Dose assessment in moving targets and organs at risk during carbon ion therapy for pancreatic cancer with respiratory gating

Christina Stengl; Jeppe B Christensen; Iván D Muñoz; Alexander Neuholz; Stephan Brons; Eduardo G Yukihara; Jakob Liermann; Oliver Jäkel; José Vedelago

doi:10.1016/j.phro.2025.100775

Dose assessment in moving targets and organs at risk during carbon ion therapy for pancreatic cancer with respiratory gating

Phys Imaging Radiat Oncol. 2025 May 8:34:100775. doi: 10.1016/j.phro.2025.100775. eCollection 2025 Apr.

Authors

Christina Stengl^{1

2

3

4}, Jeppe B Christensen⁵, Iván D Muñoz^{2

3

6}, Alexander Neuholz⁷, Stephan Brons⁷, Eduardo G Yukihara⁵, Jakob Liermann^{1

3

7

4}, Oliver Jäkel^{2

3

7}, José Vedelago^{4

2

3}

Affiliations

¹ Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 672, Heidelberg 69120, Germany.
² Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany.
³ Heidelberg Institute for Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Im Neuenheimer Feld 280, Heidelberg 69120, Germany.
⁴ Department of Radiation Oncology, Heidelberg University Hospital (UKHD), Im Neuenheimer Feld 400, Heidelberg 69120, Germany.
⁵ Department of Radiation Safety and Security, Paul Scherrer Institute (PSI), Forschungsstrasse 111, Villingen PSI, 5232, Switzerland.
⁶ Department for Physics and Astronomy, University of Heidelberg, Im Neuenheimer Feld 226, Heidelberg 69120, Germany.
⁷ Heidelberg Ion Beam Therapy Center (HIT), Heidelberg University Hospital (UKHD), Im Neuenheimer Feld 450, Heidelberg 69120, Germany.

Abstract

Background and purpose: Carbon ion radiotherapy (CIRT) has demonstrated promising treatment outcomes for pancreatic cancer. However, breathing-induced organ motion can compromise the efficacy of the treatment, leading to under- or over-dosage within the target and organs at risk (OARs). In this work, the dose during CIRT was simultaneously measured at the target and OARs using an anthropomorphic phantom to evaluate the effectiveness of respiratory gating for compensating breathing motion.

Materials and methods: The Pancreas Phantom for Ion beam Therapy (PPIeT) was irradiated with carbon ions. The phantom features a pancreas with a virtual tumour and OARs including a duodenum, kidneys, a spine and a spinal cord. Breathing-induced organ motion was imitated with amplitudes of 0 mm (control), 5 mm, 10 mm and 20 mm while irradiating with and without gating. Dose measurements were performed using an ionisation chamber and passive detectors.

Results: The prescribed uniform dose of 1.37 Gy in the virtual tumour was experimentally validated for the control. Breathing-induced motion of 20 mm led to a 75 % dose coverage at the target improving to 91 % with gating. For the OARs, the mean dose varied according to the organ, with gating showing no significant differences.

Conclusions: Accurate CIRT dosimetry with variable breathing-induced motions can be conducted with PPIeT for a pancreatic tumour and the OARs. Gating mitigated the effects of breathing-induced motion in the tumour.

Keywords: Anthropomorphic phantom; Carbon ion radiotherapy; Optically stimulated luminescence detectors (OSLDs); Respiratory gating.