Early Experience of the First Single-Room Gantry Mounted Active Scanning Proton Therapy System at an Integrated Cancer Center

Abstract

Introduction: Review the early experience with a single-room gantry mounted active scanning proton therapy system. Material and Methods: All patients treated with proton beam radiotherapy (PBT) were enrolled in an institutional review board-approved patient registry. Proton beam radiotherapy was delivered with a 250 MeV gantry mounted synchrocyclotron in a single-room integrated facility within the pre-existing cancer center. Demographic data, cancer diagnoses, treatment technique, and geographic patterns were obtained for all patients. Treatment plans were evaluated for mixed modality therapy. Insurance approval data was collected for all patients treated with PBT. Results: A total of 132 patients were treated with PBT between March 2018 and June 2019. The most common oncologic subsites treated included the central nervous system (22%), gastrointestinal tract (20%), and genitourinary tract (20%). The most common histologies treated included prostate adenocarcinoma (19%), non-small cell lung cancer (10%), primary CNS gliomas (8%), and esophageal cancer (8%). Rationale for PBT treatment included limitation of dose to adjacent critical organs at risk (67%), reirradiation (19%), and patient comorbidities (11%). Patients received at least one x-ray fraction delivered as prescribed (36%) or less commonly due to unplanned machine downtime (34%). Concurrent systemic therapy was administered to 57 patients (43%). Twenty-six patients (20%) were initially denied insurance coverage and required peer-to-peers (65%), written appeals (12%), secondary insurance approval (12%), and comparison x-ray to proton plans (8%) for subsequent approval. Proton beam radiotherapy approval required a median of 17 days from insurance submission. Discussion: Incorporation of PBT into our existing cancer center allowed for multidisciplinary oncologic treatment of a diverse population of patients. Insurance coverage for PBT presents as a significant hurdle and improvements are needed to provide more timely access to necessary oncologic care.

Implementation of MR-linac and proton therapy in two radiotherapy departments in The Netherlands: Recommendations based on lessons learned

“…Surprisingly, there is a paucity of data about downtime of PT and MRL machines. For PT it is reported that downtime more frequently leads to delayed than to missed treatments; others report to replace PT by photon fractions [19][20], which is probably dependent on whether photon therapy is available on site, and on the indication for which PT was given. Switching to photon therapy may appear problematic for a patient, but may be preferred for tumours for which a treatment interruption is associated with impaired local tumour control rates.…”

“…Ó 2021 The Authors. Published by Elsevier B.V. Radiotherapy and Oncology 167 (2022) [14][15][16][17][18][19][20][21][22][23][24] This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).…”

The Future of Proton Therapy

“…Proposals over the past several years have suggested movement to a single model of reimbursement agnostic of therapy approach, implying that proton and photon case reimbursement including the use of advanced technologies would be identical. Although these models for reimbursement have not yet been implemented, institutions planning on developing proton care must remain cognizant that reimbursement models will likely change in the near future and a strategy for both growth and cost containment must be incorporated into the business plan for proton development moving forward [25,26].…”

“…The goal for proton care moving forward is to integrate to advantages of photon care into the proton footprint. This would include tools for image guidance, beam precision, and optical tracking as well as create synergy and integration among the physics and therapy staff [25,26].…”

“…As reimbursement models change and become agnostic to radiation therapy technique, there will be more effort to move this strategy into a different pathway as reimbursement for proton care will become more aligned with photon care. It will be necessary for departments to provide hybrid strategies as reimbursement becomes photon/particle transparent and internal economies of scale for patient care will need to be enhanced [25][26][27][28][29][30][31][32][33][34][35][36][37][38].…”