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Updated: Mar 16, 2026
Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
Published on: February 6, 2019
Proton beam therapy versus photon therapy for multiple malignancies: An umbrella systematic review and meta-analysis
Zhenyu Ma1, Qipeng Yuan2, Mei Liu1
1Shandong University Cancer Center, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
Background:
Direct comparative evidence between proton beam therapy (PBT) and photon therapy for the treatment of malignant diseases is lacking.
Methods:
Electronic databases were searched for meta-analyses of PBT vs. photon therapy for patients with malignancies from database inception up until March 13, 2025. The methodological quality of meta-analyses was assessed using AMSTAR 2. Where possible, the DerSimonian and Laird random-effects model was used to repeat each meta-analysis. For pooled evidence from two-arm studies, the certainty of the evidence was assessed using GRADE criteria.
Results:
Seventeen meta-analyses covering 11 cancers were included. Compared to photon therapy, PBT was associated with improved prognosis in glioma, head and neck cancer (for certain loci), esophageal cancer, intrahepatic cholangiocarcinoma, extrahepatic biliary tract cancer, renal cell carcinoma, and colorectal cancer with pelvic recurrence. Use of PBT also correlated with reduced toxic effects in head and neck cancer, pediatric CNS tumors, esophageal cancer, early-stage NSCLC, and prostate cancer. Within the 65 outcomes from two-arm studies, GRADE assessment found that only two outcomes were supported by moderate certainty of evidence, while 63 were supported by low or very low certainty of evidence.
Conclusions:
Our findings indicate, that for several tumors, PBT is associated with improved survival outcomes and toxicities. In the absence of high-quality evidence, these findings need to be validated by more large-scale comparative studies and clinical trials.
Insights
Proton beam therapy (PBT) shows promise for improved cancer outcomes and reduced toxicity compared to photon therapy. However, high-quality evidence is limited, necessitating further large-scale clinical trials for validation.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- Comparative evidence between proton beam therapy (PBT) and photon therapy for malignant diseases is scarce.
- Existing research often lacks direct comparisons, hindering definitive treatment selection.
Purpose of the Study:
- To systematically review and synthesize existing meta-analyses comparing PBT and photon therapy for various cancers.
- To assess the comparative efficacy and toxicity profiles of PBT versus photon therapy.
Main Methods:
- A comprehensive search of electronic databases for meta-analyses of PBT vs. photon therapy up to March 2025.
- Methodological quality assessment of meta-analyses using AMSTAR 2.
- Replication of meta-analyses using the DerSimonian and Laird random-effects model and evidence certainty assessment with GRADE criteria.
Main Results:
- Seventeen meta-analyses encompassing 11 cancer types were included.
- PBT demonstrated improved prognosis in glioma, head and neck cancer, esophageal cancer, and others compared to photon therapy.
- PBT use correlated with reduced toxic effects in head and neck cancer, pediatric CNS tumors, esophageal cancer, and others, though evidence certainty was generally low to very low.
Conclusions:
- PBT is associated with improved survival and reduced toxicity for several tumor types.
- The current evidence base is largely of low certainty, highlighting the need for high-quality, large-scale comparative studies and clinical trials to validate these findings.
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