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Radiotherapy and Oncology : Journal of... Jul 2018Radiotherapy plays an important role in the management of childhood cancer, with the primary aim of achieving the highest likelihood of cure with the lowest risk of... (Review)
Review
Radiotherapy plays an important role in the management of childhood cancer, with the primary aim of achieving the highest likelihood of cure with the lowest risk of radiation-induced morbidity. Proton therapy (PT) provides an undisputable advantage by reducing the radiation 'bath' dose delivered to non-target structures/volume while optimally covering the tumor with tumoricidal dose. This treatment modality comes, however, with an additional costs compared to conventional radiotherapy that could put substantial financial pressure to the health care systems with societal implications. In this review we assess the data available to the oncology community of PT delivered to children with cancer, discuss on the urgency to develop high-quality data. Additionally, we look at the advantage of combining systemic agents with protons and look at the cost-effectiveness data published so far.
Topics: Child; Consensus; Cost-Benefit Analysis; Humans; Neoplasms; Proton Therapy; Radiotherapy Dosage
PubMed: 29937209
DOI: 10.1016/j.radonc.2018.05.020 -
JCO Oncology Practice Jun 2024With the expansion of proton radiation therapy centers across the United States and a gradually expanding body of academic evidence supporting its use, more patients are... (Review)
Review
With the expansion of proton radiation therapy centers across the United States and a gradually expanding body of academic evidence supporting its use, more patients are receiving-and asking about-proton therapy than ever before. Here, we outline, for nonradiation oncologists, the theoretical benefits of proton therapy, the clinical evidence to date, the controversies affecting utilization, and the numerous randomized trials currently in progress. We also discuss the challenges of researching and delivering proton therapy, including the cost of constructing and maintaining centers, barriers with insurance approval, clinical situations in which proton therapy may be approached with caution, and the issue of equitable access for all patients. The purpose of this review is to assist practicing oncologists in understanding the evolving role of proton therapy and to help nonradiation oncologists guide patients regarding this technology.
Topics: Proton Therapy; Humans; Neoplasms
PubMed: 38377440
DOI: 10.1200/OP.23.00674 -
The British Journal of Radiology Mar 2020Proton therapy has shown dosimetric advantages over conventional radiation therapy using photons. Although the integral dose for patients treated with proton therapy is... (Review)
Review
Proton therapy has shown dosimetric advantages over conventional radiation therapy using photons. Although the integral dose for patients treated with proton therapy is low, concerns were raised about late effects like secondary cancer caused by dose depositions far away from the treated area. This is especially true for neutrons and therefore the stray dose contribution from neutrons in proton therapy is still being investigated. The higher biological effectiveness of neutrons compared to photons is the main cause of these concerns. The gold-standard in neutron dosimetry is measurements, but performing neutron measurements is challenging. Different approaches have been taken to overcome these difficulties, for instance with newly developed neutron detectors. Monte Carlo simulations is another common technique to assess the dose from secondary neutrons. Measurements and simulations are used to develop analytical models for fast neutron dose estimations. This article tries to summarize the developments in the different aspects of neutron dose in proton therapy since 2017. In general, low neutron doses have been reported, especially in active proton therapy. Although the published biological effectiveness of neutrons relative to photons regarding cancer induction is higher, it is unlikely that the neutron dose has a large impact on the second cancer risk of proton therapy patients.
Topics: Humans; Monte Carlo Method; Neoplasms, Radiation-Induced; Neoplasms, Second Primary; Neutrons; Photons; Proton Therapy; Radiometry; Radiotherapy Dosage; Relative Biological Effectiveness
PubMed: 31868525
DOI: 10.1259/bjr.20190412 -
International Journal of Radiation... Dec 2013
Topics: Age Factors; Dose-Response Relationship, Radiation; Humans; Organs at Risk; Patient Selection; Photons; Proton Therapy; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Uncertainty
PubMed: 24267966
DOI: 10.1016/j.ijrobp.2013.08.030 -
Chinese Clinical Oncology Aug 2016Radiation therapy (RT) has become an important component in the curative management of esophageal cancer (EC) worldwide. Since most of the ECs seen in the Western... (Review)
Review
Radiation therapy (RT) has become an important component in the curative management of esophageal cancer (EC) worldwide. Since most of the ECs seen in the Western hemisphere (i.e., Europe and the United States) are located in the mid- to distal-esophageal locations, heart and lungs invariably receive significant radiation doses. Much of the normal tissue exposure could be reduced with the utilization of advanced radiation technologies, notably intensity modulated radiation therapy (IMRT). Proton beam therapy (PBT) provides the ability to even further reduce normal tissue exposure because of its lack of exit dose, which is expected to provide clinically meaningful benefit for at least some EC patients. Herein, we provide an overview of the comparative effectiveness of proton versus photon therapy, summarize the published clinical experience, and describe the future outlook of PBT development in EC.
Topics: Esophageal Neoplasms; Humans; Proton Therapy
PubMed: 27558254
DOI: 10.21037/cco.2016.07.04 -
Radiation Protection Dosimetry Oct 2022The Maastro Proton Therapy Centre is the first European facility housing the Mevion S250i Hyperscan synchrocyclotron. The proximity of the accelerator to the patient,... (Review)
Review
The Maastro Proton Therapy Centre is the first European facility housing the Mevion S250i Hyperscan synchrocyclotron. The proximity of the accelerator to the patient, the presence of an active pencil beam delivery system downstream of a passive energy degrader and the pulsed structure of the beam make the Mevion stray neutron field unique amongst proton therapy facilities. This paper reviews the results of a rem-counter intercomparison experiment promoted by the European Radiation Dosimetry Group at Maastro and compares them with those at other proton therapy facilities. The Maastro neutron H*(10) in the room (100-200 μSv/Gy at about 2 m from the isocentre) is in line with accelerators using purely passive or wobbling beam delivery modalities, even though Maastro shows a dose gradient peaked near the accelerator. Unlike synchrotron- and cyclotron-based facilities, the pulsed beam at Maastro requires the employment of rem-counters specifically designed to withstand pulsed neutron fields.
Topics: Humans; Proton Therapy; Radiation Dosage; Neutrons; Radiometry; Cyclotrons; Radiotherapy Dosage
PubMed: 36138419
DOI: 10.1093/rpd/ncac189 -
Technology in Cancer Research &... Feb 2015Proton therapy through the use of the Bragg peak affords clinicians a tool with which highly conformal dose can be delivered to the target while minimizing integral dose... (Review)
Review
Proton therapy through the use of the Bragg peak affords clinicians a tool with which highly conformal dose can be delivered to the target while minimizing integral dose to surrounding healthy tissue. To gain maximum benefit from proton therapy adequate patient immobilization must be maintained to ensure accurate dose delivery. While immobilization in external beam radiation therapy is designed to minimize inter- and intra-fraction target motion, in proton therapy there are other additional aspects which must be considered, chief of which is accurately determining and maintaining the targets water-equivalent depth along the beam axis. Over the past 23 years of treating with protons, the team at the James M. Slater Proton Treatment and Research Center at Loma Linda University Medical Center have developed and implemented extensive immobilization systems to address the specific needs of protons. In this publication we review the immobilization systems that are used at Loma Linda in the treatment of head and neck, prostate, upper GI, lung and breast disease, along with a description of the intracranial radiosurgery immobilization system used in the treatment of brain metastasis and arteriovenous malformations (AVM's).
Topics: Humans; Neoplasms; Proton Therapy; Radiosurgery
PubMed: 24354755
DOI: 10.7785/tcrt.2012.500398 -
Chinese Clinical Oncology Aug 2016Proton therapy (PT) for prostate cancer has been a subject of controversy over the past two decades. Because of its dosimetric advantages when compared to conventional... (Review)
Review
Proton therapy (PT) for prostate cancer has been a subject of controversy over the past two decades. Because of its dosimetric advantages when compared to conventional radiation, PT has the potential to improve the therapeutic ratio in the management of prostate cancer by decreasing toxicity and improving disease control. Nevertheless, its higher costs and the current lack of level I evidence documenting improved clinical outcomes have led some to question its cost-effectiveness. A number of new PT centers have been built over the past decade, leading many stakeholders, including patients, physicians, and insurers, to demand comparative effectiveness data to support its current use. In this review, we summarize the results of recently published studies that support the safety and efficacy of PT in the treatment of prostate cancer. We also review the available cost-effectiveness data for PT and discuss the future of PT, including the current randomized trial comparing PT to intensity-modulated radiation therapy and the need for additional research that may help to establish the relative benefit of PT when compared to photon-based radiation therapy.
Topics: Humans; Male; Prostatic Neoplasms; Proton Therapy
PubMed: 27558255
DOI: 10.21037/cco.2016.08.02 -
Chinese Clinical Oncology Aug 2016This review will focus on the indications, clinical experience, and technical considerations of proton beam radiation therapy in the treatment of patients with breast... (Review)
Review
This review will focus on the indications, clinical experience, and technical considerations of proton beam radiation therapy in the treatment of patients with breast cancer. For patients with early stage disease, proton therapy delivers less dose to non-target breast tissue for patients receiving partial breast irradiation (PBI) therapy, which may result in improved cosmesis but requires further investigation. For patients with locally advanced breast cancer requiring treatment to the regional lymph nodes, proton therapy allows for an improved dosimetric profile compared with conventional photon and electron techniques. Early clinical results demonstrate acceptable toxicity. The possible reduction in cardiopulmonary events as a result of reduced dose to organs at risk will be tested in a randomized control trial of protons vs. photons.
Topics: Breast Neoplasms; Female; Humans; Proton Therapy
PubMed: 27558253
DOI: 10.21037/cco.2016.06.04 -
Seminars in Radiation Oncology Apr 2018In recent years there has been increasing interest in the more extensive application of proton therapy in a clinical and preferably hospital-based environment. However,... (Review)
Review
In recent years there has been increasing interest in the more extensive application of proton therapy in a clinical and preferably hospital-based environment. However, broader adoption of proton therapy has been hindered by the costs of treatment, which are still much higher than those in advanced photon therapy. This article presents an overview of on-going technical developments, which have a reduction of the capital investment or operational costs either as a major goal or as a potential outcome. Developments in instrumentation for proton therapy, such as gantries and accelerators, as well as facility layout and efficiency in treatment logistics will be discussed in this context. Some of these developments are indeed expected to reduce the costs. The examples will show, however, that a dramatic cost reduction of proton therapy is not expected in the near future. Although current developments will certainly contribute to a gradual decrease of the treatment costs in the coming years, many steps will still have to be made to achieve a much lower cost per treatment.
Topics: Cost-Benefit Analysis; Humans; Neoplasms; Proton Therapy; Radiation Oncology
PubMed: 29735191
DOI: 10.1016/j.semradonc.2017.11.007