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Purpose <p>To compare automated treatment planning using the Ethos platform with manual planning on the Halcyon platform for pancreatic stereotactic body radiotherapy (SBRT), and to disentangle the respective impacts of automated optimization and dose calculation algorithms on dosimetric quality, radiobiological outcomes, and plan verification.</p> Materials and methods <p>Sixteen patients with pancreatic cancer treated with SBRT were retrospectively analyzed. For each patient, three plans were generated using identical target volumes, beam geometry: (1) automated Ethos planning with Acuros XB (Ethos); (2) manual Halcyon planning with Acuros XB algorithm (Halcyon-AXB); and (3) manual Halcyon planning with Anisotropic Analytical Algorithm (Halcyon-AAA). Plans were evaluated using physical dosimetric parameters for the planning target volume (PTV) and organs at risk (OARs), radiobiological assessment based on equivalent uniform dose (EUD in EQD<sub>2</sub>), and independent Monte Carlo-based dose verification with gamma analysis under multiple criteria.</p> Results <p>All plans met clinical requirements for target coverage. Ethos plans showed slightly improved dose homogeneity within the PTV and consistently reduced mean dose and low-dose exposure to both kidneys. These physical differences were reflected by significantly lower renal EUD values. Dosimetric and radiobiological differences for gastrointestinal organs were small. All plans demonstrated excellent agreement in dose verification under standard 3%/3&#xa0;mm, 3%/2&#xa0;mm, 3%/1&#xa0;mm, 2%/2&#xa0;mm and 2%/1&#xa0;mm criteria, while differences between algorithms became apparent under more stringent gamma criteria (1%/1&#xa0;mm).</p> Conclusions <p>Automated Ethos planning demonstrated comparable PTV homogeneity and lower kidney doses compared to manual Halcyon planning, with corresponding reductions in renal equivalent uniform dose. Use of Acuros XB rather than AAA further improved the estimated therapeutic ratio, while gastrointestinal OAR differences were minimal. These findings suggest comparable dosimetric quality and improved efficiency for automated Ethos planning in pancreatic SBRT, warranting prospective validation.</p>

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IOE-based automated planning on Ethos vs. manual planning on Halcyon for pancreatic SBRT: a dosimetric, radiobiological, and plan verification study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月28日

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  • Bin Zhang,
  • Xiangyue Kong,
  • Yutong Zhao,
  • Zejun Jiang,
  • Gongsen Zhang,
  • Tianyuan Dai

摘要

Purpose

To compare automated treatment planning using the Ethos platform with manual planning on the Halcyon platform for pancreatic stereotactic body radiotherapy (SBRT), and to disentangle the respective impacts of automated optimization and dose calculation algorithms on dosimetric quality, radiobiological outcomes, and plan verification.

Materials and methods

Sixteen patients with pancreatic cancer treated with SBRT were retrospectively analyzed. For each patient, three plans were generated using identical target volumes, beam geometry: (1) automated Ethos planning with Acuros XB (Ethos); (2) manual Halcyon planning with Acuros XB algorithm (Halcyon-AXB); and (3) manual Halcyon planning with Anisotropic Analytical Algorithm (Halcyon-AAA). Plans were evaluated using physical dosimetric parameters for the planning target volume (PTV) and organs at risk (OARs), radiobiological assessment based on equivalent uniform dose (EUD in EQD2), and independent Monte Carlo-based dose verification with gamma analysis under multiple criteria.

Results

All plans met clinical requirements for target coverage. Ethos plans showed slightly improved dose homogeneity within the PTV and consistently reduced mean dose and low-dose exposure to both kidneys. These physical differences were reflected by significantly lower renal EUD values. Dosimetric and radiobiological differences for gastrointestinal organs were small. All plans demonstrated excellent agreement in dose verification under standard 3%/3 mm, 3%/2 mm, 3%/1 mm, 2%/2 mm and 2%/1 mm criteria, while differences between algorithms became apparent under more stringent gamma criteria (1%/1 mm).

Conclusions

Automated Ethos planning demonstrated comparable PTV homogeneity and lower kidney doses compared to manual Halcyon planning, with corresponding reductions in renal equivalent uniform dose. Use of Acuros XB rather than AAA further improved the estimated therapeutic ratio, while gastrointestinal OAR differences were minimal. These findings suggest comparable dosimetric quality and improved efficiency for automated Ethos planning in pancreatic SBRT, warranting prospective validation.