Session in Memory of Robert J. Schulz-Bragging Rights and Bragg Peaks: Who Really Wins the Proton vs Photon Debate?
Description
Clinical evidence generally suggests proton therapy can reduce treatment-related toxicity, especially in tumors near critical structures such as the brain, spinal cord, heart. This benefit is well established in pediatric cancers, where reducing radiation exposure minimizes long-term developmental and secondary malignancy risks. In head-and-neck, skull base, and thoracic malignancies, protons can achieve comparable tumor control while potentially lower rates of xerostomia, dysphagia, and cardiopulmonary complications compared with photons. However, large, randomized trials directly comparing proton vs. intensity-modulated photon therapy (IMRT) remain limited. Moreover, recent clinical trials for lung and prostate cancers have shown equivocal outcomes for protons relative to photons. Challenges include higher cost, limited availability, and technical issues, such as range uncertainties with protons being more sensitive to tissue density and motion compared with photons. We propose a debate to tackle the various clinical and technical successes and challenges related to photons and protons. We will engage four prominent experts (2 physicists and 2 physicians) in the field of photon and proton-based radiotherapy who will argue for each modality and predict which will become a mainstay treatment in the future of cancer care.