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Like RT , the US is adopting the use of PT at a much quicker rate than Europe
Figure 33 : Manufacturers of operational PT systems
Source : goetzpartners Research , Company websites
Carbon ion therapy is still in its infancy PT is just one form of particle therapy . CIRT also provides an advantageous dose delivery over photons and are heavier still than protons thus can deliver a higher dose of radiation safely to the target tissue , resulting in an even higher RBE . CIRT is also thought to be able to target previously radioresistant cell types , such as those in hypoxia and S-phase due to the increased severity of DNA damage induced . CIRT is also predicted to stimulate an immune response by generating feasible epitopes , rather than kill traversing lymphocytes like photon and PT . Research is still in its infancy , with a focus on HNSCC and NSCLC , and only 20,000 people ever having been treated with CIRT . There is insufficient research to implement CIRT as a SoC technique , and the extremely high cost of systems prevents rapid progress in the field , hence why we predict PT to be adopted as standard before CIRT despite the additional benefits .
FLASH RT has potential to be an improved delivery method of both photon and PT
FLASH RT is on the horizon FLASH RT involves delivering an ultra-high , ultra-fast dose of radiation to a target site which has been shown to be superior to conventional RT in sparing normal tissue with non-inferior tumour cytotoxicity . The mechanism has not been fully elucidated ; however , it is hypothesised that FLASH induces rapid oxygen consumption , and the transient oxygen depletion is protective of normal tissue but not tumour tissue . FLASH is feasible with all types of radiation delivery , however not all current RT systems can achieve FLASH conditions . Preclinical studies point to many advantages of FLASH over conventional RT – a significantly wider therapeutic window ( damaging of tumour cells , but not normal tissue ), sparing of normal tissue function , and reduced inflammation and immune cell sparing . The latter could indicate an improved synergy with immunotherapy that has been hypothesised with conventional RT despite underwhelming clinical results thus far . Given the significantly reduced treatment time of FLASH ( milliseconds compared to minutes ), it would not only be more comfortable for patients , but could mitigate respiratory or tumour motion . Again , implementation of FLASH is limited by current technology and a lack of robust clinical study . Methods have been developed to upgrade existing LINACs to be capable of delivering FLASH-RT , however issues arise with some PT systems as the 3d volumetric scanning takes too long . PT system manufacturers such as IBA and Varian have however integrated FLASH capabilities into modern systems also allowing the possibility of further clinical research of FLASH , and eventually adoption of FLASH for treatment , in these centres .
Key
takeaways
PT will continue to be adopted slowly PT offers superior precision and clinical outcomes to classical RT thus we predict the trend of increased PT adoption . As companies continue to innovate methods of decreasing footprint for new PT systems , adoption of PT will continue to increase . IBA , Varian and Mevion continue to dominate the market as established players , as the high cost and slow adoption of systems make it extremely difficult for new companies to break into the market . Innovation within TPS specifically for PT systems will see a further increase in the precision and versatility of PT and we predict PT will overcome photon RT as the dominant radiation form in coming years .
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