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<p>The integration of positron emission tomography (PET) with proton therapy represents a key step toward biologically guided precision radiotherapy. PET provides metabolic and molecular information beyond conventional anatomical imaging, enabling improved target delineation and identification of radioresistant subvolumes. These biological insights complement the favorable dose distribution of proton therapy, supporting selective dose escalation or de-escalation strategies. Emerging clinical and planning studies demonstrate the feasibility and potential clinical impact of PET-guided adaptive proton therapy across multiple tumor sites. Together, these advances pave the way for a personalized radiotherapy paradigm driven by tumor biology rather than anatomy alone.</p>

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Proton therapy and Positron Emission Tomography (PET): towards a new era of biologically-guided advanced radiotherapy

  • 期刊论文

  • 发表日期：

    2026年3月5日

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  • Ciro Franzese,
  • Morten Hoyer,
  • Johannes A. Langendijk,
  • Marta Scorsetti

摘要

The integration of positron emission tomography (PET) with proton therapy represents a key step toward biologically guided precision radiotherapy. PET provides metabolic and molecular information beyond conventional anatomical imaging, enabling improved target delineation and identification of radioresistant subvolumes. These biological insights complement the favorable dose distribution of proton therapy, supporting selective dose escalation or de-escalation strategies. Emerging clinical and planning studies demonstrate the feasibility and potential clinical impact of PET-guided adaptive proton therapy across multiple tumor sites. Together, these advances pave the way for a personalized radiotherapy paradigm driven by tumor biology rather than anatomy alone.