Ethical reflections on proton radiotherapy

Proton therapy is one of the current major advances in radiation cancer radiation treatment. Its comparison, even with most refined radiotherapy techniques with X-rays, shows in many advantages, due to better physical distribution of protons in human tissues, both in terms of higher tumor dose and normal tissue sparing. A full demonstration of proton therapy advantages after formal randomized trials should be considered mandatory in the oncological community, from an ethical point of view, before its widespread use on patients. This could lead to a risk of a substantial delay while waiting for the results of trials results, the exploitation, on a large scale, of the rapidly increasing progress and dissemination of proton therapy delivery technology. This also could be considered unethical in terms of delaying expected benefits to cancer patients. A possible solution to this dilemma is to apply other methods to assure safety and ethics in patient selection for proton therapy instead of X-rays radiation therapy. The adopt and trial method coupled to a Model-Based and Knowledge-Based approach to compare a dose distribution plan using protons or X-rays may satisfy ethical requirements and avoid any delay in the wider application of proton therapy to cancer patients.