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Protons cost more than shaped X-ray beams. They are worth it when the extra punch where the beam stops, and the missing exit dose, widen the gap between killing the tumour and harming late-reacting tissue: an alpha/beta and RBE question, not a machine question.
Adult proton versus photon randomised trials have mixed toxicity results and scarce survival differences. Plans are still reported at a constant RBE of 1.1. The biological reason protons could win is site-specific: a low-alpha/beta tumour next to a low-alpha/beta late organ, plus high linear energy transfer at a distal edge that can be kept inside the target and off the organ. That predicted window should be written down before the trial reads out. The coverage-with-evidence idea asks payers to fund the trials; this idea asks the trials to test the radiobiology, not only the machine.
Shares Bragg peak, PARTIQoL, Relative biological effectiveness (RBE), Linear energy transfer (LET) and the tag radiation-wave5.
Shares Bragg peak, Pencil-beam scanning and intensity-modulated proton therapy, Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH, Proton therapy.
Shares Relative biological effectiveness (RBE), Linear energy transfer (LET), Carbon-ion therapy.
Shares Carbon-ion therapy, Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH, Proton therapy, IMRT / IGRT (modern external beam).
Shares Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH, Surgery and radiotherapy cure most, get least, IMRT / IGRT (modern external beam), HR-positive / HER2-negative breast cancer.
Shares Biologically effective dose (BED) and EQD2, The linear-quadratic model and fractionation, IMRT / IGRT (modern external beam).
Shares Pooled coverage-with-evidence for proton therapy across all centres, Carbon-ion therapy, Proton therapy.
Shares Relative biological effectiveness (RBE), Linear energy transfer (LET).