Dynamic proton arc treatment planning study for oesophageal cancer

Particle Arc Therapy (PAT) is considered a promising technique to improve conformity and reduce toxicities. Robustly optimized PAT plans were evaluated versus Intensity Modulated Proton Therapy (IMPT) for oesophageal cancer in 17 patients. Impact of motion, setup and range uncertainties on target coverage, plan quality and Organs At Risk (OAR) doses were assessed. PAT (two 80°-200°arcs) reduced OAR doses (spinal canal <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:msub><mml:mrow><mml:mi>D</mml:mi></mml:mrow> <mml:mrow><mml:mn>0</mml:mn> <mml:mo>.</mml:mo> <mml:mn>05</mml:mn> <mml:msup><mml:mrow><mml:mtext>cm</mml:mtext></mml:mrow> <mml:mrow><mml:mn>3</mml:mn></mml:mrow> </mml:msup> </mml:mrow> </mml:msub> </mml:math> : 5.12 Gy (12.8%), lungs and heart <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:msub><mml:mrow><mml:mi>D</mml:mi></mml:mrow> <mml:mrow><mml:mtext>mean</mml:mtext></mml:mrow> </mml:msub> </mml:math> : 0.39 Gy (8.8%) and 0.83 Gy (10.5%)) while maintaining robustness. Similar toxicities were observed, but delivery time was doubled for PAT, indicating that further development is needed.