An evidence based review of proton beam therapy: the report of ASTRO’s emerging technology committee. Radiother Oncol J Eur Soc Ther Radiol Oncol

Davidoff Center, Tel Aviv University, Petach Tikvah, Israel.
Radiotherapy and Oncology (Impact Factor: 4.36). 03/2012; 103(1):8-11. DOI: 10.1016/j.radonc.2012.02.001
Source: PubMed


Proton beam therapy (PBT) is a novel method for treating malignant disease with radiotherapy. The purpose of this work was to evaluate the state of the science of PBT and arrive at a recommendation for the use of PBT. The emerging technology committee of the American Society of Radiation Oncology (ASTRO) routinely evaluates new modalities in radiotherapy and assesses the published evidence to determine recommendations for the society as a whole. In 2007, a Proton Task Force was assembled to evaluate the state of the art of PBT. This report reflects evidence collected up to November 2009. Data was reviewed for PBT in central nervous system tumors, gastrointestinal malignancies, lung, head and neck, prostate, and pediatric tumors. Current data do not provide sufficient evidence to recommend PBT in lung cancer, head and neck cancer, GI malignancies, and pediatric non-CNS malignancies. In hepatocellular carcinoma and prostate cancer and there is evidence for the efficacy of PBT but no suggestion that it is superior to photon based approaches. In pediatric CNS malignancies PBT appears superior to photon approaches but more data is needed. In large ocular melanomas and chordomas, we believe that there is evidence for a benefit of PBT over photon approaches. PBT is an important new technology in radiotherapy. Current evidence provides a limited indication for PBT. More robust prospective clinical trials are needed to determine the appropriate clinical setting for PBT.

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    • "Currently, the available clinical and radiobiological data for particle irradiation are for most cases insufficient to exclusively base a treatment decision on them [6,7]. Instead, patient allocation that relies on patient-specific treatment plan comparison appears to be more robust [8] and is therefore the basis for our concept, which is explained in what follows. "
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    • "For men with low-risk features, BT costs are estimated to be $25,000, whereas IMRT costs $37,700. These authors emphasize that cost estimates were based on Medicare (government insurance) payment rates and did not include hospital costs [86]. Proton beam therapy has been advocated more recently for prostate cancer, but a clear benefit over IMRT photon therapy has yet to be demonstrated, and the costs are extraordinarily high [87]. "
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    • "Proton therapy has shown potential therapeutic benefit in treating adult malignancies in multiple other sites including the central nervous system and gastrointestinal tract (Allen et al., 2012). It is unclear if proton therapy offers superior outcomes in treatment of lung cancer (Grutters et al., 2010). "
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