The future for proton beam therapy

It is impossible to say exactly how proton beam therapy will progress over the next decade but the indications are, it will become more widely used.

The number of centres available to provide proton beam therapy is expected to double between 2012 and 2021, giving more patients access to treatment.

What about the cost?

One of the big controversies about proton beam therapy is the cost. It is usual for a medical centre to spend over £100 million to develop a proton beam therapy facility, yet an intensity modulated radiotherapy system usually costs around £4 million.

The running costs for a proton beam therapy facility are higher too, so individual treatments cost 2-3 times as much as intensity modulated radiotherapy.

Until the evidence shows that proton beam therapy is more effective than radiotherapy based on X-rays, some doctors think that spending more money on more centres is not a good use of resources.

However, more evidence is emerging that PBT is effective and with a lower risk of long-term side effects. The key to the future of proton beam therapy seems to be balance: national governments need to ensure that enough facilities are built to treat people to save the cost of funding travel outside the country but that centres collaborate so that very expensive PBT equipment is not lying idle because of too few patients.

New proton beam therapy centres worldwide

These are just some of the centres that are currently being built and developed:

• Mayo Clinic USA: The renowned Mayo Clinic in the USA is currently building its proton beam therapy centres in Minnesota and Arizona, both of which will offer four treatment rooms. They are spending $370 million and will treat 1,240 patients each year.

• The New York Proton Center: This collaborative venture involving the Memorial Sloan-Kettering Cancer Center, the Mount Sinai Medical Centre and three other leading healthcare providers in the area, is still at the planning stage. A budget of $235 million has been set aside. The project may mark a new era of collaboration in the USA; instead of individual institutions spending the money to have their own PBT centre, other groups may come together to raise the necessary funding.

• Other USA centres for PBT: Several are in the stage of building, including one at Shreveport at the Willis-Knighton Cancer Center and one at Knoxville at the Provision Center for Proton Therapy.

• Three new PBT centres planned in Germany: One will open in Dresden in 2014 and two further facilities are planned in Kiel and Marburg.

• Saudia Arabia opens its first PBT centre: this is in progress at the King Fahad Medical City in Riyadh and will open in 2015.

What about clinical trials?

There is general agreement that more clinical trials are necessary to compare the efficacy of proton beam therapy directly with that of standard radiotherapy for specific cancers.

The trouble is, these clinical trials would take years to run, as the real advantage of proton beam therapy is in the lowered risk of side effects. It would take several years to assess whether patients treated with PBT were less likely to develop radiotherapy-related cancers later in life, or to have other problems.
 
It is important to study the impact of proton beam therapy but denying patients treatment would be unethical. Clinical trials are ongoing throughout the world and new indications for proton beam therapy are being actively researched. Patients with cancers that are not usually treated by proton beam therapy can be entered into a clinical trial so that the impact of the treatment can be assessed.