Trigger-based adaptive proton therapy improves coverage and cardiac sparing in esophageal cancer
Adaptive IMPT improved cumulative target coverage and reduced heart dose without increasing lung dose in a 192-patient retrospective cohort.
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Protons
Proton FLASH requires dedicated reassessment of shielding, activation and radiation safety
Five proton centres outline why conventional radiation protection workflows cannot simply be assumed adequate for ultra-high dose-rate FLASH research.
Proton STAR workflow proved technically feasible for refractory ventricular tachycardia
A preclinical proton STAR workflow achieved benchmark-level target coverage, OAR sparing and cardiac gating latency below 30 ms.
Four support needs may help children complete proton therapy without anaesthesia
Control, predictability, information and relational continuity emerged as key needs for making awake pediatric proton therapy more manageable.
Proton reirradiation achieved durable survival with limited severe toxicity in recurrent pediatric ependymoma
After proton reirradiation for recurrent pediatric ependymoma, 5-year survival was 64% with one grade 3 radiation injury and no grade 4+ toxicity.
Elevating skin markers simplified proton CT simulation without sacrificing geometric accuracy
A 1.5–3.0 mm foam elevation reduced marker contouring time by 30–37% while keeping average positional error near 1 mm.
Adaptive IMPT preserved gross tumor dose despite frequent ITV undercoverage in esophageal cancer
ITV underdosage occurred in 21% of distal esophageal IMPT patients, yet no GTV underdosage occurred and tumor response was unchanged.
Fractionation mitigated proton interplay for most free-breathing thoracic treatments
Interplay-related underdosage largely disappeared after five fractions, although two high-motion plans retained clinically relevant target deficits.
Comorbidity mattered more than chronological age after proton therapy for hepatocellular carcinoma
Age ≥75 did not independently predict outcomes after proton therapy for HCC, while CCI ≥3 was associated with more than threefold higher mortality.
Proton RBE rose sharply beyond the Bragg peak in pancreatic cancer cells
In two PDAC cell lines, measured proton RBE remained near 1.0 through the Bragg peak but rose as high as 6.1 distally.
Proton SBRT achieved 77% two-year local control in high-risk lung tumors
In a prospective proton registry enriched for ultracentral, large, and re-irradiated lung tumors, two-year local control was 77% with no grade ≥3 toxicity.
Pretrained deep-learning IMPT planning transferred across centres with comparable plan quality
After two days of local configuration, a pretrained model generated oropharyngeal IMPT plans with overall quality comparable to manual planning.
Hypofractionated proton re-irradiation remains promising but supported by limited evidence
Across 478 patients, hypofractionated proton re-irradiation showed encouraging site-specific outcomes, but heterogeneous retrospective evidence prevents firm conclusions on efficacy or safety.
Kidney proton SBRT needed a larger superior–inferior robustness margin
Kidney proton SBRT modeling supported 4-mm superior–inferior and 3-mm lateral/anterior–posterior positioning uncertainty with intrafraction repositioning.
Hemorrhagic colitis developed during proton therapy after intensive neuroblastoma treatment
A child developed hemorrhagic colitis after only 12.6 Gy(RBE), suggesting preceding intensive systemic therapy may increase bowel vulnerability.