Skip to main content
SpringerLink
Log in

Proton Therapy

  • Chapter
  • First Online:
Technical Basis of Radiation Therapy

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

  • 4314 Accesses

Abstract

Dose distribution is the most powerful factor in determining the therapeutic ratio in radiation oncology. Developments in diagnostic imaging and computerized treatment planning justified the drive for increasingly conformal X-ray-based radiation therapy over the past two decades. The end of substantive improvements in X-ray dose distributions is near, however, because of the inherent problems of entrance and exit dose with X-rays. The unique pattern of dose deposition with protons has long made them a promising source for radiation therapy and recent developments in technology have made proton therapy applicable to almost all cancers. While proton therapy is likely to improve the therapeutic ratio in all radiation indications, the highest priorities currently include cancers requiring radiation doses that exceed the tolerance of critical adjacent structures and cancers of childhood and young adults, for which the inevitable entrance and exit dose of X-ray-based radiation produces a low-dose radiation bath resulting in early functional loss in most childhood tissues as well as a lifelong risk for second malignancies and other radiation-related dysfunctions. This chapter discusses the rationale, technical basis, and potential applications for proton therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 279.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 379.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Albertini F, Hug EB, Lomax AJ (2010) The influence of the optimization starting conditions on the robustness of intensity-modulated proton therapy plans. Phys Med Biol 55:2863–2878

    Article  PubMed  CAS  Google Scholar 

  • Ares C, Khan S, Macartain AM, Heuberger J, Goitein G, Gruber G, Lutters G, Hug EB, Bodis S, Lomax AJ (2009) Postoperative proton radiotherapy for localized and locoregional breast cancer: potential for clinically relevant improvements? Int J Radiat Oncol Biol Phys 76:685–697

    Article  PubMed  Google Scholar 

  • Bush DA, Slater JD, Bonnet R, Cheek GA, Dunbar RD, Moyers M, Slater JM (1999) Proton-beam radiotherapy for early-stage lung cancer. Chest 116:1313–1319

    Article  PubMed  CAS  Google Scholar 

  • Chang JY, Komaki R, Wen HY, De Gracia B, Bluett JB, McAleer MF, Swisher SG, Gillin M, Mohan R, Cox JD (2011) Toxicity and patterns of failure of adaptive/ablative proton therapy for early-stage, medically inoperable non-small cell lung cancer. Int J Radiat Oncol Biol Phys [Epub ahead of print, 2011 Jan 18]

    Google Scholar 

  • Chera BS, Malyapa R, Louis D, Mendenhall WM, Li Z, Lanza DC, Yeung D, Mendenhall NP (2009a) Proton therapy for maxillary sinus carcinoma. Am J Clin Oncol 32:296–303

    Article  PubMed  Google Scholar 

  • Chera BS, Rodriguez C, Morris CG, Louis D, Yeung D, Li Z, Mendenhall NP (2009b) Dosimetric comparison of three different involved nodal irradiation techniques for stage II Hodgkin’s lymphoma patients: conventional radiotherapy, intensity-modulated radiotherapy, and three-dimensional proton radiotherapy. Int J Radiat Oncol Biol Phys 75:1173–1180

    Article  PubMed  Google Scholar 

  • Chera BS, Vargas C, Morris CG, Louis D, Flampouri S, Yeung D, Duvvuri S, Li Z, Mendenhall NP (2009c) Dosimetric study of pelvic proton radiotherapy for high-risk prostate cancer. Int J Radiat Oncol Biol Phys 75:994–1002

    Article  PubMed  Google Scholar 

  • Cochran DM, Yock TI, Adams JA, Tarbell NJ (2008) Radiation dose to the lens during craniospinal irradiation-an improvement in proton radiotherapy technique. Int J Radiat Oncol Biol Phys 70:1336–1342

    Article  PubMed  Google Scholar 

  • Damato B, Kacperek A, Chopra M, Campbell IR, Errington RD (2005) Proton beam radiotherapy of choroidal melanoma: the Liverpool-Clatterbridge experience. Int J Radiat Oncol Biol Phys 62:1405–1411

    Article  PubMed  Google Scholar 

  • Dearnaley DP, Sydes MR, Graham JD, Aird EG, Bottomley D, Cowan RA, Huddart RA, Jose CC, Matthews JH, Millar J, Moore AR, Morgan RC, Russell JM, Scrase CD, Stephens RJ, Syndikus I, Parmar MK (2007) Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol 8:475–487

    Article  PubMed  Google Scholar 

  • Delaney TF, Liebsch NJ, Pedlow FX, Adams J, Dean S, Yeap BY, McManus P, Rosenberg AE, Nielsen GP, Harmon DC, Spiro IJ, Raskin KA, Suit HD, Yoon SS, Hornicek FJ (2009) Phase II study of high-dose photon/proton radiotherapy in the management of spine sarcomas. Int J Radiat Oncol Biol Phys 74:732–739

    Article  PubMed  CAS  Google Scholar 

  • Engelsman M, Delaney TF, Hong TS (2011) Proton radiotherapy: the biological effect of treating alternating subsets of fields for different treatment fractions. Int J Radiat Oncol Biol Phys 79:616–622

    Article  PubMed  Google Scholar 

  • Fontenot JD, Lee AK, Newhauser WD (2009) Risk of secondary malignant neoplasms from proton therapy and intensity-modulated x-ray therapy for early-stage prostate cancer. Int J Radiat Oncol Biol Phys 74:616–622

    Article  PubMed  Google Scholar 

  • Gragoudas ES, Lane AM, Munzenrider J, Egan KM, Li W (2002) Long-term risk of local failure after proton therapy for choroidal/ciliary body melanoma. Trans.Am Ophthalmol.Soc 100:43–48

    PubMed  Google Scholar 

  • Hoffman KE, Yock TI (2009) Radiation therapy for pediatric central nervous system tumors. J Child Neurol 24:1387–1396

    Article  PubMed  Google Scholar 

  • Hoppe BS, Flampouri S, Li Z, Mendenhall NP (2010) Cardiac sparing with proton therapy in consolidative radiation therapy for Hodgkin lymphoma. Leuk.Lymphoma 51:1559–1562

    Article  PubMed  Google Scholar 

  • Hua C, Bass JK, Khan R, Kun LE, Merchant TE (2008) Hearing loss after radiotherapy for pediatric brain tumors: effect of cochlear dose. Int J Radiat Oncol Biol Phys 72:892–899

    Article  PubMed  Google Scholar 

  • Hug EB, Sweeney RA, Nurre PM, Holloway KC, Slater JD, Munzenrider JE (2002) Proton radiotherapy in management of pediatric base of skull tumors. Int J Radiat Oncol Biol Phys 52:1017–1024

    Article  PubMed  Google Scholar 

  • Hui Z, Zhang X, Starkschall G, Li Y, Mohan R, Komaki R, Cox JD, Chang JY (2008) Effects of interfractional motion and anatomic changes on proton therapy dose distribution in lung cancer. Int J Radiat Oncol Biol Phys 72:1385–1395

    Article  PubMed  Google Scholar 

  • Kawashima M, Kohno R, Nakachi K, Nishio T, Mitsunaga S, Ikeda M, Konishi M, Takahashi S, Gotohda N, Arahira S, Zenda S, Ogino T, Kinoshita T (2011) Dose-Volume histogram analysis of the safety of proton beam therapy for unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 79:1479–1486

    Article  PubMed  Google Scholar 

  • Krejcarek SC, Grant PE, Henson JW, Tarbell NJ, Yock TI (2007) Physiologic and radiographic evidence of the distal edge of the proton beam in craniospinal irradiation. Int J Radiat Oncol Biol Phys 68:646–649

    Article  PubMed  Google Scholar 

  • Kuban DA, Tucker SL, Dong L, Starkschall G, Huang EH, Cheung MR, Lee AK, Pollack A (2008) Long-term results of the M.D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 70:67–74

    Article  PubMed  Google Scholar 

  • Lomax AJ, Goitein M, Adams J (2003) Intensity modulation in radiotherapy: photons versus protons in the paranasal sinus. Radiother Oncol 66:11–18

    Article  PubMed  Google Scholar 

  • MacDonald SM, Safai S, Trofimov A, Wolfgang J, Fullerton B, Yeap BY, Bortfeld T, Tarbell NJ, Yock T (2008) Proton radiotherapy for childhood ependymoma: initial clinical outcomes and dose comparisons. Int J Radiat Oncol Biol Phys 71:979–986

    Article  PubMed  Google Scholar 

  • MacDonald SM, Trofimov A, Safai S, Adams J, Fullerton B, Ebb D, Tarbell NJ, Yock TI (2011) Proton radiotherapy for pediatric central nervous system germ cell tumors: early clinical outcomes. Int J Radiat Oncol Biol Phys 79:121–129

    Article  PubMed  Google Scholar 

  • Mendenhall WM, Amdur RJ, Morris CG, Kirwan J, Malyapa RS, Vaysberg M, Werning JW, Mendenhall NP (2009) Carcinoma of the nasal cavity and paranasal sinuses. Laryngoscope 119:899–906

    Article  PubMed  Google Scholar 

  • Mendenhall NP, Li Z, Hoppe BS, Marcus RB, Jr, Mendenhall WM, Nichols RC, Morris CG, Williams CR, Costa J, Henderson R (2010) Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer. Int J Radiat Oncol Biol Phys [Epub ahead of print, 2010 Nov 17]

    Google Scholar 

  • Merchant TE (2009) Proton beam therapy in pediatric oncology. Cancer J 15:298–305

    Article  PubMed  Google Scholar 

  • Merchant TE, Kiehna EN, Kun LE, Mulhern RK, Li C, Xiong X, Boop FA, Sanford RA (2006) Phase II trial of conformal radiation therapy for pediatric patients with craniopharyngioma and correlation of surgical factors and radiation dosimetry with change in cognitive function. J Neurosurg 104:94–102

    PubMed  Google Scholar 

  • Merchant TE, Hua CH, Shukla H, Ying X, Nill S, Oelfke U (2008) Proton versus photon radiotherapy for common pediatric brain tumors: comparison of models of dose characteristics and their relationship to cognitive function. Pediatr.Blood Cancer 51:110–117

    Article  PubMed  Google Scholar 

  • Merchant TE, Conklin HM, Wu S, Lustig RH, Xiong X (2009) Late effects of conformal radiation therapy for pediatric patients with low-grade glioma: prospective evaluation of cognitive, endocrine, and hearing deficits. J Clin Oncol 27:3691–3697

    Article  PubMed  Google Scholar 

  • Mizumoto M, Okumura T, Hashimoto T, Fukuda K, Oshiro Y, Fukumitsu N, Abei M, Kawaguchi A, Hayashi Y, Ookawa A, Hashii H, Kanemoto A, Moritake T, Tohno E, Tsuboi K, Sakae T, Sakurai H (2010) Proton beam therapy for hepatocellular carcinoma: a comparison of three treatment protocols. Int J Radiat Oncol Biol Phys [Epub ahead of print, 2010 Sep 30]

    Google Scholar 

  • Mulrooney DA, Yeazel MW, Kawashima T, Mertens AC, Mitby P, Stovall M, Donaldson SS, Green DM, Sklar CA, Robison LL, Leisenring WM (2009) Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the childhood cancer survivor study cohort. BMJ 339:b4606

    Article  PubMed  Google Scholar 

  • Munzenrider JE , Liebsch NJ (1999) Proton therapy for tumors of the skull base. Strahlenther Onkol 175:57–63

    Google Scholar 

  • Nakayama H, Sugahara S, Tokita M, Fukuda K, Mizumoto M, Abei M, Shoda J, Sakurai H, Tsuboi K, Tokuuye K (2009) Proton beam therapy for hepatocellular carcinoma: the University of Tsukuba experience. Cancer 115:5499–5506

    Article  PubMed  Google Scholar 

  • Nichols CR (2010) Protons offer reduced normal tissue exposure for patients receiving postoperative radiotherapy (RT) for resected pancreatic head cancer. 78:S332

    Google Scholar 

  • Peeters ST, Heemsbergen WD, Koper PC, van Putten WL, Slot A, Dielwart MF, Bonfrer JM, Incrocci L, Lebesque JV (2006) Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol 24:1990–1996

    Article  PubMed  Google Scholar 

  • Pommier P, Liebsch NJ, Deschler DG, Lin DT, McIntyre JF, Barker FG, Adams JA, Lopes VV, Varvares M, Loeffler JS, Chan AW (2006) Proton beam radiation therapy for skull base adenoid cystic carcinoma. Arch Otolaryngol Head Neck Surg 132:1242–1249

    Article  PubMed  Google Scholar 

  • Rossi CJ Jr, Slater JD, Yonemoto LT, Jabola BR, Bush DA, Levy RP, Grove R, Slater JM (2004) Influence of patient age on biochemical freedom from disease in patients undergoing conformal proton radiotherapy of organ-confined prostate cancer. Urology 64:729–732

    Article  PubMed  Google Scholar 

  • Schoenfeld AJ, Hornicek FJ, Pedlow FX, Kobayashi W, Garcia RT, Delaney TF, Springfield D, Mankin HJ, Schwab JH (2010) Osteosarcoma of the spine: experience in 26 patients treated at the Massachusetts general hospital. Spine J 10:708–714

    Article  PubMed  Google Scholar 

  • Sejpal S, Komaki R, Tsao A, Chang JY, Liao Z, Wei X, Allen PK, Lu C, Gillin M, Cox JD (2011) Early findings on toxicity of proton beam therapy with concurrent chemotherapy for nonsmall cell lung cancer. Cancer [Epub ahead of print, 2011 Jan 24]

    Google Scholar 

  • Shipley WU, Verhey LJ, Munzenrider JE, Suit HD, Urie MM, McManus PL, Young RH, Shipley JW, Zietman AL, Biggs PJ (1995) Advanced prostate cancer: the results of a randomized comparative trial of high dose irradiation boosting with conformal protons compared with conventional dose irradiation using photons alone. Int J Radiat Oncol Biol Phys 32:3–12

    Article  PubMed  CAS  Google Scholar 

  • Slater JD, Rossi CJ Jr, Yonemoto LT, Bush DA, Jabola BR, Levy RP, Grove RI, Preston W, Slater JM (2004) Proton therapy for prostate cancer: the initial Loma Linda University experience. Int J Radiat Oncol Biol Phys 59:348–352

    Article  PubMed  Google Scholar 

  • Travis LB, Gospodarowicz M, Curtis RE, Clarke EA, Andersson M, Glimelius B, Joensuu T, Lynch CF, Van Leeuwen FE, Holowaty E, Storm H, Gliimelius I, Pukkala E, Stovall M, Fraumeni JF Jr, Boice JD Jr, Gilbert E (2002) Lung cancer following chemotherapy and radiotherapy for Hodgkin’s disease. J Natl Cancer Inst 94:182–192

    Article  PubMed  Google Scholar 

  • Travis LB, Hill DA, Dores GM, Gospodarowicz M, Van Leeuwen FE, Holowaty E, Glimelius B, Andersson M, Wiklund T, Lynch CF, Van’t Veer MB, Glimelius I, Storm H, Pukkala E, Stovall M, Curtis R, Boice JD Jr, Gilbert E (2003) Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease. JAMA J Am Med Assoc 290:465–475

    Article  Google Scholar 

  • Tukenova M, Guibout C, Hawkins M, Quiniou E, Mousannif A, Pacquement H, Winter D, Bridier A, Lefkopoulos D, Oberlin O, Diallo I, de Vathaire F (2011) Radiation therapy and late mortality from second sarcoma, carcinoma, and hematological malignancies after a solid cancer in childhood. Int J Radiat Oncol Biol Phys 80:339–346

    Article  PubMed  Google Scholar 

  • Vargas C, Fryer A, Mahajan C, Indelicato D, Horne D, Chellini A, McKenzie C, Lawlor P, Henderson R, Li Z, Lin L, Olivier K, Keole S (2008) Dose-volume comparison of proton therapy and intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 70:744–751

    Article  PubMed  Google Scholar 

  • Weber DC, Chan AW, Lessell S, McIntyre JF, Goldberg SI, Bussiere MR, Fitzek MM, Thornton AF, Delaney TF (2006) Visual outcome of accelerated fractionated radiation for advanced sinonasal malignancies employing photons/protons. Radiother Oncol 81:243–249

    Article  PubMed  Google Scholar 

  • Yock T, Schneider R, Friedmann A, Adams J, Fullerton B, Tarbell N (2005) Proton radiotherapy for orbital rhabdomyosarcoma: clinical outcome and a dosimetric comparison with photons. Int J Radiat Oncol Biol Phys 63:1161–1168

    Article  PubMed  Google Scholar 

  • Zietman AL, Bae K, Slater JD, Shipley WU, Efstathiou JA, Coen JJ, Bush DA, Lunt M, Spiegel DY, Skowronski R, Jabola BR, Rossi CJ (2010) Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/american college of radiology 95–09. J Clin Oncol 28:1106–1111

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Florida Proton Institute, 2015 North Jefferson Street, 32206, Jacksonville, FL, USA

    Nancy Price Mendenhall & Zuofeng Li

Authors
  1. Nancy Price Mendenhall
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zuofeng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nancy Price Mendenhall .

Editor information

Editors and Affiliations

  1. Institutet Stockholm Sweden, MMC 436, Dept.of Oncol-Pathol Karolinska, Delaware St. SE 420, Minneapolis, 55455, Minnesota, USA

    Seymour H. Levitt

  2. UC Davis Cancer Center, Dept. Radiation Oncology, University of California, Davis, X Street 4501, Sacramento, 95817, California, USA

    James A. Purdy

  3. School of Medicine, Dept. Radiation Oncology, Washington University, Forest Park Ave. 4511, St. Louis, 63108-2138, Michigan, USA

    Carlos A. Perez

  4. Instituut Verbeeten, Tilburg, 5042 SB, Netherlands

    Philip Poortmans

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Mendenhall, N.P., Li, Z. (2011). Proton Therapy. In: Levitt, S., Purdy, J., Perez, C., Poortmans, P. (eds) Technical Basis of Radiation Therapy. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_266

Download citation

  • DOI: https://doi.org/10.1007/174_2011_266

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-11571-4

  • Online ISBN: 978-3-642-11572-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation