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Proton Therapy

Proton therapy is a form of external beam radiation that uses accelerated protons instead of x-rays; protons release most of their energy at a set depth and then stop, so tissue beyond the tumor receives very little dose. In a large observational study, severe side effects were less than half as frequent as with conventional radiation, while rates of survival and cancer control were similar; phase 3 randomized trials directly comparing the two approaches are ongoing. The method requires specialized, costly equipment and is available only in a limited number of centers.

How it works

Like other external beam techniques, proton therapy damages the DNA of cancer cells so that they stop dividing or die. The difference lies in the physics of the beam. Photon (x-ray) beams deposit dose along their entire path and continue through the body beyond the tumor, whereas protons — positively charged particles accelerated to high energy — travel to a depth that can be precisely set, release most of their energy there (the so-called Bragg peak), and stop. Tissue behind the tumor is therefore largely spared, which matters most when the tumor lies close to critical structures. The evidence base is still maturing. A 2019 observational study of nearly 1,500 adults treated with simultaneous chemotherapy and radiation found that 12% of proton therapy patients had severe side effects within 90 days versus 28% with conventional radiation, with similar cancer-free and survival rates at 3 years; because the study was not randomized, it cannot prove cause and effect. Several NCI-funded phase 3 randomized trials are now directly comparing protons with photons, including in breast, lung, prostate, and liver cancers and in brain tumors.

Used in

Bone & Articular Cartilage C40-C41

Chordoma and chondrosarcoma of the skull base and spine: NCI PDQ lists proton-beam radiation as part of standard postoperative treatment for chordoma.

Soft Tissue C47, C49

Soft-tissue sarcomas in children and young adults at paraspinal and skull-base sites, where sparing critical organs and reducing second-cancer risk are decisive.

Uvea (Choroid, Ciliary Body, Iris) C69.3-C69.4

Uveal melanoma — proton-beam therapy as eye-preserving treatment and an alternative to plaque brachytherapy.

Ependymal Tumours C71-C72

Childhood ependymoma — protons limit dose to the developing brain outside the target volume, which matters for late neurocognitive effects.

CNS Embryonal Tumours C71

Proton craniospinal irradiation in children with medulloblastoma spares the cochlea, heart and thyroid while achieving disease control comparable to photon techniques.

Sources

  1. NCI Cancer Currents – Is Proton Therapy Safer than Traditional Radiation? ↗
  2. National Cancer Institute – External Beam Radiation Therapy ↗