A systematic literature review of the clinical and cost-effectiveness of hadron therapy in cancer.
BACKGROUND
In view of the continued increase in the number of hadron (i.e. neutron, proton and light or heavy ion) therapy (HT) centres we performed a systematic literature review to identify reports of the efficacy of HT.


METHODS
Eleven databases were searched systematically. No limit was applied to language or study design. Established experts were contacted for unpublished data. Data on outcomes were extracted and summarised in tabular form.


RESULTS
Seven hundred and seventy three papers were identified. For proton and heavy ion therapy, the number of RCTs was too small to draw firm conclusions. Based on prospective and retrospective studies, proton irradiation emerges as the treatment of choice for some ocular and skull base tumours. For prostate cancer, the results were comparable with those from the best photon therapy series. Heavy ion therapy is still in an experimental phase.


CONCLUSIONS
Existing data do not suggest that the rapid expansion of HT as a major treatment modality would be appropriate. Further research into the clinical and cost-effectiveness of HT is needed. The formation of a European Hadron Therapy Register would offer a straightforward way of accelerating the rate at which we obtain high-quality evidence that could be used in assessing the role of HT in the management of cancer.
Lodge
Mark
M
Cochrane Cancer Network, Oxford, UK. mlodge@canet.org
Pijls-Johannesma
Madelon
M
Stirk
Lisa
L
Munro
Alastair J
AJ
De Ruysscher
Dirk
D
Jefferson
Tom
T
D003362:Cost-Benefit Analysis; D063193:Heavy Ion Radiotherapy; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D010315:Particle Accelerators; D017785:Photons / Q000627:therapeutic use; D061766:Proton Therapy; D011882:Radiotherapy, High-Energy / Q000191:economics* / Q000379:methods*; D011522:Protons
D011522:Protons