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Updated: Feb 20, 2026
Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
Published on: February 6, 2019
Sequential proton boost after standard chemoradiation for high-grade glioma
Sebastian Adeberg1, Denise Bernhardt2, Semi Ben Harrabi1
1University Hospital of Heidelberg, Department of Radiation Oncology, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Germany; Heidelberg Institute for Radiation Oncology (HIRO), Germany.
Sequential proton boost radiotherapy for high-grade glioma (HGG) is safe and feasible, showing comparable survival rates to conventional photon therapy. This approach may reduce severe treatment toxicity and side effects in HGG patients.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- High-grade glioma (HGG) presents a significant challenge in neuro-oncology.
- Conventional photon radiotherapy is a standard treatment, but associated toxicities can impact patient outcomes.
- Optimizing radiation delivery to minimize side effects while maintaining efficacy is crucial.
Purpose of the Study:
- To evaluate the feasibility and safety of a sequential proton boost after conventional chemoradiation in HGG patients.
- To compare progression-free survival (PFS), overall survival (OS), and toxicity rates between bimodality (proton boost) and photon-only radiotherapy.
Main Methods:
- A retrospective analysis of 66 HGG patients treated with a sequential proton boost (10 Gy(RBE)) following 50 Gy photon chemoradiation.
- Matched one-to-one with 66 HGG patients receiving conventional photon-only radiotherapy (60 Gy).
- Matching criteria included age, WHO grade, performance status, PTV size, and temozolomide use. Outcomes assessed included PFS, OS, acute toxicity (CTCAE v.4.03), and pseudoprogression (RANO criteria).
Main Results:
- Median PFS and OS were similar between the bimodality (PFS: 8.8 months, OS: 19.1 months) and photon-only groups (PFS: 7.2 months, OS: 20.9 months).
- The proton boost target volume was significantly smaller than photon-only plans (p < 0.001).
- Severe acute toxicity (CTCAE grade ≥2) was comparable (9% vs 14%), but CTCAE grade 3 events (increased intracranial pressure, seizures) occurred exclusively in the photon-only group. Pseudoprogression rates were similar (8% each).
Conclusions:
- Sequential proton boost radiotherapy in HGG is feasible and safe, achieving comparable survival outcomes to photon-only RT.
- This approach allows for significantly smaller target volumes, potentially leading to reduced severe acute toxicity.
- Bimodality radiotherapy demonstrates at least equivalent efficacy with a potentially superior safety profile in HGG management.
