title: Assessment of the quality of very high-energy electron radiotherapy planning.
abstract: To assess the quality of very-high energy electron (VHEE) scanning pencil beam radiation therapy in relation to state-of-the-art volumetric modulated arc therapy (VMAT) and to determine the extent of its application.
  
  
  
  We planned five clinical cases with VHEE scanning pencil beams of 100 and 120MeV, equally distributed in a coplanar arrangement around the patient. The clinical cases included acoustic neuroma, and liver, lung, esophagus, and anal cancer cases. We performed Monte Carlo (MC) dose calculations and we optimized the dose in a research version of RayStation. VHEE plan performance was compared against clinically delivered VMAT.
  
  
  
  With equal target coverage, mean doses to organs at risk (OARs) were on average 22% lower for the VHEE plans compared to the VMAT plans. Dose conformity was equal or superior compared to the VMAT plans and integral dose to the body was in average 14% (9-22%) lower for the VHEE plans.
  
  
  
  The dosimetric advantages of VHEE as demonstrated for a variety of clinical cases, combined with the theoretical ultra fast treatment delivery, afford VHEE scanning pencil beam radiotherapy a suitable and potentially superior alternative for cancer radiotherapy.
authors.affiliation: Department of Radiation Oncology, Stanford University, USA.
authors.forename: Bianey
authors.initials: B
authors.lastname: Palma
authors.affiliation: Department of Radiation Oncology, Stanford University, USA.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Bazalova-Carter
authors.affiliation: RaySearch Laboratories AB, Stockholm, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Hårdemark
authors.affiliation: RaySearch Laboratories AB, Stockholm, Sweden.
authors.forename: Elin
authors.initials: E
authors.lastname: Hynning
authors.affiliation: Department of Radiation Oncology, Stanford University, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Qu
authors.affiliation: Department of Radiation Oncology, Stanford University, USA. Electronic address: BWLoo@Stanford.edu.
authors.forename: Billy W
authors.initials: BW
authors.lastname: Loo
authors.affiliation: Department of Radiation Oncology, Stanford University, USA. Electronic address: Peter.Maxim@Stanford.edu.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Maxim
mesh_terms: D004583:Electrons / Q000627:therapeutic use*; D004938:Esophageal Neoplasms / Q000532:radiotherapy; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy; D008175:Lung Neoplasms / Q000532:radiotherapy; D009010:Monte Carlo Method; D009369:Neoplasms / Q000532:radiotherapy*; D009464:Neuroma, Acoustic / Q000532:radiotherapy; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D011882:Radiotherapy, High-Energy / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated
keywords: Integral dose; Monte Carlo; Treatment planning; Very high-energy electrons