At Dana-Farber’s symposium, cancer care leaders examined the clinical experience, space requirements and workflows shaping upright proton therapy.
On Saturday, September 26, more than 180 clinicians, physicists and cancer center leaders gathered at Dana-Farber Cancer Institute around a practical question: how can upright proton therapy become part of everyday multidisciplinary cancer care?
Dana-Farber’s President and CEO, Dr. Benjamin Ebert, and its Chief Operating and Transformation Officer, Dr. William Hahn, opened the morning. Their remarks focused on bringing proton therapy into the cancer center as part of radiation oncology. In Boston, where new construction is extraordinarily expensive, the opportunity to integrate treatment into an existing department has particular significance.
Dr. Peter Orio, Dana-Farber’s Chair of Radiation Oncology, led “The Elephant in the Room: Pros and Cons of Upright Proton Therapy.” The morning followed four questions: “Can we?” “Should we?” “For whom?” and “How do we do it well?” Sessions examined evidence and access, facilities, pediatric care, disease-site applications and the experience of treating patients upright.
The opportunity and the evidence
A Dana-Farber presentation captured the space argument with “protons without a palace”: a LINAC-sized footprint, CT at the treatment position and a system without a gantry. The same presentation acknowledged the limitations, including less long-term outcome data and workflows that are still new. Both sides matter to centers evaluating a program.
Dr. Thomas Bortfeld emphasized access, fit and simplicity in his annotations on the published SWOT analysis of gantry-less upright radiotherapy by Dr. Underwood and colleagues (Int J Radiation Oncol Biol Phys, Vol. 122, No. 5, pp. 1337−1343, 2025). His conclusion expressed the opportunity that “The future of proton therapy may be gantry-less.”
The economics discussion focused on the potential for a smaller footprint, less construction and shielding, lower maintenance and a shorter build. Installing a compact unit within or near an existing department also offers the possibility of drawing on existing staff and resources.
Clinical experience gave those discussions a practical foundation. Northwestern Medicine reported 816 patients treated seated through the end of 2025. Stanford shared its first months of upright treatment, including its first pediatric patient, who completed treatment on June 11, 2026.
Building programs around care
Two panels brought the discussion to implementation: which patients come first, which disease sites lead and how teams train. Those questions connect the equipment decision to the work of building a clinical service.
A smaller system can make it easier to place proton therapy alongside the LINACs, imaging and multidisciplinary teams patients already rely on. Making that integration work also requires patient selection, established workflows and trained teams.
The transition to upright proton therapy is already underway. Stanford Medicine is now treating patients, providing real-world clinical experience with the technology. Dana-Farber has secured state approval for its program, while the University of Nebraska Medical Center is bringing proton therapy into an existing LINAC room. These programs reflect a broader shift from evaluating upright proton therapy as a future concept to deploying it as a practical clinical.
Thank you to the speakers and attendees who sustained the discussion through the final session. The symposium showed both the promise of upright proton therapy and the practical questions that deserve attention as programs develop.
If your center is considering its first proton program or additional capacity, talk with Mevion about how upright proton therapy could fit your facility and clinical plans.