A systematic literature review of the clinical and cost-effectiveness of hadron therapy in cancer

doi:10.1016/j.radonc.2007.04.007

Radiotherapy and Oncology

Volume 83, Issue 2, May 2007, Pages 110-122

https://doi.org/10.1016/j.radonc.2007.04.007 Get rights and content

Abstract

Background: In view of the continued increase in the number of hadron (i.e. neutron, proton and light or heavy ion) therapy (HT) centres we performed a systematic literature review to identify reports of the efficacy of HT.

Methods: Eleven databases were searched systematically. No limit was applied to language or study design. Established experts were contacted for unpublished data. Data on outcomes were extracted and summarised in tabular form.

Results: Seven hundred and seventy three papers were identified. For proton and heavy ion therapy, the number of RCTs was too small to draw firm conclusions. Based on prospective and retrospective studies, proton irradiation emerges as the treatment of choice for some ocular and skull base tumours. For prostate cancer, the results were comparable with those from the best photon therapy series. Heavy ion therapy is still in an experimental phase.

Conclusion: Existing data do not suggest that the rapid expansion of HT as a major treatment modality would be appropriate. Further research into the clinical and cost-effectiveness of HT is needed. The formation of a European Hadron Therapy Register would offer a straightforward way of accelerating the rate at which we obtain high-quality evidence that could be used in assessing the role of HT in the management of cancer.

Section snippets

Methods

The project was co-ordinated by Mark Lodge at the Cochrane Cancer Network. The Network identified a multinational team of contributors with expertise in these areas and deployed them to address specific sections of the report. Lisa Stirk (LS) designed the search strategies, Alastair Munro (AJM) reviewed the efficacy of neutron therapy; Dirk De Ruysscher (DDR) and Madelon Pijls-Johannesma (MPJ) reviewed the efficacy of proton therapy and light/heavy ion therapies. Tom Jefferson (TJ) reviewed the

Results

A total of 7209 articles were identified, reduced to 5089 articles after de-duplication. Of these 5089 the following number of articles was found to be relevant to the review: neutron therapy (563), proton therapy (137), ion therapy (49); economic viability and cost-effectiveness (10).

Discussion

There is considerable public, scientific, clinical and commercial interest in the further development of particle therapy for cancer. Worldwide, the number of new treatment facilities is increasing and there is some danger that the development of new centres may be driven by factors other than clinical need and a demonstrable superiority of particle therapy over conventional treatment. In order that the development of hadron therapy might proceed an a rational basis we need to be able to assess

Acknowledgement

The project team wishes to acknowledge the valuable input provided to this project by the following experts:

Dr. Jose R. Alonso, PhD, Senior Scientist (Retd.), Accelerator and Fusion Research Division, Lawrence Berkeley National Laboratory, USA.
Prof. Ugo Amaldi, University of Milano Bicocca and TERA Foundation, Milan, Italy.
Prof. Beth Burnside Vice Chancellor for Research & Professor of Cell and Developmental Biology, Department of Molecular and Cell Biology, University of California, USA.
Prof.