Proton or Photon Radiation?

Published on February 25, 2020


Many people with locally advanced cancers are treated with a combination of chemotherapy and either photon or proton radiation. For patients getting chemotherapy and radiation at the same time, finding ways to limit side effects without making the treatment less effective is a high priority.

A type of radiation treatment called proton beam radiation therapy may be safer than and just as effective as photon radiation therapy for adults with advanced cancer. That finding comes from a study that used existing patient data to compare the two types of radiation.

Photon radiation delivers x-rays, or beams of photons, to the tumor and beyond it. This can damage nearby healthy tissues and can cause significant side effects.

By contrast, proton therapy delivers a beam of proton particles that stops at the tumor, so it’s less likely to damage nearby healthy tissues. Some experts believe that proton therapy is safer than photon radiation, but there is limited research comparing the two treatments.

About the Study

Nearly 1,500 patients with 11 different types of cancer participated in the study. Almost 400 had received proton therapy and the rest received photon radiation.


  • In the study, patients treated with proton therapy were much less likely to experience severe side effects than patients treated with photon radiation therapy. There was no difference in how long the patients lived, however. The results were published December 26 in JAMA Oncology.
  • Those who received proton therapy experienced far fewer serious side effects than those who received photon radiation. Within 90 days of starting treatment, 45 patients (12%) in the proton therapy group and 301 patients (28%) in the photon radiation group experienced a severe side effect and hospitalized.
  • In addition, proton therapy didn’t affect people’s abilities to perform routine activities like housework as much as photon radiation. Over the course of treatment, daily capabilities were half as likely to decline for patients treated with proton therapy as for those who received photon radiation.
  • 56% of people who received proton therapy and 58% of those who received photon radiation were still alive after 3 years.

Limitations of the Study

  • It was a single institution study which makes it difficult to generalize the findings.
  • Patients were not randomly assigned to treatment groups. Patients who received proton therapy were, on average, older and had more health issues.
  • In addition, fewer people with head and neck cancer—who are more likely to suffer from radiation-associated side effects—were included in the proton therapy group.

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