The list of indications at PTC has been prepared based on therapeutic indications used for many years in foreign centers – especially at MD Anderson, University of Philadelphia, University of Florida, or MGH Boston. These centers have long-term extensive experience with proton therapy, and each of them also has state-of-the-art technology to perform photon radiotherapy. Most of the treated diagnoses are characterized by a high degree of curability and an effort to reduce the very late side effects of radiotherapy – such as meningiomas, nasopharyngeal tumors, malignant lymphomas, and paediatric tumors. Prostate cancer and breast cancer also belong to this category.
A smaller group consists of diagnoses where photon radiotherapy is either little effective (pancreatic cancer) or very toxic (tumors of the sinuses, esophageal cancer). Even in this group, protons are not the final choice but rather a chance to increase the probability of local disease control while maintaining a reasonable quality of life.
At PTC we treat the following diagnoses:
Indications for proton radiotherapy are still being intensively discussed in the community of radiation oncologists. There is currently no clear list of indications for proton radiotherapy. Each individual center treats the diagnoses according to their technology and the healthcare system in their country. It should be noted that with the exception of retinal malignant melanoma, where the benefit of proton radiotherapy has been confirmed, there are no randomized studies comparing the results of proton and photon radiotherapy. Some studies are ongoing (for example for prostate cancer or ENT tumors), others are unlikely to be initiated for ethical reasons (pediatric malignancies, malignant lymphomas). Proton radiotherapy does not currently have clearly defined indications.
There are also indications that are unsuitable for proton radiotherapy for technical reasons. This group includes all diagnoses where the reproducible position and shape of the organs in the irradiated area cannot be ensured. Examples are gastric cancer oe bladder cancer. Uterine and cervical tumors or rectal cancer also belong to this group, although in some centers these diagnoses can be treated. For some diagnoses, the benefit of proton therapy lies mainly in the reduction of the integral dose (total volume of irradiated tissue), not in the substantial reduction of doses to critical organs. Examples of such diagnoses are hypopharyngeal cancer or right breast cancer. Another possible limitation is the use of such precise radiotherapy without the possibility of accurately determining the required irradiated area (target volume). Despite the above pitfalls, there are a number of diagnoses where proton radiotherapy is feasible and provides a dosimetric advantage over IMRT.
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