Requirements for the Development and Expansion of Particle Therapy

Reviewer: Curtiland Deville, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: May 28, 2010

Presenter: Nancy Mendenhall, MD
Presenter Affiliation: University of Florida Proton Therapy Institute, Jacksonville, Florida


  • Dose delivered to normal tissues is an important barrier to dose distribution in radiation oncology.
  • Particle therapy “moves the field of external beam radiation forward” by changing the photon paradigm of dose deposition outside of the target.
  • Since August 2006, the University of Florida Proton Therapy Institute has treated 1920 patients through May 2010.
  • Institutional research protocols are active across various treatment sites including prostate, head and neck, lung, pancreas, CNS, and lymphoma.
  • Comparison between toxicity rates is highly favorable with protons thus far and necessitates further proof of principle.
  • This broad review provides recommendations for the continued development and expansion of particle therapy.

Requirements for the Development and Expansion of Particle Therapy

  • Specific short-term goals needed to increase accuracy and efficiency are:
    1. Better treatment planning systems beyond the first generation of treatment planning systems
    2. Faster and more reliable delivery systems that shorten treatment time and room utilization.
    3. Better solutions for improved target and organ tracking
    4. More robust and systematic quality assurance that reduce the amount of facility and beam time needed
    5. Overall process improvement to extend the benefits of particle therapy to a larger proportion of the population efficiently.
  • Role of Physicians:
    • Strive to provide high levels of evidence in at least one of three outcomes: survival, toxicity, cost.
    • Understand that the appropriate level of evidence may vary across treatment sites. For example, in the case of craniopharyngiomas, level 1 evidence may not be feasible or ethical. Similarly for lymphomas, level 1 may not be practical, requiring greater than 20 years to mature; thus level 2 evidence may suffice.
    • Perform comparative effectiveness studies once a new technology is well understood and appropriately applied to reduce the potential for erroneous conclusions.
  • Role of Biologists and Physicists:
    • To provide maximum knowledge to take full advantage of particle therapy.
  • Role of vendors:
    • Provide precise knowledge of technology and fully integrated systems, which are built to last, flexible, and upgradable.
    • Be competitive and collaborative, considering new alliances, not-for-profit strategies, and social responsibility.
  • Role of Policy Maker:
    • Understand that comparative cost analysis must be comprehensive and account for issues like recurrence, morbidity, hypofractionation, and social effectiveness.
    • Realize that cost will be driven down with increased effectiveness of treatment


  • Particle therapy represents a substantial step towards increased accuracy in the deposition of radiation in the target.
  • However, future technology development must organize itself around the entire spectrum of treatment planning, delivery and quality assurance to increase accuracy and efficiency.