Caution: proton therapy vs IMRT
Protons stop inside the tumour; modern X-ray beams (IMRT) still exit through healthy tissue. That physical difference only matters if it changes cure or late harm enough to justify the cost, which randomised adult trials have not settled.
Overview
IMRT and pencil-beam protons can both shape high dose around a target. Protons remove the exit dose and raise linear energy transfer at the Bragg peak; IMRT is cheaper, more widely available, and has a larger randomised evidence base. Adult comparisons are mixed: some oesophageal data favour protons on toxicity; prostate and breast trials (PARTIQoL, RADCOMP) are the tests of whether late-tissue alpha/beta plus variable RBE produce a real window. Paediatric cases and re-irradiation near critical organs remain the clearest established uses. Do not treat proton as automatically better than IMRT.
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