title: Charged-particle therapy in cancer: clinical uses and future perspectives.
abstract: Radiotherapy with high-energy charged particles has become an attractive therapeutic option for patients with several tumour types because this approach better spares healthy tissue from radiation than conventional photon therapy. The cost associated with the delivery of charged particles, however, is higher than that of even the most elaborate photon-delivery technologies. Reliable evidence of the relative cost-effectiveness of both modalities can only come from the results of randomized clinical trials. Thus, the hurdles that currently limit direct comparisons of these two approaches in clinical trials, especially those related to insurance coverage, should be removed. Herein, we review several randomized trials of charged-particle therapies that are ongoing, with results that will enable selective delivery to patients who are most likely to benefit from them. We also discuss aspects related to radiobiology, including the immune response and hypoxia, which will need to be taken into consideration in future randomized trials to fully exploit the potential of charged particles.
authors.affiliation: Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute of Nuclear Physics (INFN), University of Trento, Via Sommarive 14, 38123 Povo, Trento, Italy.|Department of Physics, University Federico II, Monte S. Angelo, Via Cintia, 80126 Naples, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Durante
authors.affiliation: National Center of Oncological Hadrontherapy (CNAO), Strada dei Campeggi 53, 27100 Pavia, Italy.|European Institute of Oncology (IEO), Via Ripamonti 435, 20141 Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, USA.|Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, USA.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Loeffler
mesh_terms: D004601:Elementary Particles / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D018787:Radiation Oncology / Q000639:trends; D016032:Randomized Controlled Trials as Topic