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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Proton radiobiology.

Francesco Tommasino1, Marco Durante2,3

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Proton therapy for cancer may have different biological effects than previously thought. A variable Relative Biological Effectiveness (RBE) for protons could impact dose delivery to healthy tissues, warranting a re-evaluation in treatment planning.

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiobiology

Background:

  • Charged particle therapy, including proton therapy, offers physical advantages like the Bragg peak.
  • While heavy ions show energy- and charge-dependent Relative Biological Effectiveness (RBE), protons are often assumed to have minimal biological differences from photons.
  • Current proton therapy planning uses a fixed RBE of 1.1, potentially overlooking differential biological responses.

Purpose of the Study:

  • To review emerging data on the distinct biological effects of protons compared to photons.
  • To discuss the implications of variable RBE in proton therapy for dose deposition in healthy tissues.
  • To highlight the need for re-evaluating the role of a variable RBE in current proton treatment planning.

Main Methods:

  • Literature review of recent studies on proton therapy's biological effects.
  • Analysis of medical physics research on RBE variations.
  • Discussion of clinical relevance for normal tissue and organs at risk.

Main Results:

  • Recent studies suggest protons can differentially modulate biological responses compared to photons for clinically relevant endpoints.
  • Neglected RBE variations may lead to significant unintended dose deposition in healthy organs, particularly in the entrance region and behind the tumor.
  • These findings challenge the assumption of a uniform RBE in proton therapy.

Conclusions:

  • A fixed RBE of 1.1 in proton therapy may not fully capture the biological complexity of proton radiation.
  • Variable RBE considerations are crucial for accurate dose assessment and minimizing toxicity in organs at risk.
  • Re-discussing and potentially implementing a variable RBE approach in proton therapy planning is timely and clinically relevant.