PM.20.023 – Proton therapy: less is more

Route: Personalised medicine: the individual at the centre

Cluster question: 094 How do we improve the quality of health care as much as possible while keeping it affordable?

Cancer radiation therapy is often associated with severe damage of surrounding healthy tissue and can even result in death. Proton therapy offers a safe alternative to standard photon-based radiation. With a lower radiation dose of positively charged particles, proton therapy effectively hits the tumour cells only. As a result, patients experience far less side effects and minor impact on their daily lives. Nevertheless, only some patients now benefit from proton therapy due to costs, limited clinical capacity and technological barriers. The solution for tackling these hurdles lies in the reduction of the number of radiation fractions. Hypofractionation will increase biological efficiency, decrease the overall radiation dose, reduce the patient journey length and associated costs, and contribute to healthcare sustainability. In this initiative, fundamental, technological and clinical scientists from the public and private sector will realize a paradigm shift in radiotherapy by the development and clinical validation and implementation of personalized hypofractionated proton therapy. Biological parameters such as DNA damage biomarkers and imaging-based tumour hallmarks will form the basis for the development of models that predict clinical efficacy and safety, allowing for the selection of the right patients for hypofractionated proton therapy. Technological advancements will include the uptake of the new FLASH technology, which delivers an ultra-high dose in a very short time frame, and translate this into clinical treatment plans. Combined with the biology-based prediction models, the hypofractionation protocols will be tested in Phase 2 trials for the current major tumour indications including breast, head and neck, lung, oesophageal cancer and lymphoma. Cost effectiveness of hypofractionated proton therapy will be established by health technology assessment integrated throughout the project. This initiative will deliver scientific and societal breakthroughs that are essential to give every eligible cancer patient in The Netherlands access to proton therapy.


Biomarker, cost-effectiveness, DNA damage, FLASH, hypofractionation, imaging, Oncology, Personalized, prediction, protons, radiation

Other organisations

Erasmus Medical Center (EMC), Erasmus Universiteit (EUR), HollandPTC, Leiden Universitair Medisch Centrum (LUMC)


Organisation TU Delft (TUD)
Name Prof. dr. M. van Vulpen