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

## TL;DR

This study evaluates how breathing motion affects radiation dose delivery in pancreatic cancer treatment using carbon ion therapy and respiratory gating.

## Contribution

The study introduces a phantom system to measure dose changes in tumors and organs at risk during carbon ion therapy with respiratory motion and gating.

## Key findings

- Respiratory gating improved dose coverage in the tumor from 75% to 91% under 20 mm breathing motion.
- Gating had no significant effect on dose delivery to organs at risk.
- The Pancreas Phantom for Ion beam Therapy (PPIeT) effectively simulated dose distribution under varying breathing conditions.

## Abstract

•Breathing-induced organ motion reduces target dose in pancreatic cancer treatment.•Respiratory gating mitigates the dose reduction in the pancreas tumour.•Respiratory gating does not significantly affect the dose in the organs at risk.

Breathing-induced organ motion reduces target dose in pancreatic cancer treatment.

Respiratory gating mitigates the dose reduction in the pancreas tumour.

Respiratory gating does not significantly affect the dose in the organs at risk.

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.

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.

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.

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.