publication date: Aug. 1, 2014


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By Minesh P. Mehta, Katja Langen and William F. Regine

The Cancer Letter recently published information regarding proton therapy facilities in the U.S., highlighting a contention that 85 percent of patients treated with protons have prostate cancer, the logical implication of which would be that this important resource is utilized minimally for other cancers. In this response, we wish to correct this erroneous impression and also wish to highlight the direction that this technology is moving in.

Proton beam therapy, characterized by its significantly lower total body integral dose relative to photon therapy, is a natural and logical extension of the bioethics concept of “primum non nocere,” or “first, do no harm” (1). There is no evidence in the literature, nor is there logical reason to believe that excess radiation to normal tissues (irrespective of whether it exceeds some arbitrarily defined threshold or not) is beneficial to any patient. The logical, almost “tongue-in-cheek” extrapolation of this is that the vast majority of patients eligible for radiation therapy should be considering proton therapy because in almost all instances they will receive a lower radiation dose to their normal tissues; in reality, significantly less than 10 percent of all cancer patients undergoing radiotherapy are treated with proton therapy (2).

There are four critical reasons why proton therapy is not in widespread use at present:

1. Availability: access to proton therapy centers is quite limited; currently, there are only 14 operational centers in the U.S., in comparison to over 2200 conventional photon therapy centers (3).

2. Cost: A key reason for the limited availability of proton therapy … Continue reading 40-31 Letter to the Editor: Expanding the Horizons Of Proton Beam Therapy

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