Particle therapy is rapidly evolving beyond highly conformal dose delivery toward biologically informed, image-guided, and patient-specific treatment strategies.

Selected preclinical and translational advances presented at the 64th Annual Meeting of the Particle Therapy Co-Operative Group (PTCOG 64) are reported with emphasis on their potential impact and expected timeline for clinical implementation.

Recent developments span accelerator technologies, treatment delivery, dosimetry, imaging, radiobiology, and predictive modeling. Near-term innovations include compact accelerator concepts, software-driven treatment acceleration, photon-counting computed tomography, prompt-gamma range verification, linear energy transfer-aware quality assurance, and uncertainty-aware normal tissue complication probability models for proton therapy selection. Emerging approaches such as optically stimulated luminescence detectors, nanodroplet ultrasound imaging, radioactive and mixed-ion beams, and mechanistic digital twins expand capabilities for biological dosimetry, adaptive imaging, and prediction of late toxicity events. Carbon-ion research is simultaneously progressing toward biologically optimized treatment through advances in immunoradiobiology, flash irradiation, predictive biomarkers, functional imaging, and multi-ion optimization. Quantum technologies represent a longer-term perspective for imaging, dosimetry, and treatment planning.

Particle therapy is transitioning from a dose-centered discipline to an integrated framework combining advanced imaging, radiation quality, biological modeling, and patient-specific decision support. Several technologies are sufficiently mature for near-term clinical translation, with digital twins, biologically optimized multi-ion therapy, and quantum-enabled systems represent innovations likely to shape the next generation of precision particle therapy and guide future priorities within the RadioTransNet network.