Auditory Toxicity after Parotid Irradiation

The potential clinical advantages of charged particle radiotherapy using protons or light ions

The increasing use of charged particle radiotherapy (CPT) in many countries will require British oncologists to establish their personal viewpoints on this subject in order to advise their patients regarding the merits or otherwise of obtaining such treatment abroad. This paper covers the advantages and some disadvantages of CPT in many anatomical locations on the basis of the achievable dose distributions as a consequence of the Bragg peak effect. The advantages in terms of normal tissue effects should follow the reduction of tissue volumes exposed to low/moderate dose: significant reductions in acute tissue effects are expected and experienced. For late reacting tissues, the predicted benefits are in the reduction of chronic low-grade symptoms and so improving the quality of life. For tumour control, dose escalation beyond what is achievable with X-ray therapy is possible only for some tumour types. Also, some tumours not presently treated by X-rays can be treated by CPT instead of radical surgery. Many of the available publications about CPT are at 'proof of principle' stage, as the treatment technique continues to be optimised: this is a similar situation to mega-voltage radiotherapy around 50 years ago. Oncologists in the UK need to familiarise themselves with CPT dose distributions, continually educate themselves by following the results of clinical studies as these emerge with time and hopefully visit CPT centres for direct experience.