{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T18:03:01Z","timestamp":1784743381497,"version":"3.55.0"},"reference-count":43,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"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":["Medical Physics"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Over the past three decades, the intensity\u2010modulated radiotherapy (IMRT) has become a standard technique, enabling highly conformal dose distributions tailored to specific clinical objectives. Despite these advancements, IMRT treatment plans are significantly susceptible to uncertainties during both the planning and delivery phases. The most commonly used strategy to address these uncertainties is the margin\u2010based or planning target volume (PTV) approach, which relies on the so\u2010called dose cloud approximation. However, the PTV concept has notable limitations, particularly in complex scenarios where target volumes are superficial or located near critical structures.<\/jats:p>\n                    <jats:p>In contrast, the advent of intensity\u2010modulated particle therapy has driven the development of robust optimization models, which have emerged as a promising alternative for managing uncertainties. Among these, the worst\u2010case scenario or minimax strategy is the most widely employed. While minimax can be directly applied to photon treatments, its use in IMRT often leads to overly conservative plans or plans that are very similar to those obtained using the conventional margin\u2010based PTV\u00a0approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>In this work, we present a robust optimization model particularly suitable for photon treatments. The new approach, called Cheap\u2010Minimax, is a generalization of the minimax strategy used for particle therapy and aims to improve the balance between plan robustness and the price of robustness in terms of dose to organs at risk (OARs), an issue particularly pronounced in photon\u00a0treatments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The c\u2010minimax model was implemented in the MatRad treatment planning system, developed at the German Cancer Research Center (DKFZ). It was applied to 20 clinical cases, comprising 5 prostate cancer cases and 15 breast cancer cases. The results were compared with those obtained using the conventional minimax model and the PTV\u2010based\u00a0approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For prostate cancer cases, the c\u2010minimax model maintained a robustness comparable to the PTV approach, while achieving a 20% reduction in  for the rectum and a 10% reduction in  for the bladder compared to the minimax model. In breast cancer cases, the c\u2010minimax model improved robustness by 23.7% relative to the PTV approach and by 18.2% compared to the minimax model. Additionally, the c\u2010minimax model reduced  for the ipsilateral lung by 3.7% and the mean heart dose by 1.2 Gy (20%) compared to minimax. Both the c\u2010minimax and minimax models reduced  skin dose by 10.9 Gy (18.9%) and 11.1 Gy (19.3%), respectively, compared to the PTV\u00a0approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The c\u2010minimax model successfully overcomes the limitations of the PTV approach and the over\u2010conservativeness of the minimax model, demonstrating significant advantages in managing uncertainties in complex cases, such as breast cancer. By providing superior robustness compared to PTV and reducing OAR doses relative to minimax, the model offers a flexible and clinically feasible strategy to enhance treatment quality. The marked reduction in high\u2010dose regions (hotspots) in superficial tissues and skin highlights its potential to lower toxicity risks and improve patient outcomes. These results provide quantitative evidence of the practical benefits of robustness\u2010compromise\u2010oriented approaches in\u00a0IMRT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mp.17709","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T18:53:09Z","timestamp":1741719189000},"page":"3360-3376","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A robust optimization model for intensity\u2010modulated radiotherapy: Cheap\u2010Minimax"],"prefix":"10.1002","volume":"52","author":[{"given":"Andr\u00e9s C.","family":"Sevilla","sequence":"first","affiliation":[{"name":"School of Applied Sciences and Engineering Universidad EAFIT Medell\u00edn Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonzalo","family":"Cabal","sequence":"additional","affiliation":[{"name":"Department of Radiation Therapy Cl\u00ednica El Rosario Medell\u00edn Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Wahl","sequence":"additional","affiliation":[{"name":"Division of Medical Physics in Radiation Oncology German Cancer Research Center Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda E.","family":"Puerta","sequence":"additional","affiliation":[{"name":"School of Applied Sciences and Engineering Universidad EAFIT Medell\u00edn Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C.","family":"Rivera","sequence":"additional","affiliation":[{"name":"School of Applied Sciences and Engineering Universidad EAFIT Medell\u00edn Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","unstructured":"LandbergT ChavaudraJ DobbsJ et\u00a0al.Reports of the International Commission on Radiation Units and Measurements. 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