Proton therapy: clinical gains through current and future treatment programs.

Area of Science:

• Medical Physics
• Radiation Oncology
• Radiotherapy Technology

Background:

• Proton beams possess unique depth-dose characteristics, enabling reduced normal tissue radiation exposure.
• This dosimetric advantage may allow for escalated tumor doses, potentially improving treatment outcomes and reducing side effects.

Purpose of the Study:

• To review the advantages and challenges of proton therapy in clinical practice.
• To discuss ongoing research in uncertainty management, imaging, and delivery techniques for proton therapy.

Main Methods:

• Review of proton and photon treatment planning processes.
• Discussion of factors influencing proton therapy planning, including anatomical uncertainties.
• Exploration of advancements in imaging, adaptive radiotherapy, and dose computation.

Main Results:

• Proton therapy allows for significant normal tissue dose reduction and potential tumor dose escalation.
• Challenges include managing inter- and intrafractional uncertainties, requiring careful margin design and plan evaluation.
• Intensity modulation techniques enhance dose shaping, plan robustness, and clinical efficiency.

Conclusions:

• Proton therapy presents a significant dosimetric advantage with the potential to improve cancer treatment efficacy and patient quality of life.
• Continued research in uncertainty reduction, advanced imaging (like PET), and technological improvements (e.g., compact machines) is crucial for broader clinical adoption and cost-effectiveness.