Proton therapy of cancer: Potential clinical advantages and cost-effectiveness

Lundkvist, Jonas; Ekman, Mattias; Ericsson, Suzanne Rehn; Jönsson, Bengt; Glimelius, Bengt

doi:10.1080/02841860500341157

Cited by 145 publications

(123 citation statements)

References 82 publications

(48 reference statements)

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“…However, the detailed assumptions of a cost-effectiveness estimation -in the absence of precise differential cost-effectiveness data from a randomized phase III trial with individual patientlevel cost data -will critically affect the conclusions and a number of similar exercises have come out favorably for proton therapy [44][45][46]. Some debaters have argued that as long as there is an under-provision of (photon) radiation therapy in many countries [47], large investments in proton facilities should be put on hold.…”

Section: Health Economics and Technology Assessmentmentioning

confidence: 99%

Randomized controlled trials in health technology assessment: Overkill or overdue?

Bentzen

2008

Radiotherapy and Oncology

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Evidence-based medicine has become a cornerstone in the development of radiation oncology and the randomized controlled phase III trial remains the gold standard for assessing differential benefits in clinical outcome between therapies. Health technologies aimed at improving treatment quality should primarily be tested using process measures or operational characteristics, the reason being that the sensitivity and specificity of clinical outcome is low for detecting quality improvements. The ongoing discussion of the relative merits of intensity modulated photon vs. proton radiotherapy is used to illustrate these concepts. Concerns over clinical and individual equipoise as well as the potential limitations of health economics considerations in this setting are also discussed. Working in a technology and science based medical discipline, radiation oncology researchers need to further develop methodology for critical assessment of health technologies as a complement to randomized controlled trials."Only two options exist. The first is that we accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions. The second is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial." Evidence-based medicine and randomized controlled trialsEvidence-based medicine is a compelling paradigm as a rational road-map, some would argue the only rational road-map, for improving the standard of health care [2,3]. The role of randomized controlled trials in this context cannot be overstated: while the allocation to different treatment options may be skewed even in a specific randomized trial, randomization is the only method that on average safe-guards against prognostic imbalances that could bias therapy effect estimates. History shows, that even when there has been overwhelming support for a novel therapeutic intervention in terms of a well-proven mechanism of action, promising pre-clinical and early clinical data as well as wide-spread consensus regarding an expected benefit among the experts, the cold-hearted scrutiny of a,

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Section: Health Economics and Technology Assessmentmentioning

confidence: 99%

Randomized controlled trials in health technology assessment: Overkill or overdue?

Bentzen

2008

Radiotherapy and Oncology

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“…Proton therapy is more expensive than X-ray radiation therapy 62 by a factor of 1.5-3 with respect to a similar accessory set-up with X-rays. 63,64 This broad range is a function of several factors including the number of patients treated per year, the number of treatment rooms and the number of gantries.…”

Section: Cost-effectivenessmentioning

confidence: 99%

“…68 Based on a series of assumptions (including direct reduced mortality through dose escalation and reduced side effects) proton therapy was deemed cost-effective in prostate cancer patients with longer life expectancy and poorer prognostic factors. 62 In this assessment, however, it was arbitrarily assumed that proton therapy could achieve a 20% reduction in mortality through dose escalation with respect to conventional photon irradiation, neglecting the current evidence that dose escalation to unprecedented dose levels can now be safely accomplished by IMRT. The assumption that an improvement in QOL through reduced treatment-related toxicity can be achieved by proton therapy is still unsubstantiated by valid clinical data.…”

Section: Cost-effectivenessmentioning

confidence: 99%

Particle therapy in prostate cancer: a review

Greco

2007

Prostate Cancer Prostatic Dis

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While dose escalation is proving important to achieve satisfactory long-term outcomes in prostate cancer, the optimal radiation modality to deliver the treatment is still a topic of debate. Charged particle beams can offer improved dose distributions to the target volume as compared to conventional 3D-conformal radiotherapy, with better sparing of surrounding healthy tissues. Exquisite dose distributions, with the fulfillment of dose-volume constraints to normal tissues, however, can also be achieved with photon-based intensity-modulated techniques. This review summarizes the literature on the use of particle therapy in prostate cancer and attempts to put in perspective its relative merits compared to current photon-based radiotherapy.

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“…The cost-effectiveness of proton beam therapy for H&N cancer has been estimated in a special study [59]. A 65-year-old man with hypopharyngeal cancer has been treated with state-of-the-art protons or with photons/electrons.…”

Section: Cost-benefit Estimatementioning

confidence: 99%