A Nordic-Baltic perspective on indications for proton therapy with strategies for identification of proper patients

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  • Petter Brandal, Oslo University Hospital
  • ,
  • Kjell Bergfeldt, Skandion Clinic
  • ,
  • Ninna Aggerholm-Pedersen
  • Gloria Bäckström, Skandion Clinic
  • ,
  • Irina Kerna, North Estonia Medical Centre
  • ,
  • Michael Gubanski, Karolinska University Hospital
  • ,
  • Kirsten Björnlinger, Skåne University Hospital, Lund
  • ,
  • Morten E. Evensen, Oslo University Hospital
  • ,
  • Maire Kuddu, North Estonia Medical Centre
  • ,
  • Erik Pettersson, Sahlgrenska University Hospital
  • ,
  • Marianne Brydøy, Haukeland University Hospital
  • ,
  • Taran P. Hellebust, University of Oslo, Oslo University Hospital
  • ,
  • Einar Dale, Oslo University Hospital
  • ,
  • Alexander Valdman, Karolinska University Hospital
  • ,
  • Lars Weber, Skåne University Hospital, Lund
  • ,
  • Morten Høyer

The beneficial effects of protons are primarily based on reduction of low to intermediate radiation dose bath to normal tissue surrounding the radiotherapy target volume. Despite promise for reduced long-term toxicity, the percentage of cancer patients treated with proton therapy remains low. This is probably caused by technical improvements in planning and delivery of photon therapy, and by high cost, low availability and lack of high-level evidence on proton therapy. A number of proton treatment facilities are under construction or have recently opened; there are now two operational Scandinavian proton centres and two more are under construction, thereby eliminating the availability hurdle. Even with the advantageous physical properties of protons, there is still substantial ambiguity and no established criteria related to which patients should receive proton therapy. This topic was discussed in a session at the Nordic Collaborative Workshop on Particle Therapy, held in Uppsala 14–15 November 2019. This paper resumes the Nordic-Baltic perspective on proton therapy indications and discusses strategies to identify patients for proton therapy. As for indications, neoplastic entities, target volume localisation, size, internal motion, age, second cancer predisposition, dose escalation and treatment plan comparison based on the as low as reasonably achievable (ALARA) principle or normal tissue complication probability (NTCP) models were discussed. Importantly, the patient selection process should be integrated into the radiotherapy community and emphasis on collaboration across medical specialties, involvement of key decision makers and knowledge dissemination in general are important factors. An active Nordic-Baltic proton therapy organisation would also serve this purpose.

Original languageEnglish
JournalActa Oncologica
Volume59
Issue10
Pages (from-to)1157-1163
Number of pages7
ISSN0284-186X
DOIs
Publication statusPublished - Oct 2020

    Research areas

  • particle therapy, Proton therapy, proton therapy indications, radiotherapy

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