Pancreatic cancer is associated with a poor prognosis and requires highly conformal radiotherapy to achieve adequate target coverage while minimizing irradiation of surrounding radiosensitive organs. This retrospective dosimetric study compared double-arc volumetric modulated arc therapy plans generated using the Monaco treatment planning system with a Monte Carlo dose-calculation algorithm and the Eclipse system with an anisotropic analytical algorithm. Twenty patients with stage II pancreatic ductal carcinoma treated between May 2023 and March 2024 were included. Treatment plans prescribed 50.4 Gy to the primary target and 45 Gy to the elective target in 28 fractions using 6-MV flattening filter-free beams delivered with a TrueBeam linear accelerator. Dosimetric parameters were evaluated using paired statistical tests. Both systems achieved comparable target coverage of approximately 98%. However, Monaco provided significantly better conformity than Eclipse (0.91 versus 0.85, p = 0.002) and improved dose sparing of adjacent organs at risk. These dosimetric advantages were accompanied by a significantly higher number of monitor units (985 versus 511, p = 0.001), indicating greater delivery workload and potentially increased treatment complexity. Within the limitations of this single-institution retrospective analysis, Monaco demonstrated superior conformity and organ-at-risk protection, whereas Eclipse offered greater delivery efficiency. These findings emphasize the importance of system-specific plan assessment and suggest that treatment platform selection should balance dosimetric quality with delivery efficiency rather than assume equivalence between planning systems.
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