An important unresolved issue in outcomes analysis for lung complications is the effect of poor or completely lacking heterogeneity corrections in previously archived treatment plans. To estimate this effect, we developed a novel method based on Monte Carlo (MC) dose calculations which can be applied retrospectively to RTOG AAPM-style archived treatment plans (ATP). We applied this method to 218 archived nonsmall cell lung cancer lung treatment plans that were originally calculated either without heterogeneity corrections or with primitive corrections. To retrospectively specify beam weights and wedges, beams were broken into Monte Carlo-generated beamlets, simulated using the VMC++ code, and mathematical optimization was used to match the archived water-based dose distributions. The derived beam weights (and any wedge effects) were then applied to Monte Carlo beamlets regenerated based on the patient computed tomography densities. Validation of the process was performed against five comparable lung treatment plans generated using a commercial convolution superposition implementation. For the application here (normal lung, esophagus, and planning target volume dose distributions), the agreement was very good. Resulting MC and convolution superposition values were similar when dose distributions without heterogeneity corrections or dose distributions with corrections were compared. When applied to the archived plans (218), the average absolute percent difference between water-based MC and water-based ATPs, for doses above 2.5% of the maximum dose was 1.8±0.6%. The average absolute percent difference between heterogeneity-corrected MC and water-based ATPs increased to 3.1±0.9%. The average absolute percent difference between the MC heterogeneity-corrected and the ATP heterogeneity-corrected dose distributions was 3.8±1.6% (available in 132/218 archives). The entire dose-volume-histograms for lung, tumor, and esophagus from the different calculation methods, as well as specific dose metrics, were compared. The average difference in maximum lung dose between water-based ATPs and heterogeneity-corrected MC dose distributions was -1.0±2.1 Gy. Potential errors in relying on primitive heterogeneity corrections are most evident from a comparison of maximum lung doses, for which the average MC heterogeneity- corrected values were 5.3±2.8 Gy less than the ATP heterogeneity- corrected values. We have demonstrated that recalculation of archived dose distributions, without explicit information about beam weights or wedges, is feasible using beamlet-based optimization methods. The method provides heterogeneity-corrected dose data consistent with convolution-superposition calculations and is one feasible approach for improving dosimetric data for outcomes analyses.
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