title: Promise and pitfalls of heavy-particle therapy.
abstract: Proton beam therapy, the most common form of heavy-particle radiation therapy, is not a new invention, but it has gained considerable public attention because of the high cost of installing and operating the rapidly increasing number of treatment centers. This article reviews the physical properties of proton beam therapy and focuses on the up-to-date clinical evidence comparing proton beam therapy with the more standard and widely available radiation therapy treatment alternatives. In a cost-conscious era of health care, the hypothetical benefits of proton beam therapy will have to be supported by demonstrable clinical gains. Proton beam therapy represents, through its scale and its cost, a battleground for the policy debate around managing expensive technology in modern medicine.
authors.affiliation: Timur Mitin, Massachusetts General Hospital, Boston, MA. mitin@ohsu.edu.
authors.forename: Timur
authors.initials: T
authors.lastname: Mitin
authors.affiliation: Timur Mitin, Massachusetts General Hospital, Boston, MA.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Zietman
mesh_terms: D004307:Dose-Response Relationship, Radiation; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D061766:Proton Therapy / Q000009:adverse effects* / Q000379:methods*; D011522:Protons / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic
chemical_list: D011522:Protons
references.citation: Cancer. 2014 Jan 1;120(1):126-33
references.pmid: 24122173
references.citation: Curr Probl Cancer. 2010 Jul-Aug;34(4):257-96
references.pmid: 20647112
references.citation: Radiother Oncol. 2013 Aug;108(2):209-14
references.pmid: 23891102
references.citation: J Urol. 2006 Oct;176(4 Pt 1):1415-9
references.pmid: 16952647
references.citation: Int J Radiat Oncol Biol Phys. 2000 Jun 1;47(3):591-6
references.pmid: 10837940
references.citation: Int J Radiat Oncol Biol Phys. 2003 Mar 1;55(3):785-92
references.pmid: 12573766
references.citation: JAMA. 2003 Jul 23;290(4):465-75
references.pmid: 12876089
references.citation: Int J Radiat Oncol Biol Phys. 2005 Aug 1;62(5):1412-22
references.pmid: 16029801
references.citation: Radiat Oncol. 2012 Oct 22;7:174
references.pmid: 23083010
references.citation: Int J Radiat Oncol Biol Phys. 2006 Apr 1;64(5):1348-54
references.pmid: 16580494
references.citation: Neuro Oncol. 2013 Nov;15(11):1552-9
references.pmid: 24101739
references.citation: Radiother Oncol. 2005 May;75(2):179-85
references.pmid: 15885828
references.citation: Expert Rev Med Devices. 2013 Mar;10(2):239-45
references.pmid: 23480092
references.citation: BJU Int. 2012 Feb;109 Suppl 1:22-9
references.pmid: 22239226
references.citation: Front Radiat Ther Oncol. 2011;43:465-485
references.pmid: 21625169
references.citation: Int J Radiat Oncol Biol Phys. 2013 Jul 1;86(3):484-90
references.pmid: 23523326
references.citation: Radiother Oncol. 2002 Nov;65(2):89-98
references.pmid: 12443804
references.citation: Semin Radiat Oncol. 2013 Apr;23(2):115-9
references.pmid: 23473688
references.citation: Int J Radiat Oncol Biol Phys. 2013 Sep 1;87(1):46-52
references.pmid: 23778197
references.citation: Int J Radiat Oncol Biol Phys. 2009 May 1;74(1):179-86
references.pmid: 19019562
references.citation: Int J Radiat Oncol Biol Phys. 2009 Jan 1;73(1):235-41
references.pmid: 18513882
references.citation: Cancer J. 2013 May-Jun;19(3):200-7
references.pmid: 23708066
references.citation: Cancer Res. 1958 Feb;18(2):121-34
references.pmid: 13511365
references.citation: Int J Radiat Oncol Biol Phys. 2010 May 1;77(1):98-105
references.pmid: 19695794
references.citation: J Clin Oncol. 2006 Jan 20;24(3):476-83
references.pmid: 16421424
references.citation: J Clin Oncol. 2006 Oct 20;24(30):4833-9
references.pmid: 17050868
references.citation: JAMA. 2012 Apr 18;307(15):1611-20
references.pmid: 22511689
references.citation: Int J Radiat Oncol Biol Phys. 2013 Sep 1;87(1):120-6
references.pmid: 23790826
references.citation: Cancer. 2011 Oct 15;117(20):4707-13
references.pmid: 21437893
references.citation: J Clin Oncol. 2007 Mar 10;25(8):953-64
references.pmid: 17350944
references.citation: Int J Radiat Oncol Biol Phys. 2006 Aug 1;65(5):1572-8
references.pmid: 16863934
references.citation: N Engl J Med. 2006 Oct 12;355(15):1572-82
references.pmid: 17035650
references.citation: Clin Breast Cancer. 2011 Aug;11(4):241-5
references.pmid: 21729673
references.citation: Phys Med Biol. 2009 Apr 21;54(8):2277-91
references.pmid: 19305036
references.citation: Cancer. 2002 May 15;94(10):2623-34
references.pmid: 12173330
references.citation: Int J Radiat Oncol Biol Phys. 2005 Nov 15;63(4):1161-8
references.pmid: 15950401
references.citation: Int J Radiat Oncol Biol Phys. 2013 May 1;86(1):18-26
references.pmid: 23040219
references.citation: Int J Radiat Oncol Biol Phys. 2013 Aug 1;86(5):1007-13
references.pmid: 23688812
references.citation: Cancer J. 2007 Mar-Apr;13(2):114-8
references.pmid: 17476139
references.citation: Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):444-53
references.pmid: 17513063
references.citation: Acta Oncol. 2011 Aug;50(6):745-56
references.pmid: 21767170
references.citation: Semin Radiat Oncol. 2011 Oct;21(4):278-86
references.pmid: 21939857
references.citation: Cancer J. 2006 Mar-Apr;12(2):155-9
references.pmid: 16630407
references.citation: J Thorac Oncol. 2012 Jun;7(6):1021-5
references.pmid: 22551902
references.citation: Int J Radiat Oncol Biol Phys. 2005 Jun 1;62(2):494-500
references.pmid: 15890592
references.citation: Phys Med Biol. 2009 Jun 7;54(11):N205-15
references.pmid: 19436099
references.citation: Lancet. 2005 Dec 17;366(9503):2087-106
references.pmid: 16360786
references.citation: J Neurosurg. 2001 Dec;95(6):933-43
references.pmid: 11765837
references.citation: Head Neck. 2009 Oct;31(10):1297-308
references.pmid: 19536762
references.citation: Radiology. 1946 Nov;47(5):487-91
references.pmid: 20274616
references.citation: Int J Radiat Oncol Biol Phys. 2007 Feb 1;67(2):497-504
references.pmid: 17084557
references.citation: J Natl Cancer Inst. 2013 Jan 2;105(1):25-32
references.pmid: 23243199
references.citation: Semin Radiat Oncol. 2013 Jan;23(1):60-73
references.pmid: 23207048
references.citation: Int J Radiat Oncol Biol Phys. 2006 Aug 1;65(5):1404-10
references.pmid: 16730137
references.citation: J Neurosurg. 1999 Aug;91(2):251-60
references.pmid: 10433313
references.citation: Int J Radiat Oncol Biol Phys. 2013 Sep 1;87(1):10-2
references.pmid: 23810521
references.citation: Int J Radiat Oncol Biol Phys. 2000 Dec 1;48(5):1363-70
references.pmid: 11121635
references.citation: Radiother Oncol. 2007 May;83(2):123-32
references.pmid: 17499374
references.citation: Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):979-86
references.pmid: 18325681
references.citation: JAMA. 2010 Mar 17;303(11):1046-53
references.pmid: 20233822
references.citation: Int J Radiat Oncol Biol Phys. 1995 Dec 1;33(5):1321-9
references.pmid: 7493857
references.citation: Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):e329-36
references.pmid: 21703781
references.citation: J Clin Oncol. 2010 Mar 1;28(7):1106-11
references.pmid: 20124169
references.citation: Zhongguo Fei Ai Za Zhi. 2013 May;16(5):252-60
references.pmid: 23676982
references.citation: Int J Radiat Oncol Biol Phys. 2013 Oct 1;87(2):228-30
references.pmid: 23958143
references.citation: J Clin Oncol. 2010 Sep 20;28(27):4275-9
references.pmid: 20697074
references.citation: Radiother Oncol. 2004 Jun;71(3):251-8
references.pmid: 15172139
references.citation: Pediatr Blood Cancer. 2008 Jul;51(1):110-7
references.pmid: 18306274
references.citation: J Pediatr Hematol Oncol. 2013 Aug;35(6):462-7
references.pmid: 23892352
references.citation: Int J Radiat Oncol Biol Phys. 2004 Mar 1;58(3):727-34
references.pmid: 14967427
references.citation: Int J Radiat Oncol Biol Phys. 2007 Jun 1;68(2):531-40
references.pmid: 17398035
references.citation: Int J Radiat Oncol Biol Phys. 2012 Mar 1;82(3):1042-4
references.pmid: 22284026
references.citation: Radiother Oncol. 2013 May;107(2):213-7
references.pmid: 23647751
references.citation: Int J Radiat Oncol Biol Phys. 2008 Jan 1;70(1):67-74
references.pmid: 17765406
references.citation: Phys Med Biol. 2012 Jun 7;57(11):R99-117
references.pmid: 22571913
references.citation: Radiat Oncol. 2006 Jul 20;1:22
references.pmid: 16857055
references.citation: Med Phys. 1986 Sep-Oct;13(5):734-41
references.pmid: 3023803
references.citation: Int J Radiat Oncol Biol Phys. 2006 Nov 1;66(3):691-8
references.pmid: 17011445
references.citation: Radiother Oncol. 2010 Apr;95(1):32-40
references.pmid: 19733410
references.citation: Int J Radiat Oncol Biol Phys. 2005 Oct 1;63(2):362-72
references.pmid: 16168831
references.citation: Acta Oncol. 2005;44(8):793-7
references.pmid: 16332585