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Euan S. Thomson, PhD.


Proton therapy is a very accurate cancer treatment method delivered to selected cancer patients presenting with tumours for which a dose escalation or a reduced dose to the organs at risk is crucial. The treatment is particularly suitable for complex childhood cancers. It can also be used to treat cancers close to sensitive structures such as the brain, head, neck and spine, and for re-treatments. In practice, treatment planning for proton therapy is complex and requires a number of steps to achieve the desired dose distributions, including 4D-CT-based simulations in the case of moving targets.

Approximately 23,000 patientsi were treated in 2019 throughout 90 centres in 20 countries, for more than 30 indicationsii. This means that the learning curve in setting the best treatment plan for some of the less prevalent indications can be further improved as more patients get treated. Without a national or international strategy to coordinate unified treatment protocolsiii, patients treated with protons have been managed with several delivery modalities, treatment paradigms (pre- vs. postoperative proton therapy, radical proton therapy) and fractionation schemes. A key area for optimising the treatment planning process is therefore in gaining experience by encouraging all centres to share treatment plans with each other, retrospectively and in real time. Using tested and proven protocols, standards, policies and guidelines will enhance training and career development. The need for systematic comparisons of treatment plans will only increase as hypo-fractionated – and down the line, FLASH – treatment plans become a reality.

Advanced Oncotherapy is committed to the training of both physicians and engineers from an early stage. Lack of training has been a major hurdle in the commercial deployment of new technologies in selected geographies. To facilitate this process, Advanced Oncotherapy is working on treatment planning software to be hosted on the cloud. This is expected to facilitate data sharing, to enable second opinions, and to swiftly establish best standards for each sub-indication. This dataset can also be shared with academic institutions, for remote training purposes as well as for retrospective studies. International networks could help Advanced Oncotherapy in this effort to promote best practice in treatment plan data sharing between protons centres.

Advanced Oncotherapy’s cloud-based solution opens new horizons for telemedicine. The LIGHT system can be installed in remote locations, where skilled and experienced personnel is scarce. Advanced Oncotherapy’s central office and experienced users can share knowledge and provide training, and problem solving for developing centres. All these improvements are expected to further democratise proton therapy by giving patients in remote areas easier access to proton therapy.


This is only as much capacity as France would need if 10 to 15 % of irradiated adult patients were to be referred as currently recommended.

ii National Proton Beam Therapy Service Development Programme, Value for Money Addendum to Strategic Outline Case, October 2012

iii D.C. Weber, J.A. Langendijk, C. Grau, and J. Thariat, Proton therapy and the European Particle Therapy Network: The past, present and future, August 2020