Estimating the Number of Patients Eligible for Carbon Ion Radiotherapy in the United States

Abstract

Purpose Carbon ion radiotherapy (CIRT) is an emerging radiotherapy modality with potential advantages over conventional photon-based therapy, including exhibiting a Bragg peak and greater relative biological effectiveness, leading to a higher degree of cell kill. Currently, 13 centers are treating with CIRT, although there are no centers in the United States. We aimed to estimate the number of patients eligible for a CIRT center in the United States. Materials and Methods Using the National Cancer Database, we analyzed the incidence of cancers frequently treated with CIRT internationally (glioblastoma, hepatocellular carcinoma, cholangiocarcinoma, locally advanced pancreatic cancer, non–small cell lung cancer, localized prostate cancer, soft tissue sarcomas, and specific head and neck cancers) diagnosed in the United States in 2015. The percentage and number of patients likely benefiting from CIRT was estimated with inclusion criteria from clinical trials and retrospective studies, and that ratio was applied to 2019 cancer statistics. An adaption correction rate was applied to estimate the potential number of patients treated with CIRT. Given the high dependency on prostate and lung cancers and the uncertain adoption of CIRT in those diseases, the data were then reanalyzed excluding those diagnoses. Results Of the 1 127 455 new cases of cancer diagnosed in the United States in 2015, there were 213 073 patients (18.9%) eligible for treatment with CIRT based on inclusion criteria. When applying this rate and the adaption correction rate to the 2019 incidence data, an estimated 89 946 patients (42.2% of those fitting inclusion criteria) are eligible for CIRT. Excluding prostate and lung cancers, there were an estimated 8922 patients (10% of those eligible for CIRT) eligible for CIRT. The number of patients eligible for CIRT is estimated to increase by 25% to 27.7% by 2025. Conclusion Our analysis suggests a need for CIRT in the United States in 2019, with the number of patients possibly eligible to receive CIRT expected to increase during the coming 5 to 10 years.

The rationale for a carbon ion radiation therapy facility in Australia

“…This is comparable to other international estimates, for Austria, France, Italy, Japan, South Korea and the USA, which range from 1% to 6% of newly diagnosed cancer patients. 84,116…”

“…On this basis, more recent estimates of the costs of a CIRT facility are approximately twice that of a PBT facility of the same size. 31,116,135,136,137 Regarding cost-effectiveness, various pre-2014 studies compare CIRT to XRT or PBT, [138][139][140][141] as summarised and compared in earlier articles. 54,136 The few more recent studies include, for example, CIRT versus Gamma-knife for skull base chordoma, 142 CIRT versus SBRT for stage 1 NSCLC 143 and a cost-based analysis of CIB-only, mixed CIB/PB and PB-only centres and treatments.…”

We are ready for clinical implementation of Carbon Ion Radiotherapy in the United States

“…For example, the use of helium ions for radiotherapy is currently an active area of investigation and may prove an ideal compromise between dosimetric characteristics, clinical efficacy, and cost 13 . There is a paucity of studies looking into how many patients are likely to benefit from the potential advantages of CIRT, although the group at the Mayo Clinic has started to address this question 14 . Practically, getting the limited number of patients who might benefit from CIRT to a limited number of CIRT centers is another challenge, particularly in non‐nationalized healthcare systems such as that in the United States.…”

The Mayo Clinic Florida microdosimetric kinetic model of clonogenic survival: formalism and first benchmark against in vitro and in silico data

“…Mayo Clinic Florida (MCF) is currently building an advanced cancer radiotherapy center in Jacksonville (Florida) which includes proton and (first-in-America) carbon ion clinical beams (Beltran et al 2020, Malouff et al 2020).…”