":"Keyur D.","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology and Winship Cancer Institute Emory University  Atlanta Georgia 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