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The biological effectiveness of proton beams relative to photon beams in radiation therapy has been taken to be 1.1 throughout the history of proton therapy. While potentially appropriate as an average value, actual relative biological effectiveness (RBE) values may differ. This Task Group report outlines the basic concepts of RBE as well as the biophysical interpretation and mathematical concepts. The current knowledge on RBE variations is reviewed and discussed in the context of the current clinical use of RBE and the clinical relevance of RBE variations (with respect to physical as well as biological parameters).

The following task group aims were designed to guide the current clinical practice:

1. Assess whether the current clinical practice of using a constant RBE for protons should be revised or maintained.
2. Identifying sites and treatment strategies where variable RBE might be utilized for a clinical benefit.
3. Assess …