On the PTV homogeneity objective in the era of photon advanced dose calculation algorithms: Bridging robust and PTV-based planning

Robust optimization proves that PTV homogeneity should not be prioritized when advanced algorithms reporting D_m,m are used with high-density heterogeneities. PTV-D_{muscle,muscle*} optimization offers a practical alternative for maintaining PTV-based planning and the PTV homogeneity objective while ensuring consistency with robust optimization. D_{muscle,muscle*} reporting simplifies plan evaluation and aligns with clinical practice, facilitating decision-making in treatment planning.