ArticleRadiation oncology (London, England)2026
Pancreatic SBRT on four modern platforms: dosimetric and radiobiological gains with the Ethos ring-gantry linac versus TrueBeam, Halcyon, and helical tomotherapy.
Article in Radiation oncology (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Abstract
purposeTo perform the first comprehensive dosimetric and radiobiological comparison of four modern delivery platforms for stereotactic body radiation therapy (SBRT) in pancreatic cancer: a conventional C-arm linac (TrueBeam), two established ring-gantry systems (Halcyon and helical tomotherapy [HT]), and the novel online-adaptive ring-gantry platform (Ethos). MATERIALS AND
methodsEighteen patients with pancreatic cancer were retrospectively planned to 35 Gy in 5 fractions using identical contours and dose constraints on all four platforms. Three-arc VMAT plans were generated for TrueBeam, Halcyon, and Ethos (Acuros XB dose calculation for Ethos; AAA for TrueBeam/Halcyon). For HT plans, a dynamic field width of 2.5 cm was used, and the collapsed cone convolution algorithm was utilized. Target coverage, conformity index (CI), homogeneity index (HI), gradient metrics (R50, D2cm), organs-at-risk (OARs) doses, and equivalent uniform dose (EUD) with tissue-specific parameters were compared using statistical tests.
resultsAll plans met clinical constraints. Coplanar platforms (TrueBeam, Halcyon, Ethos) achieved significantly better CI vs. HT (0.90 ± 0.02 vs. 0.84 ± 0.10) and lower R50 (3.48–3.53 vs. 4.71 ± 0.58) and, and steeper dose fall-off compared with HT. Ethos yielded the lowest mean doses to bilateral kidneys (2.80 ± 0.57 Gy vs. 3.98–4.93 Gy on other platforms) and the most favourable high-dose sparing for bowel, stomach, and duodenum. EUD analysis confirmed Ethos achieved the lowest values in seven of eight OARs, with the largest gains in kidneys (6.4 ± 1.4 Gy vs. 9.1–11.8 Gy) and bowel.
conclusionAmong contemporary platforms, Ethos provided a more favorable planning performance under these standardized conditions. These findings are limited to standard-dose (35 Gy/5F) SBRT planning and do not imply clinical superiority at escalated dose levels. CLINICAL TRIAL NUMBER: Not applicable.
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