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Cancers
Special Issues
Proton Therapy of Cancer Treatment
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Proton Therapy of Cancer Treatment

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 1 June 2026 | Viewed by 1311

Special Issue Editors

Dr. Minglei Kang

E-Mail Website
Guest Editor
Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
Interests: proton therapy; FLASH radiotherapy; motion management; optimization algorithm; adaptive radiation therapy; Monte Carlo simulation
Dr. Benjamin Durkee

E-Mail Website
Co-Guest Editor
Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
Interests: radiation therapy; head and neck cancers; proton therapy; stereotactic body radiotherapy; stereotactic radiosurgery
Dr. Kuo Men

E-Mail Website
Co-Guest Editor
Department of Radiation Oncology, National Cancer Center of China, Beijing, China
Interests: radiation therapy; machine learning; auto-segmentation; proton therapy; stereotactic body radiotherapy; adaptive radiation therapy

Special Issue Information

Dear Colleagues,

Proton therapy is rapidly evolving into one of the most promising modalities in radiation oncology. Its precision and ability to spare healthy tissues—especially when using pencil beam scanning—make it particularly advantageous for treating pediatric and hard-to-reach tumors. Technological innovations are expanding the limits of what is possible, bringing in a new era of enhanced capabilities, more affordable solutions, and groundbreaking treatment approaches.

Among the most exciting frontiers is FLASH radiotherapy (FLASH-RT), which delivers ultra-high dose rates and has shown remarkable potential in preclinical studies for reducing normal tissue toxicity without compromising tumor control. Proton systems, especially those based on cyclotrons with high beam current output, are uniquely positioned to deliver FLASH-RT effectively. Innovations such as single-energy layer delivery are further enabling ultra-high dose rates while simplifying hardware and maintaining high-quality dosimetry.

Beyond FLASH, a wave of cutting-edge developments—including proton arc therapy, upright positioning, MRI-guided proton therapy, compact single-room systems, and spatially fractionated proton RT—are reshaping how we approach complex and radioresistant cancers.

This Special Issue invites contributions from researchers, clinicians, and industry experts to highlight the latest breakthroughs in proton therapy. Join us in accelerating the clinical translation and shaping the future of precision cancer care worldwide.

Dr. Minglei Kang
Dr. Benjamin Durkee
Dr. Kuo Men
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • proton therapy
  • FLASH radiotherapy
  • upright
  • pediatric cancer
  • head and neck cancer
  • affordable proton solutions
  • adaptive radiation therapy
  • treatment planning optimization
  • proton system commissioning

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (2 papers)

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Research

13 pages, 1609 KiB  
Article
A Decision-Making Method for Photon/Proton Selection for Nasopharyngeal Cancer Based on Dose Prediction and NTCP
by Guiyuan Li, Xinyuan Chen, Jialin Ding, Linyi Shen, Mengyang Li, Junlin Yi and Jianrong Dai
Cancers 2025, 17(16), 2620; https://doi.org/10.3390/cancers17162620 - 11 Aug 2025
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Abstract
Introduction: Decision-making regarding radiotherapy techniques for patients with nasopharyngeal cancer requires a comparison of photon and proton plans generated using planning software, which requires time and expertise. We developed a fully automated decision tool to select patients for proton therapy that predicts [...] Read more.
Introduction: Decision-making regarding radiotherapy techniques for patients with nasopharyngeal cancer requires a comparison of photon and proton plans generated using planning software, which requires time and expertise. We developed a fully automated decision tool to select patients for proton therapy that predicts proton therapy (XT) and photon therapy (PT) dose distributions using only patient CT image data, predicts xerostomia and dysphagia probability using predicted critical organ mean doses, and makes decisions based on the Netherlands’ National Indication Protocol Proton therapy (NIPP) to select patients likely to benefit from proton therapy. Methods: This study used 48 nasopharyngeal patients treated at the Cancer Hospital of the Chinese Academy of Medical Sciences. We manually generated a photon plan and a proton plan for each patient. Based on this dose distribution, photon and proton dose prediction models were trained using deep learning (DL) models. We used the NIPP model to measure xerostomia levels 2 and 3, dysphagia levels 2 and 3, and decisions were made according to the thresholds given by this protocol. Results: The predicted doses for both photon and proton groups were comparable to those for manual plan (MP). The Mean Absolute Error (MAE) for each organ at risk in the photon and proton plans did not exceed 5% and showed a good performance of the dose prediction model. For proton, the normal tissue complication probability (NTCP) of xerostomia and dysphagia performed well, p > 0.05. There was no statistically significant difference. For photon, the NTCP of dysphagia performed well, p > 0.05. For xerostomia p < 0.05 but the absolute deviation was 0.85% and 0.75%, which would not have a great impact on the prediction result. Among the 48 patients’ decisions, 3 were wrong, and the correct rate was 93.8%. The area under curve (AUC) of operating characteristic curve (ROC) was 0.86, showing the good performance of the decision-making tool in this study. Conclusions: The decision tool based on DL and NTCP models can accurately select nasopharyngeal cancer patients who will benefit from proton therapy. The time spent generating comparison plans is reduced and the diagnostic efficiency of doctors is improved, and the tool can be shared with centers that do not have proton expertise. Trial registration: This study was a retrospective study, so it was exempt from registration. Full article
(This article belongs to the Special Issue Proton Therapy of Cancer Treatment)
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14 pages, 1413 KiB  
Article
NRG Oncology Liver Proton SBRT and Hypofractionated Radiation Therapy: Current Treatment Technical Assessment and Practice Patterns
by Minglei Kang, Paige A. Taylor, Jiajian Shen, Jun Zhou, Jatinder Saini, Theodore S. Hong, Kristin Higgins, Wei Liu, Ying Xiao, Charles B. Simone II and Liyong Lin
Cancers 2025, 17(14), 2369; https://doi.org/10.3390/cancers17142369 - 17 Jul 2025
Viewed by 674
Abstract
Background/Objectives: Proton therapy delivers highly conformal doses to the target area without producing an exit dose, minimizing cumulative doses to healthy liver tissue. This study aims to evaluate current practices, challenges, and variations in the implementation of proton stereotactic body radiation therapy (SBRT) [...] Read more.
Background/Objectives: Proton therapy delivers highly conformal doses to the target area without producing an exit dose, minimizing cumulative doses to healthy liver tissue. This study aims to evaluate current practices, challenges, and variations in the implementation of proton stereotactic body radiation therapy (SBRT) and hypofractionated therapy for liver malignancies, with the goal of providing a technical assessment to promote broader adoption and support future clinical trials. Methods and Materials: An extensive survey was conducted by NRG Oncology across North American proton treatment centers to assess the current practices of proton liver SBRT and hypofractionated therapy. The survey focused on key aspects, including patient selection, prescription and normal tissue constraints, simulation and motion management, treatment planning, quality assurance (QA), treatment delivery, and the use of image-guided radiation therapy (IGRT). Results: This survey captures the current practice patterns and status of proton SBRT and hypofractionated therapy in liver cancer treatment.  Proton therapy is increasingly preferred for treating inoperable liver malignancies due to its ability to minimize healthy tissue exposure. However, the precision required for proton therapy presents challenges, particularly in managing uncertainties and target motion during high-dose fractions and short treatment courses. Survey findings revealed significant variability in clinical practices across centers, highlighting differences in motion management, dose fractionation schedules, and QA protocols. Conclusion: Proton SBRT and hypofractionated therapy offer significant potential for treating liver malignancies. A comprehensive approach involving precise patient selection, treatment planning, and QA is essential for ensuring safety and effectiveness. This survey provides valuable insights into current practices and challenges, offering a foundation for technical recommendations to optimize the use of proton therapy and guide future clinical trials. Full article
(This article belongs to the Special Issue Proton Therapy of Cancer Treatment)
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