Proton monoenergetic arc therapy (PMAT) to enhance LETd within the target.

We show the performance and feasibility of a proton arc technique so-called proton monoenergetic arc therapy (PMAT). Monoenergetic partial arcs are selected to place spots at the middle of a target and its potential to enhance the dose-averaged linear energy transfer (LETd) distribution within the target. Single-energy partial arcs in a single 360 degree gantry rotation are selected to deposit Bragg's peaks at the central part of the target to increase LETd values. An in-house inverse planning optimizer seeks for homogeneous doses at the target while keeping the dose to organs at risk (OARs) within constraints. The optimization consists of balancing the weights of spots coming out of selected partial arcs. A simple case of a cylindrical target in a phantom is shown to illustrate the method. Three different brain cancer cases are then considered to produce actual clinical plans, compared to those clinically used with pencil beam scanning (PBS). The relative biological effectiveness (RBE) is calculated according to the microdosimetric kinetic model (MKM). For the ideal case of a cylindrical target placed in a cylindrical phantom, the mean LETd in the target increases from 2.8 keV μm