Particle therapy (PT) offers the potential for reduced normal tissue damage as well as escalation of target dose, thereby enhancing the therapeutic ratio in radiation therapy. Reflecting the building momentum of PT use worldwide, construction has recently commenced for The Australian Bragg Centre for Proton Therapy and Research in Adelaidethe first PT centre in Australia. This systematic review aims to update the clinical evidence base for PT, both proton beam and carbon ion therapy. The purpose is to inform clinical decision-making for referral of patients to PT centres in Australia as they become operational and overseas in the interim. Three major databases were searched by two independent researchers, and evidence quality was classified according to the National Health and Medical Research Council evidence hierarchy. One hundred and thirty-six studies were included, two-thirds related to proton beam therapy alone. PT at the very least provides equivalent tumour outcomes compared to photon controls with the possibility of improved control in the case of carbon ion therapy. There is suggestion of reduced morbidities in a range of tumour sites, supporting the predictions from dosimetric modelling and the wide international acceptance of PT for specific indications based on this. Though promising, this needs to be counterbalanced by the overall low quality of evidence found, with 90% of studies of level IV (case series) evidence. Prospective comparative clinical trials, supplemented by database-derived outcome information, preferably conducted within international and national networks, are strongly recommended as PT is introduced into Australasia.

Owing to its physical properties, particle therapy (PT), including proton beam therapy (PBT) and carbon ion therapy (CIT), can enhance the therapeutic ratio in radiation therapy. The major factor driving PT implementation is the reduction in exit and integral dose compared to photon plans, which is expected to translate to reduced toxicity and improved quality of life. This study extends the findings from a recent systematic review by the current authors which concentrated on tumour outcomes for PT, to now examine toxicity as a separate focus. Together, these reviews provide a comprehensive collation of the evidence relating to PT outcomes in clinical practice. Three major databases were searched by two independent researchers, and evidence quality was classified according to the National Health and Medical Research Council evidence hierarchy. One hundred and seventy-nine studies were included. Most demonstrated acceptable and favourable toxicity results. Comparative evidence reported reduced morbidities and improvement in quality of life in head and neck, paediatrics, sarcomas, adult central nervous system, gastrointestinal, ocular and prostate cancers compared to photon radiotherapy. This suggestion for reduced morbidity must be counterbalanced by the overall low quality of evidence. A concerted effort in the design of appropriate comparative clinical trials is needed which takes into account integration of PT's pace of technological advancements, including evolving delivery techniques, image guidance availability and sophistication of planning algorithms.

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BackgroundThe Cambridgeshire Hospice at Home (H@H) service provides specialist community care for people approaching the end of their lives, enabling them to be cared for and to die at home if that is their wish. An independent evaluation is underway that is both shaping the evolving service and providing commissioners with detailed information needed to ensure continuing NHS funding.MethodsA multifaceted approach has employed:a) Detailed case-note review of all 450 patients referred to the service between January 2012 and August 2013, from referral through to post bereavement follow-up. Data includes each patient/family assessment, multidisciplinary visit, telephone call and night care episode, collated to capture the range of holistic care. Analysis is descriptive.b) Interviews with individuals clustered around 17 deceased patients, including bereaved carer, H@H staff member most involved in the case, the referring healthcare professional (HCP) and other professionals significantly involved. Carer interviews generate understanding of the patient and carer in their environment, background to the illness, care provided, service related issues and experience since the death. Interviews with H@H staff and HCPs address the experience of being a H@H Nurse, involvement with the patient, communication and service related issues. Analysis uses constant comparative methods.Results/findingsData collection is still underway and ends in October. Of the 207 deaths analysed to date, 166 (80.1%) died at home, 38 (18.8%) in hospice and 3 (1.4%) in hospital; 196 (94.7%) died in their preferred place. Description of the complete quantitative dataset will be presented, alongside analysis of the qualitative interviews (by group–carer/staff/other HCP and by cluster.