[Radiotherapy for sarcoma: hadrontherapy, for whom and what for?]

Area of Science:

• Oncology
• Radiation Oncology
• Medical Physics

Background:

• Hadrons (neutrons, protons, carbon ions) are utilized in sarcoma treatment as alternatives or referent therapies to photon therapy.
• Sarcomas are often radio-resistant, necessitating advanced radiation techniques.

Purpose of the Study:

• To review current indications and future perspectives for hadron therapy in sarcoma treatment.
• To compare the radiobiological and physical properties of different hadron types against photon therapy.

Main Methods:

• Extensive literature review assessing hadron therapy's role in sarcoma management.
• Analysis of radiobiological efficiency and physical properties (e.g., Bragg Peak) of neutrons, protons, and carbon ions.

Main Results:

• Neutrons offer higher biological efficiency for radio-resistant tumors but have limitations due to late toxicities and poor ballistic properties.
• Protons provide superior conformity and organ-at-risk sparing via the Bragg Peak, establishing proton therapy as standard for specific spinal and skull base sarcomas.
• Carbon ions combine proton and neutron advantages, showing potential as a referent therapy for unresectable sarcomas.

Conclusions:

• Hadron therapy modalities present significant advantages over photon therapy for sarcoma treatment.
• Expanding access to proton and carbon ion facilities will enable further research and broader patient application.