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National Association for Proton Therapy National Association for Proton Therapy
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NAPT supports and encourages cooperative research and innovation to advance the appropriate and cost-effective utilization of proton therapy.

Compared with photon therapy, proton therapy can deliver less toxic treatments, which allows for more aggressive treatments and higher cure rates in some cancers. In other types of cancers, proton therapy reduces costly hospitalizations and long-term side effects compared with photon therapy. Less toxicity to healthy tissues is simply better for patients in the short and long term.  There are over 900 published peer reviewed journal articles and numerous active clinical trials evaluating the benefits of proton therapy. The following is a small sample of recent research supporting the value of proton therapy.

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QUALITY OF LIFE AND OUTCOMES

Proton therapy has fewer side effects across all cancers than photon therapy, reducing costly side effects and hospitalizations during the course of treatment. Proton therapy better preserves quality of life across all cancers compared with photon therapy. Cancer survivors are living longer due to effective treatments developed in the last few years. It is more important than ever to preserve quality of life for long-term survivors.

CLINICAL RESEARCH ON QUALITY OF LIFE AND OUTCOMES

  1. Baumann BC, Mitra N, Harton JG, et al. Comparative Effectiveness of Proton vs Photon Therapy as Part of Concurrent Chemoradiotherapy for Locally Advanced Cancer. JAMA Oncol. 2020;6(2):237-246. doi:10.1001/jamaoncol.2019.4889

  2. Mohan R. A Review of Proton Therapy – Current Status and Future Directions. Precis Radiat Oncol. 2022;6(2):164-176. doi:10.1002/pro6.1149


  3. Verma V, Simone CB 2nd, Mishra MV. Quality of Life and Patient-Reported Outcomes Following Proton Radiation Therapy: A Systematic Review. J Natl Cancer Inst. 2018;110(4):10.1093/jnci/djx208. doi:10.1093/jnci/djx208

HEAD AND NECK CANCERS

Proton therapy improves overall survival and reduces high grade complications for head and neck cancers compared with photon therapy. Side effects of radiation for head and neck cancer can cause malnutrition, need for feeding tubes, dehydration, and other costly side effects that can require hospitalizations. Proton therapy delivers less radiation to healthy tissue and thus reduces the incidence of these costly side effects.

CLINICAL RESEARCH ON HEAD AND NECK CANCERS

  1. Patel SH, Wang Z, Wong WW, et al. Charged particle therapy versus photon therapy for paranasal sinus and nasal cavity malignant diseases: a systematic review and meta-analysis. Lancet Oncol. 2014;15(9):1027-1038. doi:10.1016/S1470-2045(14)70268-2

  2. McDonald MW, Liu Y, Moore MG, Johnstone PA. Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy. Radiat Oncol. 2016;11:32. doi:10.1186/s13014-016-0600-3


  3. Manzar GS, Lester SC, Routman DM, et al. Comparative analysis of acute toxicities and patient reported outcomes between intensity-modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) for the treatment of oropharyngeal cancer. Radiother Oncol. 2020;147:64-74. doi:10.1016/j.radonc.2020.03.010


  4. Romesser PB, Cahlon O, Scher E, et al. Proton beam radiation therapy results in significantly reduced toxicity compared with intensity-modulated radiation therapy for head and neck tumors that require ipsilateral radiation. Radiother Oncol. 2016;118(2):286-292. doi:10.1016/j.radonc.2015.12.008


  5. Blanchard P, Gunn GB, Lin A, et al. Proton Therapy for Head and Neck Cancers. Semin Radiat Oncol. 2018: 28(1): 53-63. doi:10.1016/j.semradonc.2017.08.004


  6. Holliday EB, Esmaeli B, Pinckard J, et al. A Multidisciplinary Orbit-Sparing Treatment Approach That Includes Proton Therapy for Epithelial Tumors of the Orbit and Ocular Adnexa. Int J Radiat Oncol Biol Phys. 2016;95(1):344-352. doi:10.1016/j.ijrobp.2015.08.008


  7. Wang L, Fossati P, Paganetti H, et al. The Biological Basis for Enhanced Effects of Proton Radiation Therapy Relative to Photon Radiation Therapy for Head and Neck Squamous Cell Carcinoma. Int J Part Ther. 2021;8(1):3-13. doi:10.14338/IJPT-20-00070.1


  8. Hanania AN, Zhang X, Gunn GB, et al. Proton Therapy for Major Salivary Gland Cancer: Clinical Outcomes. Int J Part Ther. 2021;8(1):261-272. doi:10.14338/IJPT-20-00044.1


  9. Li X, Kitpanit S, Lee A, et al. Toxicity Profiles and Survival Outcomes Among Patients With Nonmetastatic Nasopharyngeal Carcinoma Treated With Intensity-Modulated Proton Therapy vs Intensity-Modulated Radiation Therapy. JAMA Netw Open. 2021;4(6):e2113205. doi:10.1001/jamanetworkopen.2021.13205


  10. Chang CL, Lin KC, Chen, WM, et al., Comparing the Oncologic Outcomes of Proton Therapy and Intensity-Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma, Radiotherapy and Oncology (2023). http://dx.doi.org/10.2139/ssrn.4465968

BASE OF SKULL CANCERS AND CHORDOMAS

Proton therapy is the treatment of choice for base of skull cancers and chordomas, where sensitive brain and ocular structures prevent safe treatment with conventional radiation. Proton therapy has been shown to improve tumor control and overall survival for these cancers compared with photon therapy.

CLINICAL RESEARCH ON BASE OF SKULL CANCERS AND CHORDOMAS

  1. Zhou J, Yang B, Wang X, Jing Z. Comparison of the Effectiveness of Radiotherapy with Photons and Particles for Chordoma After Surgery: A Meta-Analysis. World Neurosurg. 2018;117:46-53. doi:10.1016/j.wneu.2018.05.209

  2. Amichetti M, Cianchetti M, Amelio D, Enrici RM, Minniti G. Proton therapy in chordoma of the base of the skull: a systematic review. Neurosurg Rev. 2009;32(4):403-416. doi:10.1007/s10143-009-0194-4


  3. Holtzman AL, Rotondo RL, Rutenberg MS, et al. Clinical Outcomes Following Dose-Escalated Proton Therapy for Skull-Base Chordoma. Int J Part Ther. 2021;8(1):179-188. doi:10.14338/IJPT-20-00066.1

BRAIN TUMORS

Proton therapy can improve outcomes when used to treat brain tumors, offering reduced side effects and treatment options where no safe options exist in the treatment of recurrent brain tumors. Proton therapy can also decrease injury to normal brain tissues in primary brain tumor treatment.

CLINICAL RESEARCH ON BRAIN TUMORS

  1. Hug EB, Devries A, Thornton AF, et al. Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy. J Neurooncol. 2000;48(2):151-160. doi:10.1023/a:1006434124794

  2. Combs SE, Debus J, Schulz-Ertner D. Radiotherapeutic alternatives for previously irradiated recurrent gliomas. BMC Cancer. 2007;7:167. doi:10.1186/1471-2407-7-167


  3. Brown PD, Chung C, Liu DD, et al. A prospective phase II randomized trial of proton radiotherapy vs intensity-modulated radiotherapy for patients with newly diagnosed glioblastoma. Neuro Oncol. 2021;23(8):1337-1347. doi:10.1093/neuonc/noab040

BREAST CANCER

Proton therapy reduces radiation dose to the heart and lungs, preventing long term cardiac toxicity for patients with breast cancer.

CLINICAL RESEARCH ON BREAST CANCER

  1. Hug EB. Proton Therapy for Primary Breast Cancer. Breast Care (Basel). 2018;13(3):168-172. doi:10.1159/000489893

  2. Laugaard Lorenzen E, Christian Rehammar J, Jensen MB, Ewertz M, Brink C. Radiation-induced risk of ischemic heart disease following breast cancer radiotherapy in Denmark, 1977-2005. Radiother Oncol. 2020;152:103-110. doi:10.1016/j.radonc.2020.08.007


  3. Braunstein LZ, Cahlon O. Potential Morbidity Reduction With Proton Radiation Therapy for Breast Cancer. Semin Radiat Oncol. 2018;28(2):138-149. doi:10.1016/j.semradonc.2017.11.009


  4. Lin LL, Vennarini S, Dimofte A, et al. Proton beam versus photon beam dose to the heart and left anterior descending artery for left-sided breast cancer. Acta Oncol. 2015;54(7):1032-1039. doi:10.3109/0284186X.2015.1011756


  5. Mutter RW, Choi JI, Jimenez RB, et al. Proton Therapy for Breast Cancer: A Consensus Statement From the Particle Therapy Cooperative Group Breast Cancer Subcommittee. Int J Radiat Oncol Biol Phys. 2021;111(2):337-359. doi:10.1016/j.ijrobp.2021.05.110

ESOPHAGEAL CANCER

Proton therapy improves overall survival and reduces high grade complications and resulting costly hospitalizations for esophageal cancer compared with photon therapy.

CLINICAL RESEARCH ON ESOPHAGEAL CANCER

  1. Lin SH, Hobbs BP, Verma V, et al. Randomized Phase IIB Trial of Proton Beam Therapy Versus Intensity-Modulated Radiation Therapy for Locally Advanced Esophageal Cancer. J Clin Oncol. 2020;38(14):1569-1579. doi:10.1200/JCO.19.02503

  2. Xi M, Xu C, Liao Z, et al. Comparative Outcomes After Definitive Chemoradiotherapy Using Proton Beam Therapy Versus Intensity Modulated Radiation Therapy for Esophageal Cancer: A Retrospective, Single-Institutional Analysis. Int J Radiat Oncol Biol Phys. 2017;99(3):667-676. doi:10.1016/j.ijrobp.2017.06.2450


  3. Lin SH, Merrell KW, Shen J, et al. Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer. Radiother Oncol. 2017;123(3):376-381. doi:10.1016/j.radonc.2017.04.013


  4. Wang J, Wei C, Tucker SL, et al. Predictors of postoperative complications after trimodality therapy for esophageal cancer. Int J Radiat Oncol Biol Phys. 2013;86(5):885-891. doi:10.1016/j.ijrobp.2013.04.006


  5. Lin SH, Hobbs B, Thall P, et al. Results of a Phase II Randomized Trial of Proton Beam Therapy vs Intensity Modulated Radiation Therapy in Esophageal Cancer. Int J Radiat Oncol Biol Phys. 2019;105(3):680-681

HEPATOCELLULAR CARCINOMA

Proton therapy improves survival for hepatocellular carcinoma compared with photon therapy and stereotactic body radiation therapy.

CLINICAL RESEARCH ON HEPATOCELLULAR CARCINOMA

  1. Sanford NN, Pursley J, Noe B, et al. Protons versus Photons for Unresectable Hepatocellular Carcinoma: Liver Decompensation and Overall Survival. Int J Radiat Oncol Biol Phys. 2019;105(1):64-72. doi:10.1016/j.ijrobp.2019.01.076

  2. Hasan S, Abel S, Verma V, et al. Proton beam therapy versus stereotactic body radiotherapy for hepatocellular carcinoma: practice patterns, outcomes, and the effect of biologically effective dose escalation. J Gastrointest Oncol. 2019;10(5):999-1009. doi:10.21037/jgo.2019.08.03


  3. Cheng JY, Liu CM, Wang YM, et al. Proton versus photon radiotherapy for primary hepatocellular carcinoma: a propensity-matched analysis. Radiat Oncol. 2020;15(1):159. doi:10.1186/s13014-020-01605-4

  4. Bush, DA, Volk, M., Smith, JC, et al. Proton beam radiotherapy versus transarterial chemoembolization for hepatocellular carcinoma: Results of a randomized clinical trial. Cancer. 2023; 129(22): 3554-3563. doi:10.1002/cncr.34965

NON-SMALL CELL LUNG CANCER

Proton therapy improves survival for both early stage and locally advanced stage non-small cell lung cancers when compared with photon therapy.

CLINICAL RESEARCH ON NON-SMALL CELL LUNG CANCER

  1. Higgins KA, O’Connell K, Liu Y, et al. National Cancer Database Analysis of Proton Versus Photon Radiation Therapy in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys. 2017;97(1):128-137. doi:10.1016/j.ijrobp.2016.10.001

  2. Yu NY, DeWees TA, Voss MM, et al. Cardiopulmonary Toxicity Following Intensity-Modulated Proton Therapy (IMPT) Versus Intensity-Modulated Radiation Therapy (IMRT) for Stage III Non-Small Cell Lung Cancer. Clin Lung Cancer. 2022;23(8):e526-e535. doi:10.1016/j.cllc.2022.07.017


  3. Nantavithya C, Gomez DR, Wei X, et al. Phase 2 Study of Stereotactic Body Radiation Therapy and Stereotactic Body Proton Therapy for High-Risk, Medically Inoperable, Early-Stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys. 2018;101(3):558-563. doi:10.1016/j.ijrobp.2018.02.022


  4. Chi A, Chen H, Wen S, Yan H, Liao Z. Comparison of particle beam therapy and stereotactic body radiotherapy for early stage non-small cell lung cancer: A systematic review and hypothesis-generating meta-analysis. Radiother Oncol. 2017;123(3):346-354. doi:10.1016/j.radonc.2017.05.007


  5. Iocolano M, Yegya‐Raman N, Friedes C, et al. (2024). Acute hospitalizations after proton therapy versus intensity‐modulated radiotherapy for locally advanced non–small cell lung cancer in the durvalumab era. Cancer; 130(11):2031-2041. doi:10.1002/cncr.35230

PANCREATIC AND GASTROINTESTINAL TUMORS

Proton reduces side effects for pancreatic and gastrointestinal tumors compared with photon therapy.

CLINICAL RESEARCH ON PANCREATIC AND GASTROINTESTINAL TUMORS

  1. Verma V, Lin SH, Simone CB 2nd, Mehta MP. Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: a systematic review. J Gastrointest Oncol. 2016;7(4):644-664. doi:10.21037/jgo.2016.05.06

  2. Rutenberg MS, Nichols RC. Proton beam radiotherapy for pancreas cancer. J Gastrointest Oncol. 2020;11(1):166-175. doi:10.21037/jgo.2019.03.02

RECURRENT TUMORS

Proton therapy offers a curative option not available with photon therapy for recurrent tumors. When cancers recur, traditional radiation is often not a safe treatment option, leaving cancer patients with limited treatment options and prognosis. Proton therapy gives patients with cancer recurrence a treatment option they would not have with conventional radiation and can lead to cures in select patients.

CLINICAL RESEARCH ON RECURRENT TUMORS

  1.  Verma V, Rwigema JM, Malyapa RS, Regine WF, Simone CB 2nd. Systematic assessment of clinical outcomes and toxicities of proton radiotherapy for reirradiation. Radiother Oncol. 2017;125(1):21-30. doi:10.1016/j.radonc.2017.08.005

  2. Chao HH, Berman AT, Simone CB 2nd, et al. Multi-Institutional Prospective Study of Reirradiation with Proton Beam Radiotherapy for Locoregionally Recurrent Non-Small Cell Lung Cancer. J Thorac Oncol. 2017;12(2):281-292. doi:10.1016/j.jtho.2016.10.018

PROSTATE CANCER

Proton beam therapy is effective for treating prostate cancer, with excellent long-term outcomes and fewer long-term, costly side effects such as bowel toxicities.

CLINICAL RESEARCH ON PROSTATE CANCER

  1. Hoppe BS, Michalski JM, Mendenhall NP, et al. Comparative effectiveness study of patient-reported outcomes after proton therapy or intensity-modulated radiotherapy for prostate cancer. Cancer. 2014;120(7):1076-1082. doi:10.1002/cncr.28536

  2. Mendenhall NP, Hoppe BS, Nichols RC, et al. Five-year outcomes from 3 prospective trials of image-guided proton therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2014;88(3):596-602. doi:10.1016/j.ijrobp.2013.11.007


  3. Grewal AS, Schonewolf C, Min EJ, et al. Four-Year Outcomes From a Prospective Phase II Clinical Trial of Moderately Hypofractionated Proton Therapy for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys. 2019;105(4):713-722. doi:10.1016/j.ijrobp.2019.05.069

PEDIATRIC CANCER

Proton therapy is the preferred treatment for pediatric patients needing curative radiotherapy. Proton radiotherapy decreases the risks for cancers caused by radiotherapy, decreases brain injury and improves neurocognitive function after treatment, and significantly reduces overall acute and acute and chronic life-long side effects.

CLINICAL RESEARCH ON PEDIATRIC CANCER

  1. Jiang C, Kim M, Han X, et al. Outcomes of proton therapy to infradiaphragmatic sites in pediatric patients with Hodgkin lymphoma. Pediatric Blood & Cancer. 2024;e31290. doi.org/10.1002/pbc.31290

    Kahalley LS, Peterson R, Ris MD, et al. Superior Intellectual Outcomes After Proton Radiotherapy Compared With Photon Radiotherapy for Pediatric Medulloblastoma. J Clin Oncol. 2020;38(5):454-461. doi:10.1200/JCO.19.01706


  2. Chung CS, Yock TI, Nelson K, Xu Y, Keating NL, Tarbell NJ. Incidence of second malignancies among patients treated with proton versus photon radiation. Int J Radiat Oncol Biol Phys. 2013;87(1):46-52. doi:10.1016/j.ijrobp.2013.04.030


  3. Yock TI, Yeap BY, Ebb DH, et al. Long-term toxic effects of proton radiotherapy for paediatric medulloblastoma: a phase 2 single-arm. Lancet Oncol. 2016;17(3):287-298. doi:10.1016/S1470-2045(15)00167-9

SECONDARY MALIGNANCIES

Proton therapy leads to fewer secondary radiation-induced cancer across all cancers than photon therapy.

CLINICAL RESEARCH ON SECONDARY MALIGNANCIES

  1. Xiang M, Chang DT, Pollom EL. Second cancer risk after primary cancer treatment with three-dimensional conformal, intensity-modulated, or proton beam radiation therapy. Cancer. 2020;126(15):3560-3568. doi:10.1002/cncr.32938

  2. Chung CS, Yock TI, Nelson K, Xu Y, Keating NL, Tarbell NJ. Incidence of second malignancies among patients treated with proton versus photon radiation. Int J Radiat Oncol Biol Phys. 2013;87(1):46-52. doi:10.1016/j.ijrobp.2013.04.030

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The National Association for Proton Therapy (NAPT) and its members support cancer research and treatment innovation and are committed to raising awareness about the value of proton therapy among policymakers, insurers, caregivers and patients to ensure that this advanced treatment modality is affordable and available in communities across the country.

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LATEST NAPT NEWS

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  • Mark Kahrs: Moving Forward After Head and Neck Cancer
  • Advancing Cancer Care: Landmark Study Underscores Proton Therapy’s Impact in Head and Neck Cancer

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