Proton Facility Economics: The Importance of “Simple” Treatments

Johnstone, Peter A.S.; Kerstiens, John; Helsper, Richard S.

doi:10.1016/j.jacr.2012.03.014

Cited by 33 publications

(25 citation statements)

References 2 publications

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“…Clinical research opportunities are wide in order to determine which patients will gain the most benefit from proton beam considering also the economic implications of using PBT for common sites [98] . The expected decrease of side effects and improvement of quality of life should be confirmed in more studies even though some reports are already confirming this hypothesis [99][100][101] . More developments are waited also in the administration of concurrent radiation-sensitizing chemotherapy where improved hematologic tolerance may allow dose intensification [102] and of biologically targeted agents.…”

Section: Future Directionsmentioning

confidence: 79%

The actual Interest in Radiotherapy for the Utilization of Proton Beam, Highlighting Physics Basis, Technology and Common Clinical Indications

Amichetti

2016

Journal of Tumor

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. Since that years, commercial entities began to build cyclotrons and synchrotrons for clinical purposes. Over the last 10 years, PBT has gathered more interest in the scientific community and more media and patient attention and is now flourishing in the US and abroad. As of December, 2015, 57 proton therapy centers are in operation worldwide, others are under construction and many more in a planning phase [3] . Most patients who have been treated with heavy-particle therapy were treated with protons: PTCOG (Particle Therapy Co-Operative Group) reports that between 1954 and 2014, 137 000 patients globally received part or all of their radiation therapy with particles, and in particular 86% of them with protons [4] . The generation of these particles and the building of dedicated centers, however, requires large investments and operational costs and big infrastructure. Only relatively few studies have demonstrated the effectiveness of proton therapy and the effects are surrounded with uncertainty [5] being the cost-effectiveness still the core of the controversy around the use of PBT. ABSTRACTManaging expensive technology is a debated issue in modern radiation oncology. Proton beam therapy (PBT) represents, considering its cost and its foreseen benefits, a typical case of discussion waiting for more robust results demonstrating the presumable clinical gains against the available radiation therapy (XRT) treatment alternatives based on the use of photons. The treatment with particles utilizes many different beams (neutrons, protons, pions, or helium, neon, argon, and carbon ions) that represent a distinct entity respect conventional XRT which uses photons. PBT is the most common form of heavy-particle radiation therapy used so far; it is not a new invention, being its clinical use proposed in a seminal article by R. Wilson in 1946 [1] and the first patients treated in 1954 at the Lawrence Berkeley National Laboratory in California [2] . Since cyclotron or synchrotron, used to accelerate protons to therapeutic energies, were used primarily for research in particle or nuclear physics, the initial clinical activity in proton therapy was carried out in research facilities and the use of protons in clinical practice has grown slowly for several years in non-clinical setting. More than fifty years later, after a long period of seminal work in a limited number of Institutions, PBT has gained public attention in recent years because of the rapidly increasing number of centers around the world, regardless of their high cost. Hospital-based proton beam facilities have been in operation since 1990 after the opening of the first dedicated clinical center at Loma Linda Medical

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Section: Future Directionsmentioning

confidence: 79%

The actual Interest in Radiotherapy for the Utilization of Proton Beam, Highlighting Physics Basis, Technology and Common Clinical Indications

Amichetti

2016

Journal of Tumor

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“…However, according to the American Cancer Society (ACS) report (25), prostate, breast and lung are the major US cancer sites with only 1% pediatric patients. Future proton centers that aspire to a pediatric focus should evaluate the data thoroughly before proton facility planning with consideration of financial impact (13,26). It is prudent thus to evaluate national, regional and insurance data for case mix utilization before planning a proton center.…”

Section: Discussionmentioning

confidence: 99%

“…It is expected that superior dose distributions will translate into better treatment outcomes treated with proton beam for certain disease sites (2-7). However, the huge capital requirement in PBT is a major obstacle for its wide use (8)(9)(10)(11)(12) and its survival depends on the patient population and the pattern of reimbursement (13) The major cost of facility includes real estate, a cyclotron/ synchrotron and beam line that are energy dependent, number of treatment gantries, associated shielding, manpower, power supply and patient specific devices (compensators and apertures) both for passive scattering systems and uniform scanning beams. Consideration should be given to a future proton center with option of pencil beam scanning and treatment approaches that might reduce number of beams, gantry angles and beam energy.…”

Section: Introductionmentioning

confidence: 99%

Proton Therapy Facility Planning From a Clinical and Operational Model

Das

Moskvin

Zhao

et al. 2014

Technol Cancer Res Treat

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This paper provides a model for planning a new proton therapy center based on clinical data, referral pattern, beam utilization and technical considerations. The patient-specific data for the depth of targets from skin in each beam angle were reviewed at our center providing megavoltage photon external beam and proton beam therapy respectively.Further, data on insurance providers, disease sites, treatment depths, snout size and the beam angle utilization from the patients treated at our proton facility were collected and analyzed for their utilization and their impact on the facility cost. The most common disease sites treated at our center are head and neck, brain, sarcoma and pediatric malignancies. From this analysis, it is shown that the tumor depth from skin surface has a bimodal distribution (peak at 12 and 26 cm) that has significant impact on the maximum

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“…Ultimately, there is a void in data and discrepancy in money to appropriately validate the use of protons in terms of their efficacy in cancer therapy. 8,9 But perhaps the future question will be the following: as the United States potentially declines from its superpower status, can we as a nation afford to support protons at the current economic levels? Are the health outcomes supported in the academic literature?…”

Section: Economic Factorsmentioning

confidence: 99%

The Future of Medical Dosimetry

Adams

2015

Medical Dosimetry

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Proton Facility Economics: The Importance of “Simple” Treatments

Cited by 33 publications

References 2 publications

The actual Interest in Radiotherapy for the Utilization of Proton Beam, Highlighting Physics Basis, Technology and Common Clinical Indications

The actual Interest in Radiotherapy for the Utilization of Proton Beam, Highlighting Physics Basis, Technology and Common Clinical Indications

Proton Therapy Facility Planning From a Clinical and Operational Model

The Future of Medical Dosimetry

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