Indications for proton therapy

In which tumors is treatment with proton therapy indicated?

The treatment of choice for the following cancers, according to the recommendations of the Spanish Society for Radiation Oncology:

• Tumors near or at the base of the skull, including chondromas and chondrosarcomas.
• Primary lymphoma of the central nervous system or metastatic tumors in the spinal cord.
• Ocular tumors (ocular melanoma* and others).
• Pediatric tumors, requiring a radiotherapy component.
• Patients with genetic syndromes with high risk of toxicity.
• Reirradiation, in selected cases.

The American Society of Radiation Oncology also recommends funding proton therapy in “demonstrable evidence or development” categories.

Treatment (best available evidence) is considered for:

• Ocular tumors, including intraocular melanomas*.
• Tumors located at the base of the skull, including, but not limited to, the following:
  • Chordoma.
  • Chondrosarcomas.
• Primary or metastatic tumors of the spine where spinal cord tolerance may exceed conventional treatment or where the spinal cord has been subject to radiation treatments in the past.
• Hepatocellular cancer.
• Primary or benign solid tumors in children treated with an intent to cure the disease, and occasionally in palliative care when at least one of the four criteria above is applied.
• Patients with genetic syndromes of hypersensitivity to radiation and patients with retinoblastoma.
• Primary malignant and benign tumors of the central nervous system.
• Advanced and/or unresectable head and neck cancers.
• Cancers of the paranasal sinuses and other accessory sinuses.
• Nonmetastatic retroperitoneal sarcomas.
• Reirradiation cases (where the cumulative critical structure dose would exceed the tolerance dose).

Considered recommended treatment (evidence in development) for the following cancers:

• Non-T4 and resectable head and neck cancers.
• Thoracic malignancies, including primary nonmetastatic lung and esophageal cancers and mediastinal lymphomas.
• Abdominal malignancies, including primary nonmetastatic pancreatic, biliary and adrenal cancers.
• Pelvic neoplasms, including nonmetastatic rectal, anal, bladder and cervical cancers.
• Nonmetastatic prostate cancer.
• Breast cancer.
• Prostate cancer.

* In development