No randomised control trials of proton beam verses photon beam (standard external beam radiotherapy) have ever been completed as far as I know. Many of the US proton centres published results comparing their current proton beam with much older photon beam than we use in the UK without today's levels of guidance or masking. I don't know if these old systems were still in use in the US at the time, but it might be the only way they could get favorable comparison results. Photon radiotherapy advances at quite a rate because of a few companies such as Varian, Electa, etc competing very heavily on new features and continually leapfrogging each other, and likely outpacing the capabilities of the much more expensive proton machines to keep up.
We had a talk from an oncologist at a local support group. He had been sending private patients to the Rutherford centres, but he'd stopped doing so. He wasn't very specific on why, but he had formed the view that proton beam wasn't getting better results than modern photon beam.
The NHS did a comparison of proton beam verses photon beam in 2016 for prostate treatment from what data they could find around the world, and came to the conclusion the side effects weren't better with proton beam, and indeed rectal damage was very slightly worse. (All proton beam treatment in the UK was done with rectal spacers AFAIK.)
Someone here (Matron?) mentioned that outcomes for higher grade cancers were not as good with proton beam, although I haven't seen that data. I did speculate that the reduction in beam spill outside the target area might mean that local micro-mets are less likely to get mopped up.
I watched a social media conversation between several surgeons around the world who do salvage prostatectomies, and they all said the most difficult ones to do are after proton beam treatments, and the damage/fibrosis around the prostate is far worse than for any other treatment, so much so that the whole base of the bladder often has to be removed.
So, much as I appreciate the theoretical advantages often stated for proton beam, the actual advantages in practice would appear to be more elusive.
I have thought that proton beam would be ideal for treating individual lymph nodes and other ogliometastatic hot spots, but I've never heard of it being used for this purpose.
Proton beam did come up in a UCLH support group meeting when their proton beam went live, and I know they were quite keen to run a randomised control trial. I wonder if that's what the prostate treatment on their proton beam system is?
Edited by member 05 Jan 2023 at 16:24
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