title: Proton beams in cancer treatments: Clinical outcomes and dosimetric comparisons with photon therapy.
abstract: OBJECTIVE
  To review current evidence of the role of proton therapy (PT) in other tumors than skull base, sinusal/parasinusal, spinal and pediatric tumors; to determine medico-economic aspects raised by PT.
  
  
  METHODS
  A systematic review on Medline was performed with the following keywords: proton therapy, proton beam, protontherapy, cancer; publications with comparison between PT and photon-therapy were also selected.
  
  
  RESULTS
  In silico studies have shown superiority (better dose delivery to the target and/or to organs at risk) of PT toward photon-therapy in most of thoracic and abdominal malignant tumors. Potential benefits of PT could be: reduction of toxicities (including radiation-induced cancer), increase of tumor control through a dose-escalation approach, hypofractionation. Cost of treatment is always cited as an issue which actually can be managed by a precise patient selection making PT a cost-effective procedure. Comparison plan with photon therapy may be useful to determine the dosimetric and clinical advantages of PT (Normal Tissue Complications Probability).
  
  
  CONCLUSIONS
  PT may be associated with a great advantage compared to the best photon-therapies in various types of cancers. Accumulation of clinical data is on-going and will challenge the in silico data analysis. Some indications are associated with strong superiority of PT and may be discussed as a new standard within prospective observational studies.
authors.affiliation: Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Doyen
authors.affiliation: Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France.
authors.forename: Alexander Tuan
authors.initials: AT
authors.lastname: Falk
authors.affiliation: Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Floquet
authors.affiliation: Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France.
authors.forename: Joël
authors.initials: J
authors.lastname: Hérault
authors.affiliation: Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France. Electronic address: jean-michel.hannoun-levi@nice.unicancer.fr.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Hannoun-Lévi
mesh_terms: D000008:Abdominal Neoplasms / Q000473:pathology / Q000532:radiotherapy; D003362:Cost-Benefit Analysis; D006801:Humans; D018579:Patient Selection; D061766:Proton Therapy / Q000191:economics / Q000379:methods; D000069473:Radiation Dose Hypofractionation; D011834:Radiation Monitoring / Q000379:methods; D011874:Radiometry / Q000379:methods*; D013899:Thoracic Neoplasms / Q000473:pathology / Q000532:radiotherapy; D016896:Treatment Outcome
keywords: Cancer; Particle therapy; Proton beam therapy; Radiotherapy