Deciding on Radiation : Photon or Proton?

@lilacs777
Just to add to your information, at Mayo, Proton is comparable in price to Photon, mostly because they have been able to build their units with donations. I know this because I had to fight with my insurance company to get them to pay for proton beam radiation of my left breast and under arm (I had three tumors and 6 lymph nodes involved). It was extremely frustrating and took a lot of time, but I got to know the guy who fights insurance companies that Mayo MN really well. So even having it whole breast radiation on the left does not guarantee coverage, even when the price is the same. Insanity. I stayed at the Hope Lodge and was not the only one fighting their company. UHC, Aetna, BCBS - all were major gatekeepers. I think there is or was a lawsuit against UHC for denying it so rigorously. I hope in couple years this will all be better when they have 10-year outcomes as evidence to support it as no longer “experimental”. Possibly the most frustrating part of my cancer journey.

To the OP I hope you have a carrier that will approve it without trouble. Some do after the first or second appeal so don’t let one rejection get you down. If you’re at Mayo MN, they have an amazing team that will do all they can to get you there.

@jardinera25 Even for photon, the “beam” is huge, like maybe 18” in diameter? Don’t quote me, but your team uses scans of your breast/arm/chest/area of concern, and uses beautiful mathematics to program little lead fingers that open or close the beam in 3D to focus where they want. The advantage is that Proton beam can be further programmed to stop where needed whereas Photon just kind of goes thru. I hope I did not butcher the description of it, but don’t think of a laser pointer size beam; think much larger and sculpted for you and you only. Your radiologist should be able to explain it better and even provide visuals of your plan. Very interesting medicine!

@delfinogn I meant to add - those little lead fingers move as the machine moves around you. Might be a different mechanism for Proton, as I lost my ticket for that one, sadly.

This article was in Medscape newsletter; it showed no appreciable difference in outcomes. However, Proton is more targeted and can possibly do less damage to surrounding organs. I went through Proton radiation because of the cancer location. They couldn't give me Photon without risking damage to my heart so I'm thankful I could do Proton: (See entire article in the comment below, as link is not opening correctly)
https://www.medscape.com/viewarticle/proton-vs-photon-rt-breast-cancer-which-better-2025a1000v0g

@beckyboston I see this isn't opening correctly so I will copy the article here:
Medscape Medical News
Conference News
ASTRO 2025

Proton vs Photon RT in Breast Cancer: Which Is Better?
M. Alexander Otto, PA, MMSc

November 10, 2025

0
149

Following similar results in prostate and throat cancer, a recent phase 3 trial found that proton radiotherapy (RT) failed to improve patient-reported outcomes over photon RT in women with breast cancer undergoing adjuvant radiation.

Overall, at 1- and 6-month follow-up, “there were no statistically nor clinically meaningful differences in the health-related quality of life” between photon and proton RT approaches in the RadComp trial, concluded Jose Bazan, MD, breast radiation oncologist at City of Hope National Medical Center outside Los Angeles, who discussed the findings at the American Society for Radiation Oncology (ASTRO) 2025 Annual Meeting.

Photon RT options, which included intensity-modulated RT (IMRT) and 3D conformal RT in the trial, use high-energy x-rays and are less expensive than proton RT. Although costlier, proton therapy offers greater precision: Proton beams can deposit most of their energy directly in the tumor, which can limit exposure to surrounding healthy tissue and critical organs.

Some recent studies, however, have suggested no meaningful difference in patient outcomes compared to photon therapy in other cancer types.

In localized prostate cancer, for instance, the phase 3 PARTiQol trial, reported at ASTRO 2024, found no advantage of protons over IMRT in terms of progression-free survival at 5 years or quality-of-life outcomes, including urinary, bowel, or sexual problems.

Another recent phase 3 trial, TORPEdO, found no benefit in symptom or cancer control at 1 year with protons vs IMRT in patients with oropharyngeal squamous cell carcinoma.

“Radiation oncologists have debated whether photon or proton therapy is the better choice for treating breast cancer,” principal investigator Shannon MacDonald, MD, medical director of at the Southwest Florida Proton Center in Estero, Florida, said in a press release. But “there has been little high-quality evidence to guide those decisions.”

In the current RadComp trial, researchers wanted to see whether proton RT might offer a quality-of-life advantage in breast cancer.

RadComp included 1239 women with nonmetastatic breast cancer undergoing nodal irradiation — including radiation of the internal mammary nodes — after surgery, which was mastectomy for most patients.

Patients were randomized to proton RT (n = 624) or photon RT (n = 615) at a dose of 45.0-50.4 Gy in 1.8-2.0 fractions with or without a tumor bed boost.

Several questionnaires administered at baseline, the end of treatment, and at 1- and 6-month follow-up assessed chest pain, fatigue, cosmetic satisfaction, and other metrics.

Overall, MacDonald and colleagues found no significant differences between the photon and proton groups. An early signal favoring protons for less shortness of breath lost significance after researchers corrected for the likelihood of a false-positive finding.

Cardiac and locoregional control outcomes — the trial’s primary outcomes — are pending and could take several years to report, MacDonald said.

Despite the results, RadComp did reveal that patient enthusiasm for the approach remains strong: Women treated with protons were far more likely to recommend proton therapy to others and chose it again for themselves.

At baseline in RadComp, many patients thought protons were superior to photons and would yield better outcomes, Bazan noted.

Because the trial was unblinded and patients knew when they were getting protons, the proton group’s enthusiasm likely reflects “perceptions about receiving a newer or more expensive treatment” rather than anything clinical, MacDonald said.

Overall, MacDonald concluded that “most patients could be treated with either modality and receive excellent care and have excellent long-term outcomes.”

Bazan had a different take, given the results: “X-rays should remain the predominant modality for regional lymph node irradiation” after surgery.

RadComp was funded by the Patient-Centered Outcomes Research Institute. MacDonald disclosed having commercial ties with ICOTEC and Ion Beam Associates. Bazan had no disclosures.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape Medical News. Alex is also an MIT Knight Science Journalism fellow.

Lymphnode, ear pain and tooth pain persist. Seeing Radiologist next week….

@beckyboston , the links works for me. Thanks for posting.