Clinical Efficacy of Proton Therapy.

In the treatment of cancer, high doses of radiation are used to destroy cancer cells by damaging their DNA.  When the DNA of a cancer cell is destroyed beyond repair, the cell dies and is then eliminated by the body through natural processes.

Proton therapy is an advanced form of radiation treatment that has been used to treat more than 160,000 people worldwide. By 2030, it is estimated that between 300,000 and 600,000 patients will have received proton therapy treatment.

The following are research studies published between 2016 and 2018 that underscore the benefits of proton therapy for certain cancer patients. The majority of the studies employ pencil beam scanning, the most precise form of proton therapy.

ProTom’s Radiance 330® Proton Therapy System employs Fidelity Beam Scanning.  This pencil-beam scanning technology with gating capability enables the highest treatment precision.


de Boer P, van de Schoot AJAJ, Westerveld H, et. al. Target tailoring and proton beam therapy to reduce small bowel dose in cervical cancer radiotherapy: A comparison of benefits. Strahlenther Onkol. 2018 Mar;194(3):255-263.


Lin LL, Kirk M, Scholey J, et. al. Initial Report of Pencil Beam Scanning Proton Therapy for Posthysterectomy Patients With Gynecologic Cancer. Int J Radiat Oncol Biol Phys. 2016 May 1;95(1):181-9.


Moreno A, Frank S, et. al. Intensity modulated proton therapy (IMPT) – The future of IMRT for head and neck cancer. Oral Oncology. 2018 Jan 88:66-74


Sharma S,  Zhou O,  Thompson R, et. al. Quality of Life of Postoperative Photon versus Proton Radiation Therapy for Oropharynx Cancer. International Journal of Particle Therapy. 2018. In-Press.


Patel S, Edgington S. et. al. Novel use of proton beam therapy for neoadjuvant treatment of radiation-associated squamous cell carcinoma of the esophagus. J Gastrointest Cancer. 2018.


Adeberg S, Harrabi SB, et. al. Dosimetric Comparison of Proton Radiation Therapy, Volumetric Modulated Arc Therapy, and Three-Dimensional Conformal Radiotherapy Based on Intracranial Tumor Location. Cancers (Basel). 2018 Oct 26;10(11).


Giantsoudi D, Adams J, MacDonald S, Paganetti H. Can differences in linear energy transfer and thus relative biological effectiveness compromise the dosimetric advantage of intensity-modulated proton therapy as compared to passively scattered proton therapy? Acta Oncol. 2018 Sep;57(9):1259-1264


Ardenfors O, Dsu A, Lillhök J, et. al. Out-of-field doses from secondary radiation produced in proton therapy and the associated risk of radiation-induced cancer from a brain tumor treatment. Physica Medica: European Journal of Medical Physics. 2018 Sep; 53: 129-136.


Leeman JE, Lee NY, Zhou Y, et. al. Endoscopic Resection Followed by Proton Therapy With Pencil Beam Scanning for Skull Base Tumors. Laryngoscope. 2018 Sep 12.


Gu W, O’Connor D, Nguyen D, et. al. Integrated beam orientation and scanning-spot optimization in intensity-modulated proton therapy for brain and unilateral head and neck tumors. Med Phys. 2018 Apr;45(4):1338-1350.


Murray FR, Snider JW, Bolsi A, et. al. Long-Term Clinical Outcomes of Pencil Beam Scanning Proton Therapy for Benign and Non-benign Intracranial Meningiomas. Int J Radiat Oncol Biol Phys. 2017 Aug 12.


Langendijk JA, Steenbakkers RJ. Optimizing Radiotherapy in HPV-Associated Oropharyngeal Cancer Patients. Recent Results Cancer Res. 2017;206:161-171. Review.


Apinorasethkul O, Kirk M, et al. Pencil beam scanning proton therapy vs rotational arc radiation therapy: A treatment planning comparison for postoperative oropharyngeal cancer Medical Dosimetry. 2017; 42 (1): 7-11.


Weber DC, Malyapa R, Albertini F, et. al. Long term outcomes of patients with skull-base low-grade chondrosarcoma and chordoma patients treated with pencil beam scanning proton therapy. Radiother Oncol. 2016 Jul;120(1):169-74.


Zhang W, Zhang X, Yang P, er. al. Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer. Radiother Oncol. 2017 Jun;123(3):401-405.


Holm AIS, Petersen JBB, Muren LP, et. al. Functional image-guided dose escalation in gliomas using of state-of-the-art photon vs. proton therapy. Acta Oncol. 2017 Jun;56(6):826-831.


Geng C, Moteabbed M, Seco J, et. al. Dose assessment for the fetus considering scattered and secondary radiation from photon and proton therapy when treating a brain tumor of the mother. Phys Med Biol. 2016 Jan 21;61(2):683-95.


van Dijk LV, Steenbakkers RJ, ten Haken B, et. al. Robust Intensity Modulated Proton Therapy (IMPT) Increases Estimated Clinical Benefit in Head and Neck Cancer Patients. PLoS One. 2016 Mar 31;11(3):e0152477.


Sio TT, Lin HK, Shi Q, et. al. Intensity Modulated Proton Therapy Versus Intensity Modulated Photon Radiation Therapy for Oropharyngeal Cancer: First Comparative Results of Patient-Reported Outcomes. Int J Radiat Oncol Biol Phys. 2016 Jul 15;95(4):1107-14.


Blanchard P, Garden AS, Gunn GB, et. al. Intensity-modulated proton beam therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for patients with oropharynx cancer – A case matched analysis. Radiother Oncol. 2016 Jul;120(1):48-55.


McKeever MR, Sio TT, Gunn GB, et. al. Reduced acute toxicity and improved efficacy from intensity-modulated proton therapy (IMPT) for the management of head and neck cancer. Chin Clin Oncol. 2016 Aug;5(4):54.


Holliday EB, Kocak-Uzel E, Feng L, et. al. Dosimetric advantages of intensity-modulated proton therapy for oropharyngeal cancer compared with intensity-modulated radiation: A case-matched control analysis. Med Dosim. 2016 Autumn;41(3):189-94.


Phan J, Sio TT, Nguyen TP, et. al. Reirradiation of Head and Neck Cancers With Proton Therapy: Outcomes and Analyses. Int J Radiat Oncol Biol Phys. 2016 Sep 1;96(1):30-41.


Adeberg S, Harrabi SB, Bougatf N, et. al. Intensity-modulated proton therapy, volumetric-modulated arc therapy, and 3D conformal radiotherapy in anaplastic astrocytoma and glioblastoma : A dosimetric comparison. Strahlenther Onkol. 2016 Nov;192(11):770-779.


Mondlane G, Gubanski M, Lind PA, et. al. Comparative study of the calculated risk of radiation-induced cancer after photon- and proton-beam based radiosurgery of liver metastases. Phys Med. 2017 Mar 30. pii: S1120-1797(17)30078-9.


Journy N, Indelicato D, Withrow D, et. al. Patterns of proton therapy use in pediatric cancer management in 2016: An international survey. Radiotherapy and Oncology. 2018. In Press.


Huynh M, Marcu LG, Giles E, et. al. Current status of proton therapy outcome for paediatric cancers of the central nervous system – Analysis of the published literature. Cancer Treat Rev. 2018 Nov;70:272-288.


Arscott WT, Cope C. et. al. Proton Therapy for Management of Pediatric Hodgkin Lymphoma Involving the Mediastinum: Evaluation of Toxicity and Evolution of Therapy Over 7 Years of Experience. Int J Radiat Oncol Biol Phys. 2018 Nov. 102(suppl 3): S53-S54.


Ladra MM, MacDonald SM, Terezakis SA. Proton therapy for central nervous system tumors in children. Pediatr Blood Cancer. 2018 Jul;65(7):e27046.


Pulsifer MB, Duncanson H, Grieco J, et al. Cognitive and Adaptive Outcomes Following Proton Radiation for Pediatric Patients with Brain Tumors. Int J Radiat Oncol Biol Phys. 2018.


Haas-Kogan D, Indelicato D, Paganetti H, et. al. National Cancer Institute Workshop on Proton Therapy for Children: Considerations Regarding Brainstem Injury. Int J Radiat Oncol Biol Phys. 2018 May 1;101(1):152-168.


Bojaxhiu B, Ahlhelm F, Walser M, et. al. Radiation Necrosis and White Matter Lesions in Pediatric Patients With Brain Tumors Treated With Pencil Beam Scanning Proton Therapy. Int J Radiat Oncol Biol Phys. 2018 Mar 15;100(4):987-996.


Vogel J, Both S, Kirk M, et al.  Proton therapy for pediatric head and neck malignancies. Pediatr Blood Cancer. 2017;00: e26858.


Vogel, J., Lin, H., Both, S., et. al. Pencil beam scanning proton therapy for treatment of the retroperitoneum after nephrectomy for Wilms tumor: A dosimetric comparison study. Pediatr Blood Cancer. 2017, 64: 39–45.


Farace P, Bizzocchi N, Righetto R, et. al. Supine craniospinal irradiation in pediatric patients by proton pencil beam scanning. Radiother Oncol. 2017 Apr;123(1):112-118.


Giantsoudi D, Seco J, Eaton BR, et. al. Evaluating Intensity Modulated Proton Therapy Relative to Passive Scattering Proton Therapy for Increased Vertebral Column Sparing in Craniospinal Irradiation in Growing Pediatric Patients. Int J Radiat Oncol Biol Phys. 2017 May 1;98(1):37-46.


Weber DC, Murray FR, Correia D, et. al. Pencil beam scanned protons for the treatment of patients with Ewing sarcoma. Pediatr Blood Cancer. 2017 Dec;64(12).


Leiser D, Calaminus G, Malyapa R, et. al. Tumour control and Quality of Life in children with rhabdomyosarcoma treated with pencil beam scanning proton therapy. Radiother Oncol. 2016 Jul;120(1):163-8.


Ares C, Albertini F, Frei-Welte M, et. al. Pencil beam scanning proton therapy for pediatric intracranial ependymoma. J Neurooncol. 2016 May;128(1):137-45.


Geng C, Moteabbed M, Xie Y, et. al. Assessing the radiation-induced second cancer risk in proton therapy for pediatric brain tumors: the impact of employing a patient-specific aperture in pencil beam scanning. Phys Med Biol. 2016 Jan 7;61(1):12-22.


Blanco Kiely JP, White BM. Robust Proton Pencil Beam Scanning Treatment Planning for Rectal Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys. 2016 May 1;95(1):208-15.


Ho JC, Nguyen QN, Li H, et. al. Reirradiation of thoracic cancers with intensity modulated proton therapy. Pract Radiat Oncol. 2018 Jan – Feb;8(1):58-65.


Snider JW, Schneider RA, Poelma-Tap D, et. al. Long-Term Outcomes and Prognostic Factors After Pencil-Beam Scanning Proton Radiation Therapy for Spinal Chordomas: A Large, Single-Institution Cohort. Int J Radiat Oncol Biol Phys. 2018 May 1;101(1):226-233.


Stieb S, Snider JW 3rd, Placidi L, Kliebsch U, Lomax AJ, et. al. Long-Term Clinical Safety of High-Dose Proton Radiation Therapy Delivered With Pencil Beam Scanning Technique for Extracranial Chordomas and Chondrosarcomas in Adult Patients: Clinical Evidence of Spinal Cord Tolerance. Int J Radiat Oncol Biol Phys. 2017 Sep 4.


Wang Y, Deng W, Li N, et al. Combining Immunotherapy and Radiotherapy for Cancer Treatment: Current Challenges and Future Directions. Front Pharmacol. 2018;9:185.


Zhang H, Chen J. Current status and future directions of cancer immunotherapy. J Cancer 2018; 9(10):1773-1781.


Lee HJ, Zeng J, Rengan R. Proton beam therapy and immunotherapy: an emerging partnership for immune activation in non-small cell lung cancer. Transl Lung Cancer Res. 2018;7(2):180-188.


De Felice F, Polimeni A, et. al. Radiotherapy Controversies and Prospective in Head and Neck Cancer: A Literature-Based Critical Review. Neoplasia. 2018; 20(3): 227-232.

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