{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T18:14:32Z","timestamp":1761156872315},"reference-count":36,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,5,11]],"date-time":"2020-05-11T00:00:00Z","timestamp":1589155200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100008222","name":"Ben and Catherine Ivy Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008222","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01CA22221601A"],"award-info":[{"award-number":["R01CA22221601A"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To introduce the definite target volume (DTV) and evaluate dosimetric consequences of boosting dose to this region of high clinical target volume (CTV)\u2010 and low organs at risk\u00a0(OAR)\u2010probability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This work defines the DTV via occupancy probability and via contraction of the CTV by margin M less any planning risk volume (PRV) volumes. The equivalence to within varying occupancy probability of the two methods is established for spherical target volumes. We estimate a margin for four radiation treatment sites based on modern images guided radiation therapy\u2010literature utilizing repeat volumetric imaging. Based on margins and patient\u2010specific DTV targets, the ability to dose escalate the DTV including the effects of spatial uncertainty was evaluated. We simulate delivery assuming violation of the underlying spatial uncertainty of 130%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Contracting the planning target volume (PTV) by M and excluding PRV volumes, the DTV ranged from 7.3 to 93.6\u00a0cc. In a brain treatment, DTV\u2010Dmax increased to 66.8\u00a0Gy (145% of prescription isodose); in advanced lung DTV\u2010Dmax increased to 122.2\u00a0Gy (204% of prescription isodose), in a pancreatic case DTV\u2010Dmax was boosted up to 87.3\u00a0Gy (173% or prescription isodose), and in retroperitoneal sarcoma to 74.6\u00a0Gy (249% of prescription isodose). The high point doses were not associated with increased dose to OARs, even when considering the effects of spatial uncertainty. Simulated delivery at 130% of assumed spatial uncertainties revealed DTV\u2010based planning can result in minor increases in OAR Dmean\/Dmax of 2.7\u00a0\u00b1\u00a02.1\u00a0Gy\/1.8\u00a0\u00b1\u00a02.2\u00a0Gy with duodenum Dmax\u00a0&gt;\u00a0110% of prescription isodose in the pancreatic case. These dose increases were consistent with simulation of clinical, homogenous PTV\u2010dose distributions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We have proposed and tested a method to deliver extremely high doses to subvolumes of target volumes in multiple treatment sites by defining a new target volume, the DTV. Based on simulated delivery, the method does not result in significant increases in dose to OARs if spatial uncertainty can be estimated.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.14164","type":"journal-article","created":{"date-parts":[[2020,4,8]],"date-time":"2020-04-08T15:29:43Z","timestamp":1586359783000},"page":"3174-3183","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Dose escalation in the definite target volume"],"prefix":"10.1002","volume":"47","author":[{"given":"W. 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