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Updated: Nov 29, 2025

Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Roadmap: proton therapy physics and biology.

Harald Paganetti1,2, Chris Beltran3, Stefan Both4

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Proton therapy (PT) is an established cancer treatment, but ongoing research aims to improve its efficiency, planning, delivery, imaging, and patient selection. Addressing uncertainties and cost are key to advancing this advanced radiation therapy option.

Keywords:
dosimetryimagingproton radiation therapy

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Area of Science:

  • Oncology
  • Medical Physics
  • Radiation Oncology

Background:

  • Proton radiation therapy (PT) has evolved from research to mainstream clinical application since the 1950s.
  • Over 200,000 patients have received PT globally, with numerous facilities now operational.
  • PT offers advanced dose shaping but faces challenges in uncertainties, optimization, and cost.

Purpose of the Study:

  • To provide a roadmap for the current state and future directions in proton therapy.
  • To identify key areas for research and development in PT.
  • To address challenges and opportunities in PT, including efficiency, planning, delivery, imaging, and patient selection.

Main Methods:

  • The study presents a roadmap categorizing future directions in PT.
  • Key themes include improving efficiency, planning and delivery, imaging, and patient selection.
  • The roadmap synthesizes current research and identifies areas for advancement.

Main Results:

  • Proton therapy is a well-established cancer treatment with significant global adoption.
  • Active research areas include optimizing pencil beam scanning and understanding biological differences.
  • Challenges remain in managing uncertainties, improving cost-effectiveness, and enhancing treatment delivery.

Conclusions:

  • Proton therapy is a viable and growing cancer treatment option.
  • Further research is crucial to overcome existing challenges and optimize PT outcomes.
  • Advancements in efficiency, planning, delivery, imaging, and patient selection will enhance PT's role in oncology.