Estimating the percentage of patients who might benefit from proton beam therapy instead of X-ray radiotherapy

Neil G Burnet, Thomas Mee, Simona Gaito, Norman F Kirkby, Adam H Aitkenhead, Carmel N Anandadas, Marianne C Aznar, Lisa H Barraclough, Gerben Borst, Frances C Charlwood, Matthew Clarke, Rovel J Colaco, Adrian M Crellin, Noemie N Defourney, Christina J Hague, Margaret Harris, Nicholas T Henthorn, Kirsten I Hopkins, E Hwang, Sam P IngramKaren J Kirkby, Lip W Lee, David Lines, Zoe Lingard, Matthew Lowe, Ranald I Mackay, Catherine A McBain, Michael J Merchant, David J Noble, Shermaine Pan, James M Price, Ganesh Radhakrishna, David Reboredo-Gil, Ahmed Salem, Srijith Sashidharan, Peter Sitch, Ed Smith, Edward Ak Smith, Michael J Taylor, David J Thomson, Nicola J Thorp, Tracy Sa Underwood, John W Warmenhoven, James P Wylie, Gillian Whitfield

Research output: Contribution to journalArticlepeer-review


Objectives: High-energy Proton Beam Therapy (PBT) commenced in England in 2018 and NHS England commissions PBT for 1.5% of patients receiving radical radiotherapy. We sought expert opinion on the level of provision. Methods: Invitations were sent to 41 colleagues working in PBT, most at one UK centre, to contribute by completing a spreadsheet. 39 responded: 23 (59%) completed the spreadsheet; 16 (41%) declined, arguing that clinical outcome data are lacking, but joined six additional site-specialist oncologists for two consensus meetings. The spreadsheet was pre-populated with incidence data from Cancer Research UK and radiotherapy use data from the National Cancer Registration and Analysis Service. 'Mechanisms of Benefit' of reduced growth impairment, reduced toxicity, dose escalation and reduced second cancer risk were examined. Results: The most reliable figure for percentage of radical radiotherapy patients likely to benefit from PBT was that agreed by 95% of the 23 respondents at 4.3%, slightly larger than current provision. The median was 15% (range 4-92%) and consensus median 13%. The biggest estimated potential benefit was from reducing toxicity, median benefit to 15% (range 4-92%), followed by dose escalation median 3% (range 0 to 47%); consensus values were 12 and 3%. Reduced growth impairment and reduced second cancer risk were calculated to benefit 0.5% and 0.1%. Conclusions: The most secure estimate of percentage benefit was 4.3% but insufficient clinical outcome data exist for confident estimates. The study supports the NHS approach of using the evidence base and developing it through randomised trials, non-randomised studies and outcomes tracking.

Original languageEnglish
Article number20211175
JournalThe British journal of radiology
Issue number1133
Early online date17 Mar 2022
Publication statusPublished - 1 May 2022


  • Humans
  • Neoplasms, Second Primary/etiology
  • Proton Therapy/adverse effects
  • Radiation Oncology
  • Radiotherapy, Intensity-Modulated
  • X-Rays

Research Beacons, Institutes and Platforms

  • Manchester Cancer Research Centre


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