Previous advances in radiation oncology were adopted based on their ability to reduce harmful radiation to normal tissue, and proton therapy offers the greatest leap forward in a long line of advances. But given the trend toward greater cost containment in health care today, the radiation-sparing benefits of proton therapy will need to be quantified through clinical research.

Proton centers are now opening at an accelerating rate, with five centers expected to open in the U.S. in 2016. The critical mass for collaborative research in the proton realm is mounting and the investigative momentum is building, especially with some of the nation's most highly respected research institutions involved, such as Mayo Clinic, Massachusetts General Hospital and the University of Texas MD Anderson Cancer Center.


This is further underscored by the American Society for Radiation Oncology devoting a special edition to this topic in the May 2016 issue of its official journal, International Journal of Radiation Oncology, Biology, Physics. An editorial in the journal proclaimed proton research to be at a "tipping point," where better evidence could make access to the therapy more widespread.

Here's a look at some of key current and recent research studies in the field of proton therapy, and how their results could help reshape the quality of care delivered to cancer patients, both in the short term and over the long haul.

Breast cancer

A randomized trial starting this year will enroll approximately 2,000 women with locally advanced breast cancer to receive either proton or X-ray therapy. The goal is to assess the effectiveness of protons compared to X-rays in reducing major cardiovascular events in patients 10 years after their radiation treatments. A 2013 report in the New England Journal of Medicine found that women who received X-ray therapy to their left breast had a higher risk of major heart disease, which was directly linked to the dose and volume of heart that was irradiated during treatment. Scripps Health and clinical partner UC San Diego Health System plan to participate in this national, multi-institutional study, led by the Perelman School of Medicine at the University of Pennsylvania.

Lung cancer

This recently launched clinical trial will compare the overall survival of patients with inoperable non-small cell lung cancer. More than 500 patients will be randomized to receive either proton or X-ray therapy, both given with concurrent chemotherapy. A recently published study showed that escalating the X-ray radiation dose to treat lung cancer – which provides a better chance to control the tumor – was linked to an increased incidence of heart disease and cardiac death because of unwanted radiation exposure to the nearby heart. This multicenter trial aims to determine if the use of proton therapy will result in improved survival time.

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