 Solution

A strongly moving lung target is a relative contraindication to a particular proton therapy plan if respiratory motion and changing air–tissue paths make robust target coverage and normal-tissue constraints unattainable. A changing water-equivalent path changes the particle range; pencil-beam scanning can also interact with respiratory motion. A photon radiotherapy plan may then offer more reliable coverage despite its greater exit dose. This is a conditional planning contraindication, not a blanket claim that lung cancer cannot be treated with protons: gating, breath-hold, rescanning and adaptive planning can change the decision. If a robust comparative plan shows no meaningful benefit, the additional cost and access burden also weigh against the proton plan.^[ref]