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Position statement on ethics, equipoise and research on charged particle radiation therapy
  1. Mark Sheehan1,
  2. Claire Timlin2,
  3. Ken Peach2,
  4. Ariella Binik3,
  5. Wilson Puthenparampil4,
  6. Mark Lodge5,
  7. Sean Kehoe6,
  8. Michael Brada7,
  9. Neil Burnet8,
  10. Steve Clarke9,
  11. Adrian Crellin10,
  12. Michael Dunn1,
  13. Piero Fossati11,
  14. Steve Harris2,
  15. Michael Hocken12,
  16. Tony Hope1,
  17. Jonathan Ives13,
  18. Tadashi Kamada14,
  19. Alex John London15,
  20. Robert Miller16,
  21. Michael Parker1,
  22. Madelon Pijls-Johannesma17,
  23. Julian Savulescu18,
  24. Susan Short19,
  25. Loane Skene20,
  26. Hirohiko Tsujii14,
  27. Jeffrey Tuan11,
  28. Charles Weijer3
  1. 1The Ethox Centre, University of Oxford, Oxford, UK
  2. 2Particle Therapy Cancer Research Institute, University of Oxford, Oxford, UK
  3. 3Rotman Institute of Philosophy, University of Western Ontario, London, Canada
  4. 4Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
  5. 5International Network for Cancer Treatment and Research UK, Oxford, UK
  6. 6School of Cancer Sciences, University of Birmingham, Birmingham, UK
  7. 7Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, London
  8. 8Department of Oncology, University of Cambridge, Cambridge, UK
  9. 9Centre for Applied Philosophy and Public Ethics, Charles Sturt University, Canberra, Australia
  10. 10St James' Institute of Oncology, St James's University Hospital, Leeds, UK
  11. 11National Center for Oncological Hadron Therapy (CNAO), Pavia and Dipartimento di Scienze della Salute, University of Milano, Italy, Italy
  12. 12Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
  13. 13Centre for Biomedical Ethics, University of Birmingham, Birmingham, UK
  14. 14Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
  15. 15Center for Ethics and Policy, Department of Philosophy, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
  16. 16Department of Radiation Oncology and Proton Beam Therapy Program, Mayo Clinic, Rochester, USA
  17. 17Maastricht Radiation Oncology (MAASTRO) Clinic, Maastricht, The Netherlands
  18. 18Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
  19. 19Leeds Institute of Molecular Medicine, St James University Hospital, Leeds, UK
  20. 20Melbourne Law School, University of Melbourne, Australia
  1. Correspondence to Dr Mark Sheehan, The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Rosemary Rue Building Headington, Oxford OX3 7LG, UK; mark.sheehan{at}


The use of charged-particle radiation therapy (CPRT) is an increasingly important development in the treatment of cancer. One of the most pressing controversies about the use of this technology is whether randomised controlled trials are required before this form of treatment can be considered to be the treatment of choice for a wide range of indications. Equipoise is the key ethical concept in determining which research studies are justified. However, there is a good deal of disagreement about how this concept is best understood and applied in the specific case of CPRT. This report is a position statement on these controversies that arises out of a workshop held at Wolfson College, Oxford in August 2011. The workshop brought together international leaders in the relevant fields (radiation oncology, medical physics, radiobiology, research ethics and methodology), including proponents on both sides of the debate, in order to make significant progress on the ethical issues associated with CPRT research. This position statement provides an ethical platform for future research and should enable further work to be done in developing international coordinated programmes of research.

  • Clinical Trials
  • Position Statements (of organizations/groups)
  • Radiology
  • Research Ethics

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