Empowering Intensity Modulated Proton Therapy Through Physics and Technology: An Overview

Area of Science:

• Radiation Oncology
• Medical Physics
• Cancer Treatment

Background:

• Proton therapy's clinical potential is recognized, leading to increased installations and a shift from passively scattered proton therapy to intensity modulated proton therapy (IMPT).
• Despite dosimetric superiority, IMPT has not yet demonstrated a convincing clinical benefit over photon therapy, with existing methods facing significant limitations.

Purpose of the Study:

• To identify and discuss current limitations in intensity modulated proton therapy (IMPT) across treatment planning, delivery, and motion management.
• To explore current and future efforts aimed at improving IMPT methods and overcoming existing challenges for enhanced clinical efficacy.

Main Methods:

• Review and analysis of current intensity modulated proton therapy (IMPT) techniques, focusing on treatment planning, delivery systems, and motion management strategies.
• Discussion of emerging technologies and research directions, including adaptive planning, improved imaging guidance (e.g., cone beam CT, prompt gamma imaging), and beam optimization.

Main Results:

• Intensity modulated proton therapy (IMPT) presents significant dosimetric advantages over passively scattered proton therapy and intensity modulated radiation therapy (IMRT).
• Key limitations of IMPT include uncertainties in proton range, dose computation, vulnerability to setup errors, and challenges in real-time motion management.

Conclusions:

• Addressing uncertainties in treatment planning, optimizing delivery systems, and enhancing motion management are crucial for realizing the full clinical potential of IMPT.
• Advancements in adaptive planning, imaging, and beam control are anticipated to significantly improve IMPT's robustness and clinical outcomes, potentially surpassing current radiation therapy efficacy.