Postoperative proton therapy in uterine and cervical cancer: promising evidence but remaining questions
Lars Wessel and Nathalie Arians
The article reviews the potential role of proton therapy in the postoperative treatment of uterine and cervical cancers. Adjuvant pelvic radiotherapy is commonly used after surgery in patients with high-risk gynecological cancers to reduce recurrence. However, conventional photon radiotherapy can expose nearby organs such as the bowel, bladder, rectum, and bone marrow to significant radiation doses, leading to acute and long-term toxicities. The article evaluates whether proton therapy can improve the therapeutic ratio by reducing unnecessary radiation exposure while maintaining effective tumor control.
The development section discusses the physical advantages of proton therapy, particularly the Bragg peak effect, which allows radiation dose deposition to be concentrated within the target while minimizing exit dose to surrounding healthy tissues. Dosimetric studies reviewed in the article consistently demonstrated lower radiation doses to organs at risk with proton therapy compared with photon-based techniques such as IMRT. Clinical evidence, although still limited, suggested reductions in gastrointestinal, genitourinary, and hematologic toxicities. The article also highlights the possible benefits of proton therapy in preserving bone marrow function, which may be especially important for patients receiving concurrent chemotherapy. In addition, proton therapy may reduce treatment-related fatigue and improve quality of life.
In conclusion, the article states that postoperative proton therapy for uterine and cervical cancer shows encouraging potential to decrease treatment toxicity without compromising disease control. Nevertheless, important questions remain regarding patient selection, long-term outcomes, cost-effectiveness, and accessibility. The authors emphasize the need for prospective randomized clinical trials to confirm the clinical advantages suggested by early dosimetric and observational studies before proton therapy can become a standard postoperative treatment option in gynecologic oncology.
Published by Translational Cancer Research (TCR
