Proton therapy is rapidly expanding in patient care throughout the world. Once limited to a few centers of care, continued process improvements in the scope and design of proton facilities have now permitted proton centers to develop at an enterprise level in multiple geographic centers.

This is important for all aspects of patient care in both adult and pediatric patients. Although initially felt to be limited to a selected number of disease sites, proton therapy, such as stereotactic radiosurgery, can be easily applied to all disease sites.

Intensity-modulated proton therapy is now delivered on a routine basis, as proton centers now have tools used by photon systems to deliver care. Coupled with the integration of image guidance, proton centers now can deliver therapy with the ease of photon centers with the distinct advantage of additional sparing of normal tissue.

The trajectory of proton care is significant; however, there remains much to be learned about proton care as we review and compare outcomes. This addresses several key issues that will help us further refine proton care in the future.

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