Potential benefits of using radioactive ion beams for range margin reduction in carbon ion therapy

Sharp dose gradients and high biological effectiveness make ions such as (12)C an ideal tool to treat deep-seated tumors, however, at the same time, sensitive to errors in the range prediction. Tumor safety margins mitigate these uncertainties, but during the irradiation they lead to unavoidable damage to the surrounding healthy tissue. To fully exploit the Bragg peak benefits, a large effort is put into establishing precise range verification methods. Despite positron emission tomography being widely in use for this purpose in (12)C therapy, the low count rates, biological washout, and broad activity distribution still limit its precision. Instead, radioactive beams used directly for treatment would yield an improved signal and a closer match with the dose fall-off, potentially enabling precise in vivo beam range monitoring. We have performed a treatment planning study to estimate the possible impact of the reduced range uncertainties, enabled by radioactive (11)C ions treatments, on sparing critical organs in tumor proximity. Compared to (12)C treatments, (i) annihilation maps for (11)C ions can reflect sub- millimeter shifts in dose distributions in the patient, (ii) outcomes of treatment planning with (11)C significantly improve and (iii) less severe toxicities for serial and parallel critical organs can be expected.