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    Estimating the percentage of patients who might benefit from proton beam therapy instead of X-ray radiotherapy

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    Authors
    Burnet, Neil G
    Mee, Thomas
    Gaito, Simona
    Kirkby, Norman
    Aitkenhead, Adam H
    Anandadas, Carmel N
    Aznar, Marianne Camille
    Barraclough, Lisa H
    Borst, G.
    Charlwood, Frances C
    Clarke, M.
    Colaco, Rovel J
    Crellin, A. M.
    Defourney, N. N.
    Hague, Christina
    Harris, Maggie A
    Henthorn, Nicholas T
    Hopkins, K. I.
    Hwang, E.
    Ingram, Samuel
    Kirkby, Karen J
    Lee, Lip W
    Lines, D.
    Lingard, Zoe
    Lowe, Mathew
    Mackay, Ranald I
    McBain, Catherine A
    Merchant, Michael J
    Noble, D. J.
    Pan, Shermaine
    Price, James M
    Radhakrishna, Ganesh
    Reboredo-Gil, D.
    Salem, Ahmed
    Sashidharan, S.
    Sitch, Peter
    Smith, Ed
    Smith, Edward A K
    Taylor, Michael J
    Thomson, David J
    Thorp, Nicola
    Underwood, Tracy S A
    Warmenhoven, John W
    Wylie, James P
    Whitfield, Gillian A
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    Affiliation
    The Christie NHS Foundation Trust, Manchester, United Kingdom. Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, Manchester, United Kingdom. Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, United Kingdom. NHS England National Clinical Lead Proton Beam Therapy, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom. International Atomic Energy Agency, Vienna International Centre, Vienna, Austria. Department of Radiation Oncology, Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia and Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia. Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom. Proton Clinical Outcomes Unit, The Christie NHS Foundation Trust, Manchester, United Kingdom.
    Issue Date
    2022
    
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    Abstract
    Objectives: High energy Proton Beam Therapy (PBT) commenced in England in 2018 and NHS England commissions PBT for 1.5% of patients receiving radical radiotherapy. We sought expert opinion on the level of provision. Methods: Invitations were sent to 41 colleagues working in PBT, most at one UK centre, to contribute by completing a spreadsheet. 39 responded: 23 (59%) completed the spreadsheet; 16 (41%) declined, arguing that clinical outcome data are lacking, but joined six additional site-specialist oncologists for two consensus meetings. The spreadsheet was pre-populated with incidence data from Cancer Research UK and radiotherapy use data from the National Cancer Registration and Analysis Service. ‘Mechanisms of Benefit’ of reduced growth impairment, reduced toxicity, dose escalation and reduced second cancer risk were examined. Results: The most reliable figure for percentage of radical radiotherapy patients likely to benefit from PBT was that agreed by 95% of the 23 respondents at 4.3%, slightly larger than current provision. The median was 15% (range 4–92%); consensus median 13%. The biggest estimated potential benefit was from reducing toxicity, median benefit to 15% (range 4–92%), followed by dose escalation median 3% (range 0 to 47%); consensus values were 12 and 3%. Reduced growth impairment and reduced second cancer risk were calculated to benefit 0.5 and 0.1%. Conclusions: The most secure estimate of percentage benefit was 4.3% but insufficient clinical outcome data exist for confident estimates. The study supports the NHS approach of using the evidence base, and developing it through randomised trials, non-randomised studies and outcomes tracking. Advances in knowledge: Less is known about the percentage of patients who may benefit from PBT than is generally acknowledged. Expert opinion varies widely. Insufficient clinical outcome data exists to provide robust estimates. Considerable further work is needed to address this, including international collaboration; much is already underway but will take time to provide mature data.
    Citation
    Burnet N, Mee T, Gaito S, Kirkby NF, Aitkenhead AH, Anandadas CN, et al. Estimating the percentage of patients who might benefit from proton beam therapy instead of X-ray radiotherapy [Internet]. The British Journal of Radiology. British Institute of Radiology; 2022.
    Journal
    British Journal of Radiology
    URI
    http://hdl.handle.net/10541/625109
    DOI
    10.1259/bjr.20211175
    PubMed ID
    35220723
    Additional Links
    https://dx.doi.org/10.1259/bjr.20211175
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1259/bjr.20211175
    Scopus Count
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