Variation of the relative biological effectiveness in the penumbra of ion therapy beams estimated using different microdosimetric approaches.

Background and Purpose: The effort to translate clinical findings across institutions employing different relative biological effectiveness (RBE) models of ion radiotherapy has rapidly grown in recent years. Nevertheless, even for a chosen RBE model, different implementations exist. These approaches might consider or disregard the dose-dependence of the RBE and the radial variation of the radiation quality around the beam axis. This study investigated the theoretical impact of disregarding these effects during the RBE calculations. Materials and Methods: Microdosimetric simulations were carried out using the Monte Carlo code PHITS along the spread out Bragg peaks of Results: For an OAR located 5 mm laterally from the target volume, disregarding the radial variation of the radiation quality or the dose-dependence of the RBE could result in an overestimation of the RBE-weighted dose up to a factor of ∼ 3.5 or ∼ 1.7, respectively. Conclusions: The RBE-weighted dose to OARs close to the tumor volume was substantially impacted by the approach employed for the RBE calculations, even when using the same RBE model and cell line. Therefore, care should be taken in considering these differences while translating clinical findings between institutions with dissimilar approaches.