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Cancers 2015, 7(2), 688-705;

Reducing the Cost of Proton Radiation Therapy: The Feasibility of a Streamlined Treatment Technique for Prostate Cancer

Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, LA 70803, USA
Department of Physics, Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, LA 70809, USA
Departments of Radiation Physics and Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
The University of Texas Graduate School of Biomedical Sciences, Houston, TX 77030, USA
Department of Physics, Abilene Christian University, ACU Box 27963, Abilene, TX 79699, USA
Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356043, Seattle, WA 98195, USA
Current address: 343 Van Gordan St 18-503, Lakewood, CO 80228, USA.
Current address: Scripps Proton Therapy Center, 9730 Summers Ridge Road, San Diego, CA 92121, USA.
Current address: Department of Radiation Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon.
Author to whom correspondence should be addressed.
Academic Editor: Xiaodong Zhang
Received: 16 January 2015 / Revised: 3 April 2015 / Accepted: 15 April 2015 / Published: 24 April 2015
(This article belongs to the Special Issue Proton Therapy for Cancer)
Full-Text   |   PDF [1251 KB, uploaded 24 April 2015]   |  


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. View Full-Text
Keywords: proton therapy; prostate cancer; multileaf collimator; cost proton therapy; prostate cancer; multileaf collimator; cost

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Newhauser, W.D.; Zhang, R.; Jones, T.G.; Giebeler, A.; Taddei, P.J.; Stewart, R.D.; Lee, A.; Vassiliev, O. Reducing the Cost of Proton Radiation Therapy: The Feasibility of a Streamlined Treatment Technique for Prostate Cancer. Cancers 2015, 7, 688-705.

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