{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T03:02:04Z","timestamp":1789700524785,"version":"4.0.1"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100018537","name":"National Science and Technology Major Project","doi-asserted-by":"publisher","award":["2024ZD0519901"],"award-info":[{"award-number":["2024ZD0519901"]}],"id":[{"id":"10.13039\/501100018537","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":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Proton arc therapy (PAT) is an emerging delivery modality that delivers proton beams through continuous gantry rotation combined with spot scanning. Compared with intensity\u2010modulated proton therapy (IMPT), PAT improves target conformity and spares organs at risk. However, the dynamic multi\u2010angle irradiation pattern may alter the low\u2010dose region distribution: the low\u2010dose bath expands while the integral dose decreases. The net effect on secondary cancer risk, especially in radiosensitive lungs, remains unclear. Quantitative risk assessment is essential for clinical translation of PAT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To quantitatively compare secondary lung cancer risk between PAT and IMPT using organ equivalent dose (OED) and lifetime attributable risk (LAR) models, and to assess cross\u2010population robustness across China, France, Sweden, and Germany.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data from 25 lung cancer patients (60\u00a0Gy\/30 fractions) were retrospectively included. For each patient, robustly optimized IMPT and PAT plans were generated with a 3\u00a0mm setup and 3% range uncertainties across 21 error scenarios. Dosimetric parameters\u2014ipsilateral lung , , and mean dose; whole lungs , , and mean dose; and esophageal mean dose\u2014were compared between the two techniques. The mechanistic OED model (with repopulation factor R) and its simplified linear model were used to calculate OED for the ipsilateral lung, both lungs, and the esophagus. LAR was computed by integrating excess absolute risk over the remaining lifetime using patient age, sex, and population\u2010specific parameters (China, France, Sweden, Germany). Relative risk was assessed via the LAR ratio (IMPT\/PAT). Paired t\u2010tests or Wilcoxon tests were used with\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Under the linear model, PAT produced statistically markedly but modest reductions in absolute LAR for lungs (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Under the mechanistic model, reductions were markedly only in certain populations: ipsilateral lung in France (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001), Sweden (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), Germany (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.003); whole lungs in France (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.046) and Sweden (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.014); but not in China (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.083;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a01.000) or Germany for whole lungs (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.317). No marked esophageal differences (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&gt;\u00a00.05). LAR ratios were consistent across countries (ipsilateral lung: 1.07\u20131.09; esophagus: 1.04\u20131.13), demonstrating robustness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PAT does not increase the modeled in\u2010field secondary cancer risk in the lungs compared with IMPT and shows comparable risk for the esophagus. The risk reduction trend is robust across Chinese and European populations. These findings suggest that PAT does not increase modeled secondary lung cancer risk compared with IMPT and may even provide a modest risk reduction, providing quantitative evidence for clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70793","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:37:56Z","timestamp":1789025876000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of in\u2010field secondary cancer risk based on therapeutic proton dose between proton arc therapy and intensity\u2010modulated proton therapy in lung cancer patients"],"prefix":"10.1002","volume":"27","author":[{"given":"Yuankang","family":"Xu","sequence":"first","affiliation":[{"name":"School of Physics University of Electronic Science and Technology  Chengdu China"},{"name":"Department of Radiation Oncology Precision Radiation in Oncology Key Laboratory of Sichuan Province Sichuan Clinical Research Center for Cancer Sichuan Cancer Center, Sichuan Cancer Hospital &amp; Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4983-9405","authenticated-orcid":false,"given":"Wenguang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Precision Radiation in Oncology Key Laboratory of Sichuan Province Sichuan Clinical Research Center for Cancer Sichuan Cancer Center, Sichuan Cancer Hospital &amp; Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China  Chengdu China"},{"name":"The College of Nuclear Technology and Automation Engineering Chengdu University of Technology  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junxiang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Precision Radiation in Oncology Key Laboratory of Sichuan Province Sichuan Clinical Research Center for Cancer Sichuan Cancer Center, Sichuan Cancer Hospital &amp; Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Precision Radiation in Oncology Key Laboratory of Sichuan Province Sichuan Clinical Research Center for Cancer Sichuan Cancer Center, Sichuan Cancer Hospital &amp; Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanrui","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Precision Radiation in Oncology Key Laboratory of Sichuan Province Sichuan Clinical Research Center for Cancer Sichuan Cancer Center, Sichuan Cancer Hospital &amp; Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China  Chengdu China"},{"name":"The College of Nuclear Technology and Automation Engineering Chengdu University of Technology  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Precision Radiation in Oncology Key Laboratory of Sichuan Province Sichuan Clinical Research Center for Cancer Sichuan Cancer Center, Sichuan Cancer Hospital &amp; 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