Proton Therapy in Neurosurgery: A Historical Review and Future Perspective Based on Currently Available New Generation Systems

Purpose: To evaluate of Proton therapy (PT) for neurosurgery patients and is also to explain the need for this system in Iran.Methods: A literature review was conducted (1984–2016). The strategy included a combination of keywords including proton therapy, neck, neurosurgery, brain, head, tumor, spine, arteriovenous malformation (AVMs), cervical and spine in database of PubMed. New generation PT systems were assessed. Findings are summarized, with a focus on the application of PT in neurosurgery. Finally, the future of PT is discussed.Results: A total of 1329 citations were screened. In all, 60 articles were included. The synthesis of the data showed two applications of PT in neurosurgery, including: (a) the use in head disease such as AVMs, acromegaly, medulloblastoma, primitive neuroectodermal tumors, papillary tumors of the pineal region, low-grade astrocytoma, head and neck adenoid cystic carcinoma, meningioma, mesenchymal tumors, pediatric cranial tumors, squamous cell carcinoma of the head, craniospinal, and skull base chordomas and chondrosarcomas; (b) the apply in the spinal disease as chordoma or chondrosarcoma of the cervical, sacrum, thoracic and lumbar spine, ependymomas, tumor locations included cervical, thoracic, lumbar, S1-S2, and S3 or below. In addition, the combination of a gantry and cyclotron with new proton therapy systems, results in a lower cost.Conclusion: PT may be associated with better outcomes for selected patients with malignant diseases of the head and spine. The findings suggest that there exists a need for at least one center to treat the patient demand in Iran