Clinical Application of Proton Pencil Beam Scanning Radiotherapy in Cancer
A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".
Deadline for manuscript submissions: 28 February 2026 | Viewed by 17
Special Issue Editor
Interests: oncology in clinical practice; proton therapy; radiation oncology
Special Issues, Collections and Topics in MDPI journals
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Dear Colleagues,
Proton radiotherapy (PRT) has rapidly evolved as a method of radiation therapy within the last 15 years. The availability of PRT keeps increasing, the number of centers has more than doubled, and PRT has spread to almost all continents.
PRT requires substantial expenses; thus, crucial questions must be answered: “Do we need it?” Are there final clinical benefits justifying investments? From physical and radiobiological points of view, any benefit of PRT relates to dosimetric data in more favorable dose distributions. A more recent PRT administration technology—“pencil beam scanning” (PBS)—further improves dose distribution compared to older “scattering” methods. PBS achieves very accurate conformity and dose homogeneity at target volumes.
Comparing dose distribution plans, there is a clear advantage for PBS intensity-modulated PBT (PBS IMPT) compared to conventional photon radiotherapy. Anyway, a question remains regarding how far the dosimetric advantage translates into clinical results regarding efficacy and safety. It may be rather difficult to prove that the clinical results have indeed improved. Randomized clinical trials may be conducted in only a few diagnoses. In other diagnoses, randomization may not be ethical (pediatric cancer, some CNS tumors), and some diagnoses are too rare to conduct any comparative trial. In some diagnoses, there is little interest in conducting a randomized comparative trial despite high incidence (prostate cancer). Moreover, the method used may be rather simplified to derive the clinical benefit of dose distribution only. There are more physical and radiobiological factors impacting the final clinical benefit such as the robustness of plans, different RBEs in various parts of spread-out Bragg peaks, the influence of varying LETs, etc. More recently, an evolving body of information on crucial influence lymphocyte radiosensitivity and lymphocyte survival (also strongly related to dose distribution) on the final effect of PRT acting together with anti-tumor immunologic reaction has emerged.
PBS IMPT, which offers clinical benefits, is currently widely employed for a variety of diagnoses, and various clinical trials are ongoing. Finally, consistent data collection and evaluation of trials results may reveal the benefit of PBS IMPT. The number of publications on PBS IMPT keeps increasing together with the increasing availability of the technology. The summarized and rigorously analysed data, ready for publication, justifies the use of PBS IMPT in particular contexts.
Dr. Pavel Vítek
Guest Editor
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Keywords
- proton radiotherapy
- pencil beam scanning
- randomized trial
- dosimetry
- plan robustness
- LET—linear energy transfer
- RBE—radiobiologic equivalence
- lymphocyte
- immunologic reaction
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