Abstract
Proton radiation therapy is an effective modality for cancer treatments, but the cost of proton therapy is much higher compared to conventional radiotherapy and this presents a formidable barrier to most clinical practices that wish to offer proton therapy. Little attention in literature has been paid to the costs associated with collimators, range compensators and hypofractionation. The objective of this study was to evaluate the feasibility of cost-saving modifications to the present standard of care for proton treatments for prostate cancer. In particular, we quantified the dosimetric impact of a treatment technique in which custom fabricated collimators were replaced with a multileaf collimator (MLC) and the custom range compensators (RC) were eliminated. The dosimetric impacts of these modifications were assessed for 10 patients with a commercial treatment planning system (TPS) and confirmed with corresponding Monte Carlo simulations. We assessed the impact on lifetime risks of radiogenic second cancers using detailed dose reconstructions and predictive dose-risk models based on epidemiologic data. We also performed illustrative calculations, using an isoeffect model, to examine the potential for hypofractionation. Specifically, we bracketed plausible intervals of proton fraction size and total treatment dose that were equivalent to a conventional photon treatment of 79.2 Gy in 44 fractions. Our results revealed that eliminating the RC and using an MLC had negligible effect on predicted dose distributions and second cancer risks. Even modest hypofractionation strategies can yield substantial cost savings. Together, our results suggest that it is feasible to modify the standard of care to increase treatment efficiency, reduce treatment costs to patients and insurers, while preserving high treatment quality.
Highlights
Proton radiation therapy is a safe and effective treatment for cancers of the central nervous system [1], eye [2], prostate [3], and other anatomical sites [4,5,6,7,8]
The inclusion criteria were a diagnosis of localized adenocarcinoma of the prostate, treatment with passively scattered proton beam therapy (PSPT), and under the direction of one single radiation oncologist to avoid intra-physician variations in contouring of the clinical target volume (CTV) and other structures
The major findings of this study showed that the predicted dosimetric impacts of removing the range compensators (RC) and replacing the custom collimator with an multileaf collimator (MLC) are clinically insignificant
Summary
Proton radiation therapy is a safe and effective treatment for cancers of the central nervous system [1], eye [2], prostate [3], and other anatomical sites [4,5,6,7,8]. Most aspects of proton therapy are well understood, including the physics clinical operation, accelerator and beamline engineering, treatment planning, and radiation protection of staff and patients [9,10,11,12,13,14]. Several medical manufacturers offer proton therapy systems at costs ranging from approximately $20M to $100M (US), depending on the capacity and capability of the equipment. These costs are much higher than those of conventional radiotherapy equipment based on electron linacs, which presents a formidable barrier to most clinical practices that wish to offer proton therapy.
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