Exploring the dosimetric impact of systematic and random setup uncertainties in robust optimization of head and neck IMPT plans

Purpose: This study aims to compare the dosimetric impact of incorporating systematic and random setup uncertainties in the robust optimization of head and neck cancer (HNC) Intensity Modulated Proton Therapy (IMPT) plans. Methods: Bilateral HNC patients (n =10) previously treated with conventional photon therapy at our institution were included. Both systematic and random setup uncertainties were incorporated into the robust optimization process of IMPT planning. Dosimetric comparisons were made between plans optimized with systematic (IMPTS) versus random (IMPT-R) setup uncertainties, assessing both the clinical target volume (CTVs) and organs at risk (OARs) across various dosimetric metrics. Both plans applied a fixed range uncertainty of f 3 % and a maximum setup uncertainty of f 3 mm. Results: Both IMPT-S and IMPT-R plans achieved similar target coverage, meeting robustness criteria for CTVs. On average, the D95% voxel-wise min to the high-risk CTV (CTV_HR) was slightly higher in IMPT-S plans by 1.78 f 0.72 % compared to IMPT-R plans. However, IMPT-R plans provided better OAR sparing, which was evident in both nominal and voxel-wise maximum values. While random setup errors in robust optimization improved OAR sparing, the clinical impact may be minimal where OAR doses are already well below tolerance levels. Conclusion: Both IMPT-S and IMPT-R techniques met the robustness criteria for CTVs in HNC IMPT planning. Incorporating random setup uncertainties in robust optimization improves OAR sparing compared to systematic setup uncertainties. Further research is needed to explore the broader applicability of random setup errors and to integrate random uncertainties in robustness evaluations for a more comprehensive assessment of treatment plans.