A systematic review on the clinical implementation of 4D particle therapy
Abstract
Intrafractional motion in the thoracic and abdominal regions remains a major challenge in particle therapy representing one of the key anatomical changes during radiotherapy. Interfractional changes further contribute to cumulative uncertainties and may require adaptive strategies over the course of treatment. The high dose conformality and steep dose fall-off of particle beams, combined with motion-induced range variations, make dose delivery highly sensitive to temporal and anatomical changes. This systematic review provides an overview of clinically implemented 4D treatment approaches addressing intrafractional motion for thoracic and abdominal indications, aiming to support harmonisation of clinical practices across centres and vendors. Systematic searches in PubMed and Web of Science identified relevant publications from January 2020 to December 2025 covering the full 4D workflow in particle therapy. The focus was on clinical implementation for lung, pancreas, liver, lymphoma, oesophagus, and breast, complemented by phantom studies and ongoing research activities. Publications were screened by eight experts using predefined inclusion and exclusion criteria. Writing and synthesis were conducted by a multidisciplinary panel of eighteen experts. A total of 751 publications were identified, of which 231 were included and categorised into six key subtopics: motion management, imaging, treatment planning optimisation and evaluation, clinical indications, phantom studies, and…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Preliminary Toxicity Analysis of 3DCRT versus IMRT on the High Dose Arm of the RTOG 0126 Prostate Cancer Trial
- Adaptive Radiotherapy for Head and Neck Cancer: Initial Clinical Outcomes from a Prospective Trial
- American Association of Physicists in Medicine Task Group 263: Standardizing Nomenclatures in Radiation Oncology
- Motion Management Strategies and Technical Issues Associated with Stereotactic Body Radiotherapy of Thoracic and Upper Abdominal Tumors: A Review from NRG Oncology
- High-dose-rate interstitial brachytherapy as a monotherapy for localized prostate cancer: treatment description and preliminary results of a phase I/II clinical trial
- Highly efficient training, refinement, and validation of a knowledge-based plan quality control system for radiotherapy clinical trials
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.