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  • Review Article
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Charged particles in radiation oncology

Nature Reviews Clinical Oncology volume 7, pages 37–43 (2010)Cite this article

Abstract

Radiotherapy is one of the most common and effective therapies for cancer. Generally, patients are treated with X-rays produced by electron accelerators. Many years ago, researchers proposed that high-energy charged particles could be used for this purpose, owing to their physical and radiobiological advantages compared with X-rays. Particle therapy is an emerging technique in radiotherapy. Protons and carbon ions have been used for treating many different solid cancers, and several new centers with large accelerators are under construction. Debate continues on the cost:benefit ratio of this technique, that is, on whether the high costs of accelerators and beam delivery in particle therapy are justified by a clear clinical advantage. This Review considers the present clinical results in the field, and identifies and discusses the research questions that have resulted with this technique.

Key Points

  • Particle therapy is an emerging technique in radiotherapy, and several new centers are under construction all over the world

  • Protons are ideal for conformal treatment, and already have applications for pediatric tumors, where reduced late morbidity is expected owing to the reduced integral dose to normal tissue

  • Heavy ions (carbon) provide not only physical, but also biological advantages compared with X-rays (such as high relative biological effectiveness and reduced oxygen enhancement ratio in the tumor region)

  • Clinical trials in Japan and Germany with carbon ions provided excellent results, especially for radiotherapy-resistant tumors, and suggest that hypofractionation is effective with particles

  • Spot scanning provides better dose profiles than passive beam modulation, but requires corrections for treating moving targets

  • Several research issues remain to be studied towards a wide application of heavy-ion therapy

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Figure 1: Charged particles have an advantageous radiation dose–tissue depth profile compared with photons.
Figure 2: Comparison of treatment plans for a large target volume in the base of the skull.
Figure 3: A pediatric tumor treated with proton therapy.
Figure 4: The principles of intensity-controlled magnetic raster scanning.
Figure 5: The rotating gantry installed at the Heidelberg Ion Therapy Center facility.

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Authors and Affiliations

  1. Biophysics Department, Gesellschaft für Schwerionenforschung (GSI), Helmholtzzentrum für Schwerionenforschung, Plackstraße 1, 64291, Darmstadt, Germany

    Marco Durante

  2. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

    Jay S. Loeffler

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Correspondence to Marco Durante.

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M. Durante declares no competing interests. J. Loeffler is a Consultant for Procure Inc.

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Durante, M., Loeffler, J. Charged particles in radiation oncology. Nat Rev Clin Oncol 7, 37–43 (2010). https://doi.org/10.1038/nrclinonc.2009.183

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