The Quest for Evidence for Proton Therapy: Model-Based Approach and Precision Medicine
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)
- Department of Radiation Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht (Netherlands)
- Department of Radiation Oncology, Leiden University Medical Center, Leiden (Netherlands)
- Department of Radiation Oncology, Erasmus Medical Center Cancer Institute, Rotterdam (Netherlands)
- Department of Radiation Oncology, Academic Medical Center, Amsterdam (Netherlands)
- Department of Radiation Oncology, VU Medical Center, Amsterdam (Netherlands)
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam (Netherlands)
Purpose: Reducing dose to normal tissues is the advantage of protons versus photons. We aimed to describe a method for translating this reduction into a clinically relevant benefit. Methods and Materials: Dutch scientific and health care governance bodies have recently issued landmark reports regarding generation of relevant evidence for new technologies in health care including proton therapy. An approach based on normal tissue complication probability (NTCP) models has been adopted to select patients who are most likely to experience fewer (serious) adverse events achievable by state-of-the-art proton treatment. Results: By analogy with biologically targeted therapies, the technology needs to be tested in enriched cohorts of patients exhibiting the decisive predictive marker: difference in normal tissue dosimetric signatures between proton and photon treatment plans. Expected clinical benefit is then estimated by virtue of multifactorial NTCP models. In this sense, high-tech radiation therapy falls under precision medicine. As a consequence, randomizing nonenriched populations between photons and protons is predictably inefficient and likely to produce confusing results. Conclusions: Validating NTCP models in appropriately composed cohorts treated with protons should be the primary research agenda leading to urgently needed evidence for proton therapy.
- OSTI ID:
- 22648614
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 95, Issue 1; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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