What does a proton have that a photon does not? Implications for the pediatric patient

Abstract

Introduction. Improved survival in childhood cancer requires attempting to minimize treatment-related sequelae. Radiotherapy plays a key role in the treatment of many pediatric tumors, although the irradiation of growing tissues can trigger significant adverse effects.

Body. Protons deposit most of their energy at the end of their path, with a sharp dose fall-off known as Bragg peak. This dose distribution allows, in selected cases, a reduction in the irradiation of healthy tissues compared to conventional radiotherapy, which is of relevance in young patients. Available evidence supports its utility in these patients due to its efficacy in tumor control and the reduction of acute and late radiation effects. However, its acquisition and delivery requires dedicated infrastructure and specialized multidisciplinary teams. In Spain, the implementation of eleven facilities within the Public Health System will dramatically increase access to the technique. The creation of a National Proton Therapy Registry will generate prospective data on clinical outcomes and late effects.

Conclusions. Proton therapy offers dosimetric advantages that are particularly relevant in the pediatric population. The expansion of the public network and the multicenter registry represent opportunities to enhance equitable access and evaluate its long-term clinical benefit in our population.