RAPTORplus aims at adapting proton therapy treatment with multi-modality image information acquired at various time scales. Daily anatomical changes would be characterized by on-board X-ray based imaging systems (or eventually MRI), while longer term biological modifications would be detected with offline functional imaging (PET or MRI). The optimal timing of image acquisition and subsequent adaptations depend on the potential gains in outcome which must be balanced against practical considerations. For instance, it might be more productive to develop very fast treatment workflows without online adaptation to maximize patient throughput on an expensive proton therapy machine, instead of performing systematic online adaptation with minor gains in clinical outcome and a reduction in machine capacity due to the time required for the adaptation. The opensource treatment planning system (OpenTPS) will be extended to optimize and/or evaluate a treatment using multi-modality image information (3 first dimensions), timing considerations (4^th dimension), and biological modeling (5^th dimension). Variability in treatment outcome will be expressed using normal tissue complication and tumor control probabilities. Treatments with X-rays and protons will be both simulated.

We provide here a more detailed description of the workpackages (WP) associated to this project

WP1 – Development of a flexible clinical workflow simulator in OpenTPS: OpenTPS features an advanced robustness evaluation tool for proton therapy treatments (MCsquare), including LET computation. OpenTPS will also soon feature photon dose calculation. By introducing multi-modality imaging, treatment adaptations on various timescales, and, when necessary, biological functions (TCP and NTCP), it would be possible to provide a comprehensive and quantitative assessment of the treatment outcome for many adaptation, fractionation, and treatment prescription schemes.