Onkologie. 2015:9(4):175-177

Proton radiotherapy of colorectal cancer-options and expectations

Pavel Vítek

Proton Therapy Center Czech, s.r.o., Praha

Proton radiotherapy differs from conventional photon one (gamma radiation) in dose distribution in tissues, not in mechanisms of effect.

The advantage of proton radiation consists in dosimetry only. Indications of proton radiotherapy are warranted in diagnoses principally

indicated to radiotherapy simultaneously with some potential advantage resulting of dosimetry. In field of colorectal cancer only preoperative

radiotherapy may be a subject of proton therapy considerations. The indications of radiotherapy for rectal cancer are based

on data proving survival benefit and decreased risk of local relapse as well as data proving the advantage of preoperative setting and

chemotherapy potentiation. Together with a continuously increasing quality of total mesorectal excision, growing evidence of acute and

chronic toxicity of radiotherapy and increasing quality of radiotherapy itself substantial questions occur. They concern indication area

of radiotherapy in context of toxicity and long term effect of radiotherapy if a complete regression was achieved and surgery deferred.

Moreover a documented toxicity/effect relationship desires to take a chance of toxicity reduction and eventually dose escalation, both

provided by proton radiation. The initial proton radiotherapy models in rectal cancer are more than 20 years old. Within the last 4 years

the next ones have been published, proving the advantage of advanced technologies of proton administration. A clinical application is

still missing. However the recent advances in both radiotherapy and surgery indications strongly support proton radiotherapy.

Keywords: proton radiotherapy, rectal cancer, preoperative chemoradiotherapy, complete regression

Published: September 18, 2015  Show citation