Application of Proton Beam Therapy in Cancer Treatment

Dear Colleagues,

The advantageous physical characteristics of protons over other types of radiation for cancer treatment have been known for many years. However, due to the high investment costs, the number of proton facilities has remained low. Technological developments such as intensity-modulated radiotherapy and daily 3D (cone-beam) imaging first became widely available in photon facilities, at a time when proton beams were generally created by passive scattering, and patient positioning was based on 2D kV imaging.

However, proton therapy is catching up, and the number of facilities around the world has quadrupled in the past two decades (from 20 in 2001 to 82 in 2020; ptcog.ch). The capacity is still limited, but NTCP model-based patient selection has been implemented to optimally use resources and select patients that will benefit the most from protons. In addition, various developments have been introduced in the clinic, such as intensity modulation with pencil beam scanning, robust treatment plan optimization, Monte Carlo dose calculation and CBCT imaging.

This Special Issue will cover further improvements in the quality and efficiency of proton treatments. For example, automated treatment planning and NTCP-based planning can improve the efficiency and quality of treatment plans. The 3D or 4D imaging-based tracking of the doses actually delivered can be used to adapt plans. These are exciting times, as several more topics are being investigated and may find their way to the clinic in the coming years. We look forward to FLASH radiotherapy, LET- and RBE-based planning, and proton arcs, to name a few.

Dr. Erik W. Korevaar
Dr. Arjen van der Schaaf
Guest Editors

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