Advantages and Benefits: Proton Therapy vs. X-Ray Treatment in Cancer

Dear Colleagues,

The expansion of proton therapy in cancer treatment has increased the interest in identifying the differential biological and clinical effects of the interaction of both ionizing radiation beams in cancer patients. The advantages and benefits are related to the improvement of the therapeutic index (toxicity in normal tissues vs. cancer control). Proton therapy has consolidated evidence as the best dosimetric option in pediatric cancer and complex anatomical regions such as the brain, skull base, craniofacial and paravertebral areas. The clinical benefit induced by the dosimetric advantage has generated new evidence in human cancer models where unnecessary scatter irradiation (superior in irradiation with high precision techniques with IMRT or VMAT photons) is minimized to organs and systems decisive for quality of life and long-term survival, including the heart, circulating blood, immune system and central nervous system, among others. The spectrum of human cancer showing clinical benefit measured in objective parameters of organ and system functionality (metrics of gastrointestinal, rectal, hematologic tolerance, lymphopenia, neurocognition and cardiac events) includes head and neck cancer, esophagus, breast, lung, hepatocarcinoma, prostate, central nervous system tumors and patients who are candidates for re-irradiation.

Radiotherapy in its usual indication of oncologic clinical practice is an anatomical “focal” treatment that promotes local control of cancer, with a usually favorable balance of acceptable toxicity in normal tissues adjacent to the region of high-dose irradiation. However, the possibility of obtaining a differential effect through proton therapy or photon therapy in minimizing unnecessary scattered irradiation with low and intermediate doses of anatomical areas of normal tissues allows the introduction of a new model for studying clinical benefit. Radiotherapy as a “focal” treatment has an associated “systemic effect” component: the clinical radiobiology associated with proton and photon therapy is amenable to acute and subacute analysis by biomarkers and delayed analysis by functional assessments of organs and systems.

The impact of the dosimetric difference between protons and photons in its clinical application is additionally measurable in health and social cost metrics and health value. “Costicity” (the accumulated cost of radiotherapy toxicity) is a complex and multifactorial parameter that must be taken into account in the analysis of the advantages or benefits of both oncological irradiation techniques.

Evidence on differential values between proton therapy and photon therapy in oncology is increasing. There is a large number of prospective studies that evaluate criteria of comparison for clinical benefit using the proton vs. photon dosimetric difference in multiple models of human cancer. For this Special Issue, we invite you to submit manuscripts that provide innovative information from molecular differential observations (biomarkers) to the functionality and quality of life of patients and their tissues studied by experts in clinical radiotherapy with proton or photon irradiation resources.

Prof. Dr. Felipe A. Calvo
Guest Editor

Manuscript Submission Information

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• proton therapy
• X-ray therapy
• foton therapy
• in silico dosimetry
• in vivo dosimetry
• quality assurance
• NTCP models
• pediatric cancer patients
• vascular biomarkers
• hematological biomarkers
• hepatic biomarkers
• lymphopenia
• cardiac toxicity
• hepatotoxicity
• neurocognition
• pneumonitis
• long-term sequelae
• radiation induced cancer
• survival
• supportive care
• survivors
• quality of life
• health value
• cost