Absorption characteristics of protons and photons in tissue.
This presentation reviews the radiation quality of protons and other energetic ion beams, where radiation quality refers to those relevant physical properties other than the dose of the different types of radiations that can contribute to differences in the absorption characteristics in various tissues and the corresponding clinical outcomes. Prior to initiation of clinical trials with protons, neutrons, pions, and heavy ions, it was generally believed that such particles might have a therapeutic advantage resulting from their greater relative biological effectiveness (RBE). Potential clinical advantages resulting from a greater biological effectiveness, however, have generally been overshadowed during the last three decades by improved controls or reduced complications resulting primarily from the better dose delivery and localization that was possible with these heavier particles in conjunction with improved imaging. The successes both in delivery and in the clinical responses with protons and other light ions resulting from improved dose localization have arguably led the way in stereotactic radiosurgery, intensity modulated radiation therapy, and tomotherapy, stimulating improved methods with conventional radiations as well. Protons or light ions differ significantly in comparison with photon or electron beams in how they interact with the tissue atoms and molecules, and in how they transfer energy to those tissues. Microscopically, the heavier particles tend to travel in straight lines and produce long tracks with the energy concentrated closer to the track of the primary particle, while photons or electrons tend to scatter more easily and produce a more uniform distribution of energy transfers. Because they are hadrons, i.e., nuclear particles, protons and ions are more likely to produce long-range nuclear secondaries with higher masses. This higher concentration of energy associated with the heavier particle beams and the more massive secondaries results in differences in dose localization, clinically and microscopically, and therefore potential differences in short-term and long-term chemical and biological processes. Protons tend to have the least differences in clinical response in comparison with photons and electrons, the radiations used conventionally in therapy, but biological differences have been observed for these particles; it behooves us, therefore, to understand these different mechanisms if we are to take full advantage of their benefits. This article reviews the physical properties of these different particles in terms of microdosimetric distributions of energy deposition in order to compare protons with photons and heavy ions.