ASTRO committee issues evidence-based report on applicability of PBRT


People have strong views about the clinical use of proton beam radiation therapy (PBRT) in the management of localized prostate cancer. The Emerging Technology Committee of the American Society of Radiation Oncology (ASTRO) has now published a report of the applicability of PBRT in many forms of cancer, including prostate cancer.

According to the abstract of this report by Allen et al. in “The Green Journal”:

  • The report reflects evidence collected through November 2009.
  • Current data do not provide sufficient evidence to recommend PBRT in cancers of the lung, the head and neck, or the gastrointestinal system, or in pediatric cancers other than those of the central nervous system.
  • Current data do provide evidence of efficacy for PBRT in cancers of the liver and the prostate … but there is “no suggestion that it is superior to photon based approaches.”
  • PBRT appears to be superior to photon-based approaches in the management of  pediatric cancers of the central nervous system (but more data are needed).
  • There is evidence of a benefit for PBRT compared to photon-based radiation therapy in the treatment of large ocular melanomas and chordomas.
  • PBRT is “an important new technology in radiotherapy.”

The report concludes that PBRT at this time there is “a limited indication” for PBRT, based on the available evidence. It further suggest that “robust prospective clinical trials are needed” to determine the appropriate appropriate clinical application of this technology.

The full text of the report of the Emerging Technology Committee is also available on line on the ASTRO web site.

For clarity, once again, The “New” Prostate Cancer has never denied the effectiveness of PBRT in the management of localized forms of prostate cancer, or the right of individuals to select this form of treatment. Our concern has always been twofold: (a) the lack of good data to support the constant claims that PBRT is safer than other forms of high-quality, modern, photon-based radiation therapy and (b) the cost of PBRT given the lack of such data in the management of prostate cancer. We believe that our concerns reflect precisely the concerns expressed by this report from an ASTRO expert committee.

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