Spot-Scanning Hadron Arc (SHArc) Therapy: A Study With Light and Heavy Ions

PURPOSE: To evaluate the clinical potential of spot-scanning hadron arc (SHArc) therapy with a heavy-ion gantry. METHODS AND MATERIALS: A series of in silico studies was conducted via treatment plan optimization in FRoG and the RayStation TPS to compare SHArc therapy against reference plans using conventional techniques with single, parallel-opposed, and 3-field configurations for 3 clinical particle beams (protons [p], helium [(4)He], and carbon [(12)C] ions). Tests were performed on water-equivalent cylindrical phantoms for simple targets and clinical-like scenarios with an organ-at-risk in proximity of the target. Effective dose and dose-averaged linear energy transfer (LET(D)) distributions for SHArc were evaluated against conventional planning techniques applying the modified microdosimetric kinetic model for considering bio-effect with (α/β)(x) = 2 Gy. A model for hypoxia-induced tumor radio-resistance was developed for particle therapy with dependence on oxygen concentration and particle species/energy (Z(eff)/β)(2) to investigate the impact on effective dose. RESULTS: SHArc plans exhibited similar target coverage with unique treatment attributes and distributions compared with conventional planning, with carbon ions demonstrating the greatest potential for tumor control and normal tissue sparing among the arc techniques. All SHArc plans exhibited a low-dose bath outside the target volume with a reduced maximum dose in normal tissues compared with single, parallel-opposed, and 3-field configuration plans. Moreover, favorable LET(D) distributions were made possible using the SHArc approach, with maximum LET(D) in the r = 5 mm tumor core (~8 keVμm(-1), ~30 keVμm(-1), and ~150 keVμm(-1) for p,(4)He, and (12)C ions, respectively) and reductions of high-LET regions in normal tissues and organs-at-risk compared with static treatment beam delivery. CONCLUSION: SHArc therapy offers potential treatment benefits such as increased normal tissue sparing. Without explicit consideration of oxygen concentration during treatment planning and optimization, SHArc-C may mitigate tumor hypoxia-induced loss of efficacy. Findings justify further development of robust SHArc treatment planning toward potential clinical translation.