热疗和放疗的联合效应可以通过增强等效辐射剂量（EQDRT）来量化。热疗计划和治疗期间调整的不确定性可能会影响达到的 EQDRT。我们开发并比较了放射治疗计划的 EQDRT 优化策略，重点关注针对常见调整的稳健性。使用 Plan2Heat，我们计算了三名宫颈癌患者的预先计划热疗计划和治疗调整方案。我们将这些场景导入 RayStation 12A，使用四种不同的策略进行优化：(1) 传统放疗优化，为规划目标体积 (PTV) 指定 46 Gy，(2) 使用预规划场景的标称 EQDRT 优化，目标为统一 58 Gy总肿瘤体积 (GTV)、保持处于危险中的器官 (OAR) 剂量如计划 (1)、(3) 稳健的 EQDRT 优化，如 (2) 但添加调整后的优化方案、(4) 计划库（四个计划），具有策略 (2) 标准，但针对每个计划的一个调整后的场景进行优化。我们计算了每个放疗计划的预先计划和调整方案的 EQDRT 分布，评估每个组合的 GTV 覆盖范围和同质性目标。EQDRT95% 从策略 (1) 中的 49.9-50.9 Gy 增加到策略 (2) 中的 56.1-57.4 Gy预先规划的场景，将同质性提高约 10%。策略 (2) 表现出最佳的整体稳健性，所有 GTV 目标中有 62% 在容忍范围内。策略 (3) 的容差范围内覆盖目标百分比高于策略 (2)（68% vs 54%），但均匀性百分比较低（44% vs 71%）。策略 (4) 在调整后的场景中显示出与策略 (2) 相似的 EQDRT95% 和同质性。通过策略 (2-4)，OAR 的 D0.1% 增加了高达 ∼6 Gy。与传统优化相比，EQDRT 优化增强了 EQDRT 水平和均匀性。通过优化预先规划的热疗计划，实现了更好的整体鲁棒性。稳健的优化提高了覆盖范围，但降低了同质性。计划库可确保处理调整后的热疗场景时的覆盖范围和一致性。版权所有 © 2024。由 Elsevier Inc. 出版。

The combined effect of hyperthermia and radiotherapy can be quantified by an enhanced equivalent radiation dose (EQDRT). Uncertainties in hyperthermia treatment planning and adjustments during treatment can impact achieved EQDRT. We developed and compared strategies for EQDRT optimization of radiotherapy plans, focusing on robustness against common adjustments.Using Plan2Heat, we computed pre-planning hyperthermia plans and treatment adjustment scenarios for three cervical cancer patients. We imported these scenarios into RayStation 12A for optimization with four different strategies: (1) Conventional radiotherapy optimization prescribing 46 Gy to the planning target volume (PTV), (2) Nominal EQDRT optimization using the pre-planning scenario, targeting uniform 58 Gy in the gross tumor volume (GTV), keeping organs at risk (OAR) doses as in plan (1), (3) Robust EQDRT optimization, as (2) but adding adjusted scenarios for optimization, (4) Library of Plans (four plans), with strategy (2) criteria but optimizing on one adjusted scenario per plan. We calculated for each radiotherapy plan EQDRT distributions for pre-planning and adjusted scenarios, evaluating for each combination GTV coverage and homogeneity objectives.EQDRT95% increased from 49.9-50.9 Gy in strategy (1) to 56.1-57.4 Gy in strategy (2) with the pre-planning scenario, improving homogeneity in ∼10%. Strategy (2) demonstrated the best overall robustness, with 62% of all GTV objectives within tolerance. Strategy (3) had higher percentage of coverage objectives within tolerance than strategy (2) (68% vs 54%), but lower percentage for uniformity (44% vs 71%). Strategy (4) showed similar EQDRT95% and homogeneity for adjusted scenarios than strategy (2) for pre-planning scenario. D0.1% for OARs was increased by strategies (2-4) by up to ∼6 Gy.EQDRT optimization enhances EQDRT levels and uniformity compared to conventional optimization. Better overall robustness is achieved optimizing on the pre-planning hyperthermia plan. Robust optimization improves coverage but reduces homogeneity. A library of plans ensures coverage and uniformity when dealing with adjusted hyperthermia scenarios.Copyright © 2024. Published by Elsevier Inc.