Three discipline collaborative radiation therapy (3DCRT) special debate: The United States needs at least one carbon ion facility

Abstract

Three discipline collaborative radiation therapy (3DCRT) special debate: The United States needs at least one carbon ion facility 1 | THREE DISCIPLINE COLLABORATIVE RAD IATION THERAPY (3DCRT) DEBATE SERIESRadiation oncology is a highly multidisciplinary medical specialty, drawing significantly from three scientific disciplinesmedicine, physics, and biology. As a result, discussion of controversies or changes in practice within radiation oncology involves input from all three disciplines. For this reason, significant effort has been expended recently to foster collaborative multidisciplinary research in radiation oncology, with substantial demonstrated benefit.( 1,2 ) In light of these results, we endeavor here to adopt this "team-science" approach to the traditional debates featured in this journal. This article is part of a series of special debates entitled "Three Discipline Collaborative Radiation Therapy (3DCRT)" in which each debate team will include a radiation oncologist, medical physicist, and radiobiologist. We hope that this format will not only be engaging for the readership but will also foster further collaboration in the science and clinical practice of radiation oncology. Dominello serves as the Assistant Program Director for the RadiationOncology Residency Program and as an instructor in courses for both graduate and undergraduate students at the university. Dr.Griffin is a professor of radiation biology at the University of Arkansas for Medical Sciences. His group studies living tissue response to high-dose radiotherapy (SBRT) and spatially fractionated radiation approaches with targeted drug delivery to tumors. He served as a ---

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

“…Furthermore, the National Institute of Radiological Sciences (Chiba, Japan) estimates approximately 1826 million yen per year (approximately $17 million) in operating costs and depreciation, with a personnel cost of $150 million yen ($1.4 million) [ 38 ]. The overall construction and operating costs remain a limiting factor in the United States, especially given the ever-changing reimbursement landscape [ 11 ]. Given the relatively high cost of particle therapy compared with photon irradiation, developing appropriate reimbursement remains a potential pitfall to the adoption of CIRT in the United States.…”

“…Centers developing randomized studies do involve a substantial amount of risk that CIRT is neither safe nor more effective, despite having a significantly higher cost than more-conventional treatments. Additionally, treating with CIRT in the United States will allow further development of CIRT in combination with new treatment modalities, including immunotherapy, FLASH radiotherapy, and other advanced modalities; many of which are already under investigation [ 11 ]. Additional prospective data are needed to further evaluate and define the potential number of patients eligible for, the potential adoption of, and the potential clinical benefit of, CIRT in the US population.…”

“…The University of Texas Southwestern recently opened a phase III trial randomizing patients to CIRT (NCT03536182 [ 9 ]), and Albert Einstein College of Medicine, in collaboration with the Shanghai Proton and Heavy Ion Center, recently completed accrual for a phase I trial investigating CIRT (NCT03403049 [ 10 ]). The precise role and the need for CIRT in the United States remain controversial, particularly within the context of the larger debate in the United States regarding the cost of health care [ 11 ].…”

Evaluation of the Response of HNSCC Cell Lines to γ-Rays and 12C Ions: Can Radioresistant Tumors Be Identified and Selected for 12C Ion Radiotherapy?

“…Since that time, particle therapy has continuously developed predominantly based upon advances in engineering, imaging, and physics. The first dedicated clinical heavy ion therapy center was opened in 1994, and this facility focused on the use of accelerated carbon ions because of the physical and biological advantages over photons and protons including steeper lateral dose penumbra at greater depths in the body, a higher LET which results in a higher relative biological effectiveness (RBE) and took into account the experience gained at the Lawrence Berkeley Laboratory where the initial results for the use of heavy charged particles as a cancer therapy took place (1)(2)(3)(4).…”

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

“…Major stakeholders in the cancer treatment field have shown strong interests in building a CIRT facility in the United States. Our previous Parallel Opposed editorial also debated on the need of having at least one carbon ion facility in the country 4 . Yet the question remains whether it is clinically and financially ready for construction and implementation of a CIRT facility in the United States.…”