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.

@delfinogn That sounds right about photon beam. I had it on a few of my spine mets and had a burn exactly matched on front and back of me and everything in-between. I didn't even know there was something that doesn't go right through, that would have been a nice option/alternative.

@dick61 I will have an appointment with a Proton Radiologist soon, to see if they could reach an "unresectable" tumor within my chest wall. It's a recurrence they say from my tumors 32 years ago in the right breast that I had a mastectomy & chemo 6 mo. for. Pretty surprising it could be growing all this time right below the old site, & not metastasizing. It has shrunk from its former size by 2/3 using 2 different AI's, but they gave me labile hypertension so had to go off them. Then tried Fulvestrant shots, but too many side effects too. So now I'm wondering if they could reach the rest of the tumor via Proton. Can it avoid bones like ribs, like go in between ribs? It's right next to the sternum. I guess I'll get answers from them, but wondered what you know? I'm 76 in Seattle with Fred Hutch Cancer Ctr/UW. Glad to hear of your great outcome!

J., The magic of proton radiation is the following: Protons flow from the gantry to the target. They pass harmlessly through bone, muscle and tissue until reaching the target (your tumor), and then release all of their energy! The protons do NOT flow beyond the target. They pass through ribs, etc., without doing harm. I had 20 treatments of proton radiation in 2018 for the treatment of prostate cancer (I have a bad gene!), and the protons passed through my hips, pelvis, etc., with no damage. The protons released all of their energy at my prostate and nowhere else.

Send me an email if you have other questions about my treatment or what you hopefully will have.

Dick

From: Richard Hark < dickhark@gmail.com>
Sent: Saturday, December 20, 2025 11:55 AM
To: Clinic Connect Mayo < nf+303f7d13+90507159@n1.hubapplication.com>
Subject: Re: @jardinera25 mentioned you in comment on Mayo Clinic Connect

I will bet that they can aim the flow of protons to the tumor and avoid damage just like my experience. Cancer is an evil and insidious disease. I wish you good luck and success! Proton radiation is the very best form! 🤞Dick