Background and purpose The impact of treatment accuracy on NTCP-based patient selection for proton therapy is currently unknown. This study investigates this impact for oropharyngeal cancer patients. Materials and methods Data of 78 patients was used to automatically generate treatment plans for a simultaneously integrated boost prescribing 70 GyRBE/54.25 GyRBE in 35 fractions. IMRT treatment plans were generated with three different margins; intensity modulated proton therapy (IMPT) plans for five different setup and range robustness settings. Four NTCP models were evaluated. Patients were selected for proton therapy if NTCP reduction was ≥10% or ≥5% for grade II or III complications, respectively. Results The degree of robustness had little impact on patient selection for tube feeding dependence, while the margin had. For other complications the impact of the robustness setting was noticeably higher. For high-precision IMRT (3 mm margin) and high-precision IMPT (3 mm setup/3% range error), most patients were selected for proton therapy based on problems swallowing solid food (51.3%) followed by tube feeding dependence (37.2%), decreased parotid flow (29.5%), and patient-rated xerostomia (7.7%). Conclusions Treatment accuracy has a significant impact on the number of patients selected for proton therapy. Therefore, it cannot be ignored in estimating the number of patients for proton therapy.

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Keywords Head and neck cancer, IMPT, IMRT, Oropharyngeal cancer, Proton therapy, Robust optimization
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Journal Radiotherapy & Oncology
Arts, T. (Tine), Breedveld, S, de Jong, M.A. (Martin A.), Astreinidou, E, Tans, L, Keskin-Cambay, F, … Hoogeman, M.S. (2017). The impact of treatment accuracy on proton therapy patient selection for oropharyngeal cancer patients. Radiotherapy & Oncology, 125(3), 520–525. doi:10.1016/j.radonc.2017.09.028