@article{779d28b980304487b9d1f643664c87b7,
title = "Estimating the percentage of patients who might benefit from proton beam therapy instead of X-ray radiotherapy",
abstract = "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.",
keywords = "Humans, Neoplasms, Second Primary/etiology, Proton Therapy/adverse effects, Radiation Oncology, Radiotherapy, Intensity-Modulated, X-Rays",
author = "Burnet, {Neil G} and Thomas Mee and Simona Gaito and Kirkby, {Norman F} and Aitkenhead, {Adam H} and Anandadas, {Carmel N} and Aznar, {Marianne C} and Barraclough, {Lisa H} and Gerben Borst and Charlwood, {Frances C} and Matthew Clarke and Colaco, {Rovel J} and Crellin, {Adrian M} and Defourney, {Noemie N} and Hague, {Christina J} and Margaret Harris and Henthorn, {Nicholas T} and Hopkins, {Kirsten I} and E Hwang and Ingram, {Sam P} and Kirkby, {Karen J} and Lee, {Lip W} and David Lines and Zoe Lingard and Matthew Lowe and Mackay, {Ranald I} and McBain, {Catherine A} and Merchant, {Michael J} and Noble, {David J} and Shermaine Pan and Price, {James M} and Ganesh Radhakrishna and David Reboredo-Gil and Ahmed Salem and Srijith Sashidharan and Peter Sitch and Ed Smith and Smith, {Edward Ak} and Taylor, {Michael J} and Thomson, {David J} and Thorp, {Nicola J} and Underwood, {Tracy Sa} and Warmenhoven, {John W} and Wylie, {James P} and Gillian Whitfield",
note = "Funding Information: We are indebted to the Oncology Forum whose invitation to speak in 2020 served as a catalyst for this work and to Michael Simmons, previously at The Cavendish Laboratory, for beta testing the spreadsheet calculations. We are also grateful to Prof Steve Watts and the Science Unlocked programme at the University of Manchester for providing a forum for discussion. KJK, NFK, and RIM are supported by the National Institute for Health Research (NIHR) Manchester Biomedical Research Centre. TM is supported by the Cancer Research UK ART-Net project [grant number C309/A21993]. Support was also provided by The Christie Charity, the Engineering and Physical Sciences Council [grant number EP/R023220/1, EP/N02716], the Science and Technology Facilities Council [grant number ST/N002423/1], the Cancer Research UK ART-Net project [grant number C309/A21993, Cancer Research UK via funding to the Cancer Research UK Manchester Centre [C147/A25254] and UK RadNet Manchester [C1994/A28701] and the European Union's Horizon 2020 research and innovation programme under grant agreement no 730983 (INSPIRE). KJK holds research grants from Varian Medical Systems. DJN receives support from the Jamie King Foundation. The funders had no involvement in the study design, analysis or report writing. Source data used in this work was in part provided through public access by Cancer Research UK and in part is based on patient-level information collected by the NHS, as part of the care and support of cancer patients [www.cancerdata.nhs.uk]. The data is collated, maintained and quality assured by the National Cancer Registration and Analysis Service, part of Public Health England (PHE). Publisher Copyright: {\textcopyright} 2022 British Institute of Radiology. All rights reserved.",
year = "2022",
month = may,
day = "1",
doi = "10.1259/bjr.20211175",
language = "English",
volume = "95",
pages = "20211175",
journal = "British Journal of Radiology",
issn = "0007-1285",
publisher = "British Institute of Radiology",
number = "1133",
}