{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:06:47Z","timestamp":1790698007926,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01CA301448"],"award-info":[{"award-number":["R01CA301448"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002669","name":"Elekta","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002669","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>\n                      Esophageal cancer presents significant treatment challenges due to its proximity to critical structures such as the heart, lungs, and spinal cord. While intensity\u2010modulated proton therapy (IMPT) improves dose conformity, it is limited by factors such as the number of beam angles and lateral penumbra. Proton arc therapy (PAT) may overcome these issues by utilizing continuous gantry rotation to enhance conformity and spare organs\u2010at\u2010risk (OARs). This study compared PAT and IMPT in esophageal cancer, focusing on dosimetric outcomes, and dose\u2010averaged linear energy transfer (LET\n                      <jats:sub>d<\/jats:sub>\n                      ) distributions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective analysis was conducted on ten esophageal cancer patients with variable tumor characteristics. Treatment plans were created using Monaco v6.1 treatment planning system for both PAT and IMPT, maintaining identical robustness parameters\u00a0(\u00b1\u00a05\u00a0mm setup and\u00a0\u00b1\u00a03.5% range uncertainties). Both modalities were prescribed a total dose of 50.4\u00a0Gy(RBE) in 28 fractions, ensuring \u226595% clinical target volume (CTV) coverage in the worst\u2010case scenarios. Key metrics, including conformity index (CI), heterogeneity index (HI), and LET\n                      <jats:sub>d<\/jats:sub>\n                      , were compared. Robustness evaluations were performed across 21 worst\u2010case scenarios to assess plan quality and OAR sparing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PAT demonstrated superior dose conformity (CI: 0.67\u00a0\u00b1\u00a00.17\u00a0vs. 0.54\u00a0\u00b1\u00a00.13;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01) and reduced lung V20 (6.88%\u00a0vs. 13.44%;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01) compared to IMPT. Critical structure sparing, including reduced spinal cord doses (max dose of (30.93\u00a0\u00b1\u00a010.85) Gy(RBE) vs (23.22\u00a0\u00b1\u00a09.55) Gy(RBE),\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02), was achieved without compromising CTV coverage. PAT showed higher LET\n                      <jats:sub>d<\/jats:sub>\n                      within the CTV and lower LET\n                      <jats:sub>d<\/jats:sub>\n                      in adjacent organs\u2010at\u2010risk relative to IMPT, without statistically significant differences. While the clinical significance remains uncertain, this pattern may support more refined biological dose shaping.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PAT emerged as a promising modality for esophageal cancer treatment, delivering improved dose conformity and reduced OAR exposure. These advantages suggest PAT's potential to decrease radiation\u2010associated complications and improve therapeutic outcomes, warranting further clinical validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70607","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T01:39:54Z","timestamp":1778031594000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Advancing proton therapy: Dosimetric superiority of proton arc therapy over IMPT in esophageal cancer treatment"],"prefix":"10.1002","volume":"27","author":[{"given":"Xiaoda","family":"Cong","sequence":"first","affiliation":[{"name":"Corewell Health William Beaumont University Hospital  Royal oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebin","family":"Sebastian","sequence":"additional","affiliation":[{"name":"Corewell Health William Beaumont University Hospital  Royal oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1498-3228","authenticated-orcid":false,"given":"Peilin","family":"Liu","sequence":"additional","affiliation":[{"name":"Corewell Health William Beaumont University Hospital  Royal oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqiang","family":"Li","sequence":"additional","affiliation":[{"name":"Corewell Health William Beaumont University Hospital  Royal oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Dolan","sequence":"additional","affiliation":[{"name":"Elekta AB  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Dalfson","sequence":"additional","affiliation":[{"name":"Elekta AB  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Soukup","sequence":"additional","affiliation":[{"name":"Elekta AB  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Lessard","sequence":"additional","affiliation":[{"name":"Elekta AB  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan L.","family":"Deraniyagala","sequence":"additional","affiliation":[{"name":"Corewell Health William Beaumont University Hospital  Royal oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig W.","family":"Stevens","sequence":"additional","affiliation":[{"name":"Corewell Health William Beaumont University Hospital  Royal oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Y.","family":"Chen","sequence":"additional","affiliation":[{"name":"Corewell Health William Beaumont University Hospital  Royal oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuanfeng","family":"Ding","sequence":"additional","affiliation":[{"name":"Corewell 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