Current practice for selection of adult patients for proton therapy across Europe

Abstract

Purpose or Objective Among individual proton therapy (PT) centres and European countries, there are major differences regarding patient selection for PT. This is especially true for adult patients who would normally be treated with photon therapy but may benefit from the delivery of PT instead. To obtain insight in the current practice in Europe, we performed a survey on the different selection methods currently applied in the European PT centres. Materials and Methods We first designed electronic questionnaires for eight different tumour sites. The questionnaires consisted of multiple choice, checkbox and open questions regarding the application of PT for adult patients. We focused on four main topics including indications and patient selection methods and criteria, reimbursement, clinical and preclinical on-going or planned studies, and the average number of patients treated with PT per year. Results Links to the online questionnaires were sent to 23 European PT centers of which 19 (83%) participated. Major variability existed regarding the number of tumor types treated with PT (average: 4; range: 1-8) among the participating centres (Figure 1). All centers treated central nervous system tumours (CNS), while tumours of the head and neck cancer (HNC) were treated in 79% , lymphoma in 47%, gastrointestinal in 47%, breast in 32%, prostate in 26%, lung in 26% and gynecological cancers in 11 % of the centers. reimbursement issues (29%), technical limitations (20%), and lack of patient referral (13%). Interestingly, limited treatment capacity was the least reported factor (3%) for not treating a specific tumour type with PT Conclusion Across European PT centres, CNS tumours and HNC are the most frequently treated tumour types. Most centres use indication protocols. Interestingly, some countries are more conservative in the number of cancers treated with PT than others. Lack of evidence for PT and reimbursement issues are the most commonly reported reasons for not treating specific tumour types with PT rather than limited treatment capacity.