Proton beam therapy

Abstract

Conventional radiation therapy directs photons (X-rays) and electrons at tumours with the intent of eradicating the neoplastic tissue while preserving adjacent normal tissue. Radiation-induced damage to healthy tissue and second malignancies are always a concern, however, when administering radiation. Proton beam radiotherapy, one form of charged particle therapy, allows for excellent dose distributions, with the added benefit of no exit dose. These characteristics make this form of radiotherapy an excellent choice for the treatment of tumours located next to critical structures such as the spinal cord, eyes, and brain, as well as for paediatric malignancies.

Figure 1

Depth–dose distributions for a spread-out Bragg peak (SOBP, red), its constituent pristine Bragg peaks (blue), and a 10 MV photon beam (black). The SOBP dose distribution is created by adding the contributions of individually modulated pristine Bragg peaks. The penetration depth, or range, measured as the depth of the distal 90% of plateau dose, of the SOBP dose distribution is determined by the range of the most distal pristine peak (labeled ‘Pristine peak’). The modulation width, measured as the distance between the proximal and distal 90% of plateau dose values, of the SOBP dose distribution is controlled by varying the number and intensity of pristine Bragg peaks that are added, relative to the most distal pristine peak, to form the SOBP. The dashed lines (black) indicate the clinical acceptable variation in the plateau dose of ±2%. The dot–dashed lines (green) indicate the 90% dose and spatial, range and modulation width, intervals. The SOBP dose distribution of even a single field can provide complete target volume coverage in depth and lateral dimensions, in sharp contrast to a single photon dose distribution; only a composite set of photon fields can deliver a clinical target dose distribution. Note the absence of dose beyond the distal fall-off edge of the SOBP.

Figure 2

Sagittal and coronal composite dose displays for a child with high-risk medulloblastoma undergoing craniospinal irradiation with protons. Prescription dose to the craniospinal axis for this child with high-risk disease is 36 CGE and the dose to the posterior fossa is 54 CGE. Note the absence of significant exit dose beyond the anterior border of the vertebral bodies, thus sparing the bowel, heart, and mediastinum from potential side effects of radiotherapy.