What are the applications of proton beam therapy?

Proton beam therapy can be used to treat cancer and also some non-cancerous tumours, particularly those that occur in the brain. It is a form of radiotherapy but is different to standard X-ray radiotherapy. Because a proton beam has different properties, it can deliver a destructive dose to the three-dimensional area of a tumour with only a small dose ending up in the surrounding healthy tissue.

What sorts of cancers are suitable for proton beam therapy?

  • Localised primary cancers – proton beam therapy is most likely to extend someone’s life if the tumour being treated is the primary tumour and it has not spread. It helps if the tumour has not spread out of the tissue in which it originated.
  • Solitary secondary cancers – if a primary cancer is treatable by surgery but has spread to another site but has only caused a single secondary tumour, this can be treated by proton beam therapy. Solitary secondary tumours in a lymph node or in the lung or liver can respond well to proton therapy.
  • Tumours next to vital structures that are easily damaged – such as eye cancers that lie close to the optic nerve or that are near to the spinal cord.
  • Childhood cancers – as proton beam therapy is less likely to damage healthy tissue, using it in children could lessen the risk of radiation-related problems later in life. These include radiation-related cancers and problems with physical and mental development.

Conditions for which proton beam therapy is the treatment of choice

  • Eye cancer in adults, such as choroidal melanoma, optic glioma and uveal melanoma.
  • Cancers that affect the spinal cord, such as malignant meningioma, chordoma and chondrosarcoma.
  • Primary tumours of the brain, including those inside the skull and at the skull base.
  • Arteriovenous malformations – non-cancerous but dangerous clumps of abnormal blood vessels in or near to the brain.

Conditions for which proton beam therapy can be used

  • Rare childhood cancers of the brain, the spinal cord and of the eye. These include retinoblastoma and Children may receive proton therapy for rare cancers of the central nervous system (brain and spinal cord) and the eye, such as orbital rhabdomyosarcoma and retinoblastoma.
  • Benign (non-cancerous) tumours of the brain. These can be difficult to remove and can still damage the brain and/or important nerves as they expand and crush tissue. Examples include acoustic neuroma and craniopharyngioma.
  • Sarcomas – soft tissue cancers that can occur near to the spine or in the pelvis.
  • Cancers of the head and neck such as those that arise in the nose, the sinuses and the nasopharyngeal area.
  • Non-small cell lung cancer. Lung tumours that cannot easily be removed can be treated with radiotherapy but the risk of damage to the delicate healthy lung tissue around the tumour is high. Proton beam therapy enables the tumour to be targeted with less collateral damage.
  • Pancreatic cancer
  • Liver cancer
  • Prostate cancer – particularly those near to the rectum or nerves that lead into the penis. PBT is less likely to damage the rectum or to lead to long-term side effects such as incontinence or erectile dysfunction.
  • Bladder cancer
  • Cervical cancer
  • Cancer of the oesophagus
  • Rectal cancers that have recurred after surgery.

In many proton beam therapy centres around the world, doctors give priority treatment to children and young adults with a cancer that is at an early stage, still localised and that has a good chance of being cured. Those that are in places that make surgery tricky, or that are near to vital structures, are particularly suitable for PBT.

Which cancers are not suitable for proton beam therapy?

  • Blood cancers such as leukaemia or lymphoma – the cancer cells are too widely dispersed in the body.
  • Stomach cancer, cancer of the bowel or small intestines - proton beam therapy, like X-ray radiotherapy, causes ulcers to form in the membranes in the digestive system.
  • Tumours in any part of the body that are more than 12cm across. This causes technical difficulties as the proton beam therapy has to be given over too wide an area.
  • Metastatic cancers – if the primary cancer has spread to several sites, it is difficult to manage the cancer with a view to curing it. This type of advanced cancer may be best managed using palliative care.

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