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Proton therapy costs far more than standard radiotherapy and, for most adult cancers, nobody knows whether it is better. Payers would cover it only inside trials or registries that answer that question, across every centre at once.
National payers and proton centres agree that reimbursement for adult indications without established benefit is conditional on enrolment in pragmatic randomised trials (proton versus photon) or, where randomisation is unacceptable, in a common prospective registry with matched photon comparators, pooled internationally. Existing trials (PARTIQoL in prostate, RADCOMP in breast, NRG lung and oesophageal trials) have struggled with accrual partly because patients can obtain protons outside trials. Pooling and conditioning payment fixes accrual and produces evidence proportionate to the investment already made in dozens of centres.
Shares RADCOMP, PARTIQoL: phase 3 randomised trial of proton therapy versus IMRT for localised prostate cancer (ASTRO 2024 late-breaking abstract), PARTIQoL, Caution: proton therapy vs IMRT.
Shares Caution: proton therapy vs IMRT, Alpha/beta ratio, Relative biological effectiveness (RBE), Use LET, RBE and alpha/beta to decide when protons beat IMRT.
Shares Alpha/beta ratio, Relative biological effectiveness (RBE), Use LET, RBE and alpha/beta to decide when protons beat IMRT, Linear energy transfer (LET).
Shares Jürgen Debus, A coordinated FLASH radiotherapy evidence programme with shared dose-rate standards, Coverage-with-evidence registries for MR-guided and adaptive radiotherapy, Carbon-ion therapy.
Shares Caution: proton therapy vs IMRT, Relative biological effectiveness (RBE), Use LET, RBE and alpha/beta to decide when protons beat IMRT, Linear energy transfer (LET).
Shares Mevion Medical Systems, IBA (Ion Beam Applications), Surgery and radiotherapy cure most, get least, Proton therapy.
Shares Mevion Medical Systems, IBA (Ion Beam Applications), Proton therapy, IMRT / IGRT (modern external beam).
Shares Relative biological effectiveness (RBE), Linear energy transfer (LET), Carbon-ion therapy.