Proton beam therapy indications in the Kingdom of Saudi Arabia

ABSTRACT Objectives: To update the national guidelines for proton therapy to reflect the evolving literature. The Saudi Particle Therapy Centre is making efforts to establish proton therapy services in the Kingdom of Saudi Arabia. Methods: The Saudi Particle Therapy Center collaborated with the Saudi Association of Radiation Oncology to formulate a panel of radiation oncologists with proton therapy experience to refine and update our previous publication. The recommendation level was based on the overall evidence using a 4-grade scale following the World Health Organization quality of evidence recommendations. These updates focus on summarizing the literature and the level of recommendation for each disease site. The Panel identified key clinical questions to ensure that the guidelines were evidence-based, followed by a comprehensive literature review of PubMed, EMBASE, and other academic databases. Results: The Panel reported that the body of evidence favored proton therapy for specific indications, including ocular tumors, skull and spine tumors, oropharyngeal cancer, hepatocellular carcinoma, specific genetic syndromes and mutations, pediatric rhabdomyosarcoma, pediatric central nervous system malignancies, tumors of the paranasal sinuses/nasal cavity, and for re-irradiation of all sites when curative treatment was intended. In addition, proton therapy may be considered at other sites when photon therapy exceeds the acceptable dose constraints for critical structures. Conclusion: The Panel did not recommend the routine use of proton therapy for all cancers. Each case should be assessed individually following a multidisciplinary review and expert consultation while accounting for financial, logistical, and patient-specific factors.

• Publication year

  2025

• Venue

  Saudi Medical Journal

• Publication date

  2025-11-01

• Fields of study

  Medicine, Physics

• Identifiers
  DOI 10.15537/smj.2025.46.11.20250572PMID 41224339PMCID 12625664
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Phase III randomized trial of intensity-modulated proton therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for the treatment of head and neck oropharyngeal carcinoma (OPC).

  2024cited by this paper
• Prostate Advanced Radiation Technologies Investigating Quality of Life (PARTIQoL): Phase III Randomized Clinical Trial of Proton Therapy vs. IMRT for Localized Prostate Cancer

  2024cited by this paper
• Reirradiation With Proton Therapy for Recurrent Malignancies of the Esophagus and Gastroesophageal Junction: Results of the Proton Collaborative Group Multi-Institutional Prospective Registry Trial

  2024cited by this paper
• A Retrospective Comparison of Acute Toxicities in Patients Receiving Pelvic Radiation for Newly Diagnosed Gynecologic Primaries with Intensity Modulated Proton Therapy and Volume Modulated Arc Therapy

  2024cited by this paper
• Comparative Evaluation of Proton Therapy and Volumetric Modulated Arc Therapy for Brachial Plexus Sparing in the Comprehensive Reirradiation of High-Risk Recurrent Breast Cancer

  2023influential reference
• Proton Beam Therapy in Breast Cancer Patients: The UK PARABLE Trial is Recruiting.

  2023cited by this paper
• Proton beam radiotherapy versus transarterial chemoembolization for hepatocellular carcinoma: Results of a randomized clinical trial

  2023influential reference
• Evaluation of Proton Therapy Reirradiation for Patients With Recurrent Head and Neck Squamous Cell Carcinoma

  2023influential reference
• Treatment tolerability and toxicity of postoperative proton beam therapy for gynecological malignancies - results of the prospective phase II APROVE-trial.

  2023cited by this paper
• Treatment of Thymoma and Thymic Carcinoma with Proton Beam Therapy: Outcomes from the Proton Collaborative Group Prospective Registry.

  2023cited by this paper
• NRG/RTOG 1112: Randomized Phase III Study of Sorafenib vs. Stereotactic Body Radiation Therapy (SBRT) Followed by Sorafenib in Hepatocellular Carcinoma (HCC) (NCT01730937)

  2022cited by this paper
• Comparison of 3D Conformal Proton Therapy, Intensity-Modulated Proton Therapy, and Intensity-Modulated Photon Therapy for Retroperitoneal Sarcoma

  2022cited by this paper
• Evidence Brief: Proton Beam Therapy for Treatment of Localized Prostate Cancer

  2022cited by this paper
• Reirradiation with Proton Therapy for Recurrent Malignancies of the Esophagus and Gastroesophageal Junction: Results of the Proton Collaborative Group Multi-Institutional Prospective Registry Trial

  2022cited by this paper
• Second tumor risk in children treated with proton therapy

  2021cited by this paper
• Decade Long Disease, Secondary Malignancy, and Brainstem Injury Outcomes in Pediatric and Young Adult Medulloblastoma Patients Treated with Proton Radiotherapy.

  2021cited by this paper
• PROTECT: Prospective Phase-II-Trial Evaluating Adaptive Proton Therapy for Cervical Cancer to Reduce the Impact on Morbidity and the Immune System

  2021cited by this paper
• Comparison of hypothyroidism, growth hormone deficiency, and adrenal insufficiency following proton and photon radiotherapy in children with medulloblastoma

  2021cited by this paper
• Multi-institutional Comparison of Intensity Modulated Photon Versus Proton Radiation Therapy in the Management of Squamous Cell Carcinoma of the Anus

  2021cited by this paper
• Proton beam therapy in rectal cancer: A systematic review and meta-analysis.

  2021cited by this paper
• Human Radiosensitivity and Radiosusceptibility: What Are the Differences?

  2021cited by this paper
• Selection of Mediastinal Lymphoma Patients for Proton Therapy Within the Proton Collaborative Group Registry

  2021cited by this paper
• Intensity-modulated proton therapy for oropharyngeal cancer reduces rates of late xerostomia.

  2021cited by this paper
• Selection criteria for early breast cancer patients in the DBCG proton trial – The randomised phase III trial strategy

  2021cited by this paper
• Proton Therapy for Pediatric Ependymoma: Mature Results from a Bicentric Study.

  2021cited by this paper
• Dosimetric analysis and normal tissue complication probability modeling of Child-Pugh score and Albumin-Bilirubin grade increase after hepatic irradiation.

  2020cited by this paper
• A Multi-institutional Comparative Analysis of Proton and Photon Therapy-Induced Hematologic Toxicity in Patients With Medulloblastoma.

  2020cited by this paper
• Prospective Assessment of Proton Therapy for Malignant Pleural Mesothelioma

  2020cited by this paper
• Reirradiation for Rectal Cancer Using Pencil Beam Scanning Proton Therapy: A Single Institutional Experience

  2020cited by this paper
• Proton beam radiotherapy vs. radiofrequency ablation for recurrent hepatocellular carcinoma: a randomized phase trial.

  2020cited by this paper
• Overall Survival After Treatment of Localized Prostate Cancer With Proton Beam Therapy, External-Beam Photon Therapy, or Brachytherapy

  2020cited by this paper
• Proton Accelerated Partial Breast Irradiation: Clinical Outcomes at a Planned Interim Analysis of a Prospective Phase II Trial.

  2020cited by this paper
• Proton versus photon radiotherapy for primary hepatocellular carcinoma: a propensity-matched analysis

  2020cited by this paper
• Clinical Trial of Proton Craniospinal Irradiation for Leptomeningeal Metastases.

  2020cited by this paper
• Initial clinical outcomes for prostate cancer patients undergoing adjuvant or salvage proton therapy after radical prostatectomy

  2020cited by this paper
• Second cancer risk after primary cancer treatment with three‐dimensional conformal, intensity‐modulated, or proton beam radiation therapy

  2020cited by this paper
• Management of Hereditary Breast Cancer: ASCO, ASTRO, and SSO Guideline

  2020cited by this paper
• Proton and carbon ions radiotherapy in skull base chordomas: a prospective study based on a dual particle and a patient-customized treatment strategy.

  2020cited by this paper
• Randomized Phase IIB Trial of Proton Beam Therapy Versus Intensity-Modulated Radiation Therapy for Locally Advanced Esophageal Cancer.

  2020cited by this paper
• Outcomes and toxicities of definitive radiotherapy and reirradiation using 3‐dimensional conformal or intensity‐modulated (pencil beam) proton therapy for patients with nasal cavity and paranasal sinus malignancies

  2020cited by this paper
• Evaluation of plan quality and robustness of IMPT and helical IMRT for cervical cancer

  2020cited by this paper
• Outcomes following Proton Therapy for Group III Pelvic Rhabdomyosarcoma.

  2020cited by this paper
• Toxicity after radiotherapy in patients with historically accepted contraindications to treatment (CONTRAD): An international systematic review and meta-analysis.

  2019cited by this paper
• Predictors of Radiation-Induced Liver Disease in Eastern and Western Patients With Hepatocellular Carcinoma Undergoing Proton Beam Therapy.

  2019cited by this paper
• Comparative Effectiveness of Proton vs Photon Therapy as Part of Concurrent Chemoradiotherapy for Locally Advanced Cancer.

  2019cited by this paper
• Superior Intellectual Outcomes After Proton Radiotherapy Compared With Photon Radiotherapy for Pediatric Medulloblastoma.

  2019cited by this paper
• Pragmatic randomised clinical trial of proton versus photon therapy for patients with non-metastatic breast cancer: the Radiotherapy Comparative Effectiveness (RadComp) Consortium trial protocol

  2019cited by this paper
• Individual Radiosensitivity in Oncological Patients: Linking Adverse Normal Tissue Reactions and Genetic Features

  2019cited by this paper
• Reduced Acute Toxicity after Proton Versus Photon Chemoradiation for Anal Cancer: Outcomes from the Proton Collaborative Group REG001-09 Trial

  2019cited by this paper
• Lower doses to hippocampi and other brain structures for skull-base meningiomas with intensity modulated proton therapy compared to photon therapy.

  2019cited by this paper
• Phase II Study of Proton Beam Radiation Therapy for Patients With Breast Cancer Requiring Regional Nodal Irradiation.

  2019cited by this paper
• A Multi-Institutional Experience of Proton Beam Therapy for Sinonasal Tumors

  2019cited by this paper
• Prostate bed irradiation with alternative radio-oncological approaches (PAROS) - a prospective, multicenter and randomized phase III trial

  2019cited by this paper
• Clinical Intensity Modulated Proton Therapy for Hodgkin Lymphoma: Which Patients Benefit the Most?

  2019cited by this paper
• Protons versus Photons for Unresectable Hepatocellular Carcinoma: Liver Decompensation and Overall Survival.

  2019influential reference
• Proton Therapy for Locally Advanced Oropharyngeal Cancer: Initial Clinical Experience at the University of Washington.

  2019cited by this paper
• Long-term outcomes and late adverse effects of a prospective study on proton radiotherapy for patients with low-grade glioma.

  2019cited by this paper
• Concurrent chemoradiotherapy using proton beams for unresectable locally advanced pancreatic cancer.

  2019influential reference
• Outcomes Following Proton Therapy for Pediatric Low-Grade Glioma.

  2019cited by this paper
• Endocrine Deficiency As a Function of Radiation Dose to the Hypothalamus and Pituitary in Pediatric and Young Adult Patients With Brain Tumors.

  2018cited by this paper
• Bayesian Adaptive Randomization Trial of Passive Scattering Proton Therapy and Intensity-Modulated Photon Radiotherapy for Locally Advanced Non-Small-Cell Lung Cancer.

  2018cited by this paper
• Long term outcome of skull-base chondrosarcoma patients treated with high-dose proton therapy with or without conventional radiation therapy.

  2018influential reference
• Initial experience with intensity modulated proton therapy for intact, clinically localized pancreas cancer: Clinical implementation, dosimetric analysis, acute treatment-related adverse events, and patient-reported outcomes

  2018influential reference
• Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC

  2018cited by this paper
• Proton therapy for low-grade gliomas in adults: A systematic review.

  2018cited by this paper
• Proton Therapy Reduces Normal Tissue Dose in Extended-Field Pelvic Radiation for Endometrial Cancer.

  2018cited by this paper
• Long-Term Outcomes of Radiation Therapy (RT) in the Management of Malignant Peripheral Nerve Sheath Tumors (MPNST) in Patients with Neurofibromatosis Type 1 (NF1)

  2018cited by this paper
• Proton Stereotactic Radiosurgery for Brain Metastases: A Single-Institution Analysis of 370 Patients.

  2018cited by this paper
• Proton therapy for adults with mediastinal lymphomas: the International Lymphoma Radiation Oncology Group guidelines.

  2018cited by this paper
• Proton beam reirradiation for locally recurrent pancreatic adenocarcinoma.

  2017cited by this paper
• A prospective study of proton reirradiation for recurrent and secondary soft tissue sarcoma.

  2017cited by this paper
• Consolidative proton therapy after chemotherapy for patients with Hodgkin lymphoma

  2017cited by this paper
• Evidence-based Review on the Use of Proton Therapy in Lymphoma From the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee.

  2017cited by this paper
• Comparative Outcomes After Definitive Chemoradiotherapy Using Proton Beam Therapy Versus Intensity Modulated Radiation Therapy for Esophageal Cancer: A Retrospective, Single-Institutional Analysis.

  2017influential reference
• Multi‐Institutional Prospective Study of Reirradiation with Proton Beam Radiotherapy for Locoregionally Recurrent Non–Small Cell Lung Cancer

  2017cited by this paper
• Outcomes and patterns of care in a nationwide cohort of pediatric medulloblastoma: Factors affecting proton therapy utilization

  2017cited by this paper
• Proton pencil beam scanning for mediastinal lymphoma: treatment planning and robustness assessment

  2016cited by this paper
• Helical tomotherapy and volumetric modulated arc therapy: New therapeutic arms in the breast cancer radiotherapy.

  2016cited by this paper
• Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy

  2016cited by this paper
• Intensity-modulated proton beam therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for patients with oropharynx cancer - A case matched analysis.

  2016cited by this paper
• Long-term toxic effects of proton radiotherapy for paediatric medulloblastoma: a phase 2 single-arm study.

  2016cited by this paper
• Postoperative Intensity-Modulated Proton Therapy for Head and Neck Adenoid Cystic Carcinoma.

  2016cited by this paper
• Reirradiation of Head and Neck Cancers With Proton Therapy: Outcomes and Analyses.

  2016cited by this paper
• Proton Therapy for Vaginal Reirradiation.

  2016cited by this paper
• Initial Report of Pencil Beam Scanning Proton Therapy for Posthysterectomy Patients With Gynecologic Cancer.

  2016cited by this paper
• Endocrine outcomes with proton and photon radiotherapy for standard risk medulloblastoma.

  2016influential reference
• Long-Term Breast Cancer Patient Outcomes After Adjuvant Radiotherapy Using Intensity-Modulated Radiotherapy or Conventional Tangential Radiotherapy

  2016cited by this paper
• Proton Beam Reirradiation for Recurrent Head and Neck Cancer: Multi-institutional Report on Feasibility and Early Outcomes.

  2016cited by this paper
• Tumour control and Quality of Life in children with rhabdomyosarcoma treated with pencil beam scanning proton therapy.

  2016cited by this paper
• Prospective Study of Patient-Reported Symptom Burden in Patients With Non-Small-Cell Lung Cancer Undergoing Proton or Photon Chemoradiation Therapy.

  2016cited by this paper
• Long-term outcomes and prognostic factors of skull-base chondrosarcoma patients treated with pencil-beam scanning proton therapy at the Paul Scherrer Institute.

  2016cited by this paper
• Comparing Intelligence Quotient Change After Treatment With Proton Versus Photon Radiation Therapy for Pediatric Brain Tumors.

  2016cited by this paper
• Proton beam therapy for pediatric ependymoma

  2015cited by this paper
• Revisiting Li-Fraumeni Syndrome From TP53 Mutation Carriers.

  2015cited by this paper
• Ionizing radiation, inflammation, and their interactions in colon carcinogenesis in Mlh1-deficient mice

  2015cited by this paper
• High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors.

  2015cited by this paper
• Proton therapy for atypical meningiomas

  2015cited by this paper
• Proton therapy for low‐grade gliomas: Results from a prospective trial

  2015cited by this paper
• Long-term Results of the UCSF-LBNL Randomized Trial: Charged Particle With Helium Ion Versus Iodine-125 Plaque Therapy for Choroidal and Ciliary Body Melanoma.

  2015cited by this paper
• Late toxicity of proton beam therapy for patients with the nasal cavity, para-nasal sinuses, or involving the skull base malignancy: importance of long-term follow-up

  2015influential reference

• No citing papers are available for this paper.