{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T02:56:32Z","timestamp":1769050592064,"version":"3.49.0"},"reference-count":50,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To compare plan quality among photon volumetric modulated arc therapy (VMAT) and intensity\u2010modulated proton therapy (IMPT) with robustness using three different proton beam delivery systems with various spot size (\u03c3) ranges: cyclotron\u2010generated proton beams (CPBs) (\u03c3: 2.7\u20137.0\u00a0mm), linear accelerator proton beams (LPBs) (\u03c3: 2.9\u20135.5\u00a0mm), and linear accelerator proton mini beams (LPMBs) (\u03c3: 0.8\u20133.9\u00a0mm) for the treatment of head and neck (HN) cancer with bilateral neck irradiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ten patients treated for oropharynx cancer with bilateral neck irradiation were planned using CPBs, LPBs, LPMBs, and VMAT. The homogeneity index (HI), mean body dose, and defined volumetric doses for selected critical organs\u2010at\u2010risk (OARs) were compared. Set\u2010up uncertainties of\u00a0\u00b13\u00a0mm and\u00a0\u00b1\u00a03.5% range uncertainties were included in robust evaluation using V<jats:sub>95%Rx\u00a0<\/jats:sub>&gt;\u00a095% (Volume that covers 95% of the target volume at 95% of the prescription (Rx) dose) to high dose and low dose CTV volumes (CTV_70\u00a0Gy and CTV_56\u00a0Gy). VMAT and proton plans were compared in terms of OAR doses and mean body dose only. Homogeneity Indices were compared among IMPT plans in addition to OAR doses. The Wilcoxon signed\u2010rank test was used to evaluate statistical differences between evaluation metrics for VMAT plans and all proton plan types.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>OAR dose metrics were improved by 2% to 30% from CPB plans to LPB or LPMB plans. Compared to photon VMAT plans, all OAR doses except for mandible dose metrics were improved by 2% to 53% for all proton plans. The mean body dose was also improved by 7.5% from CPB to LPB and by 10.8% from CPB to LPMB. In addition, the mean body dose was also improved by 44% from VMAT to CPB, by 48% from VMAT to LPB, and by 50% from VMAT to LPMB plans. Compared to CPB plans, HI was significantly better (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05) for the LPB and LPMB plans. HI also improved considerably from VMAT to CPB, LPB, and LPMB. For both CTV_70\u00a0Gy and CTV_56\u00a0Gy, average robust evaluation across all worst\u2010case scenarios was slightly better for CPB plans, with an average of V<jats:sub>95%Rx<\/jats:sub> of the CTV_70\u00a0Gy of 97.6%\u00a0\u00b1\u00a01.22%, followed by 97.2%\u00a0\u00b1\u00a01.31% and 97.2%\u00a0\u00b1\u00a01.35% for LPB and LPMB plans, respectively. Robustness for CTV_56\u00a0Gy showed comparable robustness across all proton plan types, with an average V<jats:sub>95%Rx<\/jats:sub> of 97.4%\u00a0\u00b1\u00a00.87% for CPB, 97.4%\u00a0\u00b1\u00a01.21%, and 97.5%\u00a0\u00b1\u00a01.08% for CPB, LPB, and LPMB plans, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>With decreased spot size, the LPB and LPMB are excellent alternatives to VMAT and CPB therapy and can significantly reduce the dose to normal tissue.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.70013","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T14:14:07Z","timestamp":1739801647000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Assessing proton plans with three different beam delivery systems versus photon plans for head and neck tumors"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2526-7847","authenticated-orcid":false,"given":"Tara","family":"Gray","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Cleveland Clinic Foundation  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chieh\u2010Wen","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cleveland Clinic Foundation  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saeed","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Kansas Medical Center  Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Maria","family":"Kolano","sequence":"additional","affiliation":[{"name":"Applications of Detectors and Accelerators to Medicine (ADAM) Advanced Oncotherapy (AVO) plc  London 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