US-UK collaboration in proton therapy: The Proton Overseas Program
Gaito, Simona Hwang, E. Burnet, Neil G Foden, P. Howells, C. Pan, Shermaine Whitfield, Gillian A Crellin, A. Smith, Ed
Gaito, Simona
Hwang, E.
Burnet, Neil G
Foden, P.
Howells, C.
Pan, Shermaine
Whitfield, Gillian A
Crellin, A.
Smith, Ed
Citations
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Abstract
Purpose/Objective(s): In 2008 the National Health Service (NHS) in the
United Kingdom (UK) started the Proton Overseas Program (POP). This
enabled and still enables eligible UK patients to access high energy Proton
Beam Therapy (PBT) overseas, a large majority of which were sent to the
United States (US), preceding the opening of the first NHS England PBT
center in late 2018. More than 10 years since its inception, we report the
long-term outcomes on patient groups who have accessed this program and
were treated in the US proton centers.
Materials/Methods: Between 2008 and 2018, 1102 patients with indications
eligible for PBT (adhering to approved criteria) were treated in
the US. The majority of these were managed at the University of Florida
Proton Therapy Institute, Jacksonville, although significant numbers have
also been treated at Procure Oklahoma. All cases were of sufficient performance
status to travel and were appropriately staged. Patient, tumor,
treatment and follow-up data were collated in a centralized database. In
light of the establishment of the NHS England PBT centers, the Proton
Clinical Outcomes Unit (PCOU) has been simultaneously initiated and
developed to systematically monitor this patient cohort as well as standardize
and improve prospective outcome data collection for UK PBT
patients going forward. Systematic follow-up data was available for 878
patients (79.7% of those treated in the US). Analysis has been conducted
on the subgroups <25 vs 25 years old (y).
Results: After a median follow-up of 34 months (range 6-105), the Local
Control (LC) rate for the entire cohort was 81%; by age (<25 y vs 25 y) LC rates were 82.1% for the younger group vs 74.8% for the older group.
For tumors of the central nervous system (CNS), the LC rate was 80%
(81.6% < 25 y vs 74.4% 25 y). For tumors outside the CNS (referred to
as ‘body’ tumors), the LC rate was 82.6% (82.8% in <25 y vs 78.6% in
25 y). The data show that LC was highest for craniopharyngioma
(90.3%) in the CNS subgroup and for Adult type Sarcomas (85.7%) in the
body subgroup. Table 1 illustrates the 1- and 5-years survival estimates
(95% Confidence Intervals) for the main subgroups.
Conclusion: The outcome of patients treated through the POP compares
favorably with that reported in the literature (1). The POP has been successful
in facilitating equitable access to PBT abroad for patients with
complex needs from across the UK without disadvantaging patient outcomes.
It is arguably the largest national PBT access program, drawing
equitably from a whole population, with treatment, transport abroad and
accommodation funded by the NHS, and has enabled collaborative ties and
a strengthening of network between the UK and the US.
Affiliation
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Gaito S, Hwang E, Burnet NG, Foden P, Howells C, Pan S, et al. US-UK collaboration in proton therapy: The Proton Overseas Program. International Journal of Radiation Oncology Biology Physics. 2020;108(3):E405-E