Proton therapy

  • Widely used for pediatric tumors (to spare developing tissues).

  • CNS tumors, base of skull, and tumors near critical organs benefit from Bragg peak sparing.

Carbon ion therapy

  • Available in specialized centers (Japan, Germany, Italy).

  • Indicated for radioresistant tumors: sarcomas, salivary gland cancers, chordomas, melanomas.

Challenges

  • Cost and infrastructure: very high compared to photons.

  • RBE uncertainty: clinical RBE not always equal to 1.1 for protons.

  • Limited clinical trial evidence: still building data vs. IMRT/VMAT.

Future directions

  • FLASH RT: ultra-high dose rates may spare normal tissues while maintaining tumor kill.

  • Radiogenomics: tailoring modality to patient’s molecular radiosensitivity.

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