The current state of proton radiotherapy

Radiotherapy is indicated for nearly all cancers and at all stages in one form or another. More than half of all cancer patients are treated with radiation at some point in their cancer treatment. Conventional X-ray (photon) based radiotherapy does have a number of physical limitations which were theorized to be overcome by instead employing proton based radiotherapy. The late 1990s and early 2000s saw a rapid adoption in proton therapy as many speculated a greatly improved therapeutic window compared with photon therapy. Only a few randomized clinical trials have been reported, but to-date proton therapy has not shown to improve cancer control metrics. There is improved treatment related toxicity which may be clinically meaningful in some scenarios, but further expansion and wide spread utilization of the technology may be drastically limited by the substantially higher start up and operational costs of a proton center. Nonetheless, proton therapy may be beneficial in select scenarios which warrant individualized consideration.