Debates and reflection on modern proton radiotherapy and photon radiotherapy

doi:10.3760/cma.j.cn371439-20240619-00068

Abstract

Abstract:

The debate on the merits of proton radiotherapy and photon radiotherapy has lasted for more than 20 years， mainly reflected in the comparison of dose distribution and clinical outcomes. Because dosimetric advantages do not always translate to better clinical outcomes， several phase Ⅲ comparative clinical studies are being conducted in Western countries. However， it is highly questionable that these studies will bring great value to the advancement of radiation therapy or settle the debate. This is because the effectiveness of the treatment depends not only on the type of radiation， but also on the technology used. Therefore， the focus of the research should not be which type of radiation is superior， but how to avoid its disadvantages while taking full advantage of the dose characteristics of each type of radiation. Both proton therapy and photon therapy will play an important role in cancer treatment in the future， and limited resources should be applied to maximize the effectiveness of each. With the rapid development of radiotherapy technology and systemic therapies including immunotherapy， reducing treatment fractions in the form of stereotactic radiosurgery and stereotactic body radiotherapy （SRS/SBRT） will be the inevitable trend. The need for dose focusing will drive photon therapy toward 4π radiotherapy using more non-coplanar fields， while higher geometric accuracy requirements will cause wide adoption of artificial intelligence-based online adaptive radiotherapy.

Key words: Proton therapy, Clinical study, Artificial intelligence, Photon radiotherapy, Dose focusing, Non-coplanar fields, Online adaptive radiotherapy

Yu Cedric, Ren Lei, Lu Xiaoguang. Debates and reflection on modern proton radiotherapy and photon radiotherapy[J]. Journal of International Oncology, 2024, 51(7): 411-416.

Figures/Tables 1

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