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

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 pa...

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Autores principales: Newhauser, Wayne D., Zhang, Rui, Jones, Timothy G., Giebeler, Annelise, Taddei, Phillip J., Stewart, Robert D., Lee, Andrew, Vassiliev, Oleg
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491679/
https://www.ncbi.nlm.nih.gov/pubmed/25920039
http://dx.doi.org/10.3390/cancers7020688
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author Newhauser, Wayne D.
Zhang, Rui
Jones, Timothy G.
Giebeler, Annelise
Taddei, Phillip J.
Stewart, Robert D.
Lee, Andrew
Vassiliev, Oleg
author_facet Newhauser, Wayne D.
Zhang, Rui
Jones, Timothy G.
Giebeler, Annelise
Taddei, Phillip J.
Stewart, Robert D.
Lee, Andrew
Vassiliev, Oleg
author_sort Newhauser, Wayne D.
collection PubMed
description 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.
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spelling pubmed-44916792015-07-06 Reducing the Cost of Proton Radiation Therapy: The Feasibility of a Streamlined Treatment Technique for Prostate Cancer Newhauser, Wayne D. Zhang, Rui Jones, Timothy G. Giebeler, Annelise Taddei, Phillip J. Stewart, Robert D. Lee, Andrew Vassiliev, Oleg Cancers (Basel) Article 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. MDPI 2015-04-24 /pmc/articles/PMC4491679/ /pubmed/25920039 http://dx.doi.org/10.3390/cancers7020688 Text en © 2015 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Newhauser, Wayne D.
Zhang, Rui
Jones, Timothy G.
Giebeler, Annelise
Taddei, Phillip J.
Stewart, Robert D.
Lee, Andrew
Vassiliev, Oleg
Reducing the Cost of Proton Radiation Therapy: The Feasibility of a Streamlined Treatment Technique for Prostate Cancer
title Reducing the Cost of Proton Radiation Therapy: The Feasibility of a Streamlined Treatment Technique for Prostate Cancer
title_full Reducing the Cost of Proton Radiation Therapy: The Feasibility of a Streamlined Treatment Technique for Prostate Cancer
title_fullStr Reducing the Cost of Proton Radiation Therapy: The Feasibility of a Streamlined Treatment Technique for Prostate Cancer
title_full_unstemmed Reducing the Cost of Proton Radiation Therapy: The Feasibility of a Streamlined Treatment Technique for Prostate Cancer
title_short Reducing the Cost of Proton Radiation Therapy: The Feasibility of a Streamlined Treatment Technique for Prostate Cancer
title_sort reducing the cost of proton radiation therapy: the feasibility of a streamlined treatment technique for prostate cancer
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491679/
https://www.ncbi.nlm.nih.gov/pubmed/25920039
http://dx.doi.org/10.3390/cancers7020688
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