title: Optimization of Carbon Ion Treatment Plans by Integrating Tissue Specific α/β-Values for Patients with Non-Resectable Pancreatic Cancer.
abstract: BACKGROUND
  The aim of the thesis is to improve treatment plans of carbon ion irradiation by integrating the tissues' specific [Formula: see text]-values for patients with locally advanced pancreatic cancer (LAPC).
  
  
  METHODS
  Five patients with LAPC were included in this study. By the use of the treatment planning system Syngo RT Planning (Siemens, Erlangen, Germany) treatment plans with carbon ion beams have been created. Dose calculation was based on [Formula: see text]-values for both organs at risk (OAR) and the tumor. Twenty-five treatment plans and thirty-five forward calculations were created. With reference to the anatomy five field configurations were included. Single Beam Optimization (SBO) and Intensity Modulated Particle Therapy (IMPT) were used for optimization. The plans were analyzed with respect to both dose distributions and individual anatomy. The plans were evaluated using a customized index.
  
  
  RESULTS
  With regard to the target, a field setup with one single posterior field achieves the highest score in our index. Field setups made up of three fields achieve good results in OAR sparing. Nevertheless, the field setup with one field is superior in complex topographic conditions. But, allocating an [Formula: see text]-value of 2 Gy to the spinal cord leads to critical high maximum doses in the spinal cord. The evaluation of dose profiles showed significant dose peaks at borders of the [Formula: see text]-gradient, especially in case of a single posterior field.
  
  
  CONCLUSIONS
  Optimization with specific [Formula: see text]-values allows a more accurate view on dose distribution than previously. A field setup with one single posterior field achieves good results in case of difficult topographic conditions, but leads to high maximum doses to the spinal cord. So, field setups with multiple fields seem to be more adequate in case of LAPC, being surrounded by highly radiosensitive normal tissues.
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.|Department of Radiooncology, Klinikum rechts der Isar, Munich, Germany.
authors.forename: Constantin
authors.identifier: http://orcid.org/0000-0001-5671-9389
authors.initials: C
authors.lastname: Dreher
authors.affiliation: Imaging & Therapy Division, Healthcare Sector, Siemens AG, Mannheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Scholz
authors.affiliation: Hottinger Baldwin Messtechnik GmbH, Darmstadt, Germany.
authors.forename: Mira
authors.initials: M
authors.lastname: Pommer
authors.affiliation: Heidelberg Ion Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Brons
authors.affiliation: Heidelberg Ion Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Hannah
authors.initials: H
authors.lastname: Prokesch
authors.affiliation: Heidelberg Ion Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Swantje
authors.initials: S
authors.lastname: Ecker
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Jäkel
authors.affiliation: Department of Radiooncology, Klinikum rechts der Isar, Munich, Germany.|Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, München, Germany.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Combs
authors.affiliation: Department of Radiooncology, Klinikum rechts der Isar, Munich, Germany.|Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, München, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Habermehl
mesh_terms: D000368:Aged; D005260:Female; D063193:Heavy Ion Radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D013116:Spinal Cord / Q000528:radiation effects; D014057:Tomography, X-Ray Computed