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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Proton therapy - Present and future.

Radhe Mohan1, David Grosshans2

  • 1Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX 77030, United States.

Advanced Drug Delivery Reviews
|December 7, 2016
PubMed
Summary
This summary is machine-generated.

Proton therapy offers significant advantages over photon therapy by reducing normal tissue dose, but clinical evidence for broad use is mixed. Ongoing research and robust optimization are needed to overcome uncertainties and realize its full potential in cancer treatment.

Keywords:
Intensity-modulated proton therapyParticle therapyProton therapyRadiation therapy

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Cancer Treatment

Background:

  • Proton therapy utilizes protons' unique depth-dose characteristics for precise radiation delivery, potentially reducing normal tissue toxicity compared to conventional photon therapy.
  • Current applications of proton therapy are established for specific cancers like pediatric malignancies and ocular melanomas, but evidence for broader use remains under investigation.
  • The high cost of proton therapy centers necessitates robust data to demonstrate cost-effectiveness and clinical superiority over existing treatments.

Purpose of the Study:

  • To review the clinical advantages, current limitations, and future directions of proton therapy in cancer treatment.
  • To highlight the technical aspects of proton delivery, including passively scattered proton therapy (PSPT) and intensity-modulated proton therapy (IMPT).
  • To discuss the challenges related to treatment planning, uncertainties, and the relative biological effectiveness (RBE) of protons.

Main Methods:

  • Review of existing literature on proton therapy physics, clinical applications, and treatment planning.
  • Discussion of treatment delivery techniques: PSPT and IMPT.
  • Analysis of uncertainties in proton therapy, including anatomical variations and RBE modeling.

Main Results:

  • Proton therapy demonstrates potential for dose escalation and improved normal tissue sparing, leading to better outcomes and reduced toxicity.
  • Clinical evidence supporting widespread proton therapy use is mixed, with strong recommendations for specific cancer types but limited data for others.
  • Treatment planning for proton therapy requires specialized considerations due to proton physics and increased sensitivity to uncertainties.

Conclusions:

  • Proton therapy holds significant promise for cancer treatment, but further randomized trials and outcome data are essential to confirm its advantages.
  • Addressing uncertainties through advanced techniques like image-guidance, adaptive radiotherapy, and robust optimization is crucial for maximizing proton therapy's potential.
  • Continued research into proton RBE and improved dose computation methods will enhance treatment precision and expand the applicability of proton therapy.