Systematic Review: Charged-Particle Radiation Therapy for Cancer
- Teruhiko Terasawa, MD;
- Tomas Dvorak, MD;
- Stanley Ip, MD;
- Gowri Raman, MD;
- Joseph Lau, MD; and
- Thomas A. Trikalinos, MD, PhD
Abstract
Background: Radiation therapy with charged particles can potentially deliver maximum doses while minimizing irradiation of surrounding tissues, and it may be more effective or less harmful than other forms of radiation therapy.
Purpose: To review evidence about the benefits and harms of charged-particle radiation therapy for patients with cancer.
Data Sources: MEDLINE (inception to 11 July 2009) was searched for publications in English, German, French, Italian, and Japanese. Web sites of manufacturers, treatment centers, and professional organizations were searched for relevant information.
Study Selection: Four reviewers identified studies of any design that described clinical outcomes or adverse events in 10 or more patients with cancer treated with charged-particle radiation therapy.
Data Extraction: The 4 reviewers extracted study, patient, and treatment characteristics; clinical outcomes; and adverse events for nonoverlapping sets of articles. A fifth reviewer verified data on comparative studies.
Data Synthesis: Currently, 7 centers in the United States have facilities for particle (proton)–beam irradiation, and at least 4 are under construction, each costing between $100 and $225 million. In 243 eligible articles, charged-particle radiation therapy was used alone or in combination with other interventions for common (for example, lung, prostate, or breast) or uncommon (for example, skull-base tumors or uveal melanomas) types of cancer. Of 243 articles, 185 were single-group retrospective studies. Eight randomized and 9 nonrandomized clinical trials compared treatments with or without charged particles. No comparative study reported statistically significant or important differences in overall or cancer-specific survival or in total serious adverse events.
Limitation: Few studies directly compared treatments with or without particle irradiation.
Conclusion: Evidence on the comparative effectiveness and safety of charged-particle radiation therapy in cancer is needed to assess the benefits, risks, and costs of treatment alternatives.
Primary Funding Source: Agency for Healthcare Research and Quality.
Article and Author Information
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Note: The full report is available at http://effectivehealthcare.ahrq.gov.
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Disclaimer: The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
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Grant Support: By contract HHSA-290-2007-10055-1-EPC3 from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.
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Potential Conflicts of Interest: Other: Dr. Dvorak is a radiation oncologist but does not work in a charged-particle radiation therapy facility. Tufts Medical Center has an agreement with American Shared Hospitals Services (ASHS) pursuant to which it will lease from ASHS a Clinatron 250 proton-beam radiation therapy system (Still River Systems, Littleton, Massachusetts). This system is in design and production by Still River Systems and will not be delivered to Tufts Medical Center for 2 to 3 years. Tufts Medical Center does not have a direct relationship with Still River Systems that in any way involves the Clinatron 250 proton-beam radiation therapy system.
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Requests for Single Reprints: Teruhiko Terasawa, MD, Tufts Medical Center, Box 63, 800 Washington Street, Boston, MA 02111; e-mail, tterasawa{at}tuftsmedicalcenter.org.
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Current Author Addresses: Drs. Terasawa, Ip, Raman, Lau, and Trikalinos: Tufts Medical Center, Box 63, 800 Washington Street, Boston, MA 02111.
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Dr. Dvorak: Tufts Medical Center, 800 Washington Street, Proger Basement, Boston, MA 02111.
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Author Contributions: Conception and design: T. Terasawa, J. Lau, T.A. Trikalinos.
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Analysis and interpretation of the data: T. Terasawa, T. Dvorak, S. Ip, G. Raman, J. Lau, T.A. Trikalinos.
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Drafting of the article: T. Terasawa, T. Dvorak, T.A. Trikalinos.
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Critical revision of the article for important intellectual content: T. Terasawa, T. Dvorak, S. Ip, G. Raman, J. Lau, T.A. Trikalinos.
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Final approval of the article: T. Terasawa, T. Dvorak, S. Ip, G. Raman, J. Lau, T.A. Trikalinos.
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Statistical expertise: T. Terasawa, T.A. Trikalinos.
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Obtaining of funding: J. Lau.
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Administrative, technical, or logistic support: J. Lau.
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Collection and assembly of data: T. Terasawa, S. Ip, G. Raman, T.A. Trikalinos.
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