title: A systematic literature review of the clinical and cost-effectiveness of hadron therapy in cancer.
abstract: 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 Established experts were contacted for unpublished data.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.
authors.affiliation: Cochrane Cancer Network, Oxford, UK. mlodge@canet.org
authors.forename: Mark
authors.initials: M
authors.lastname: Lodge
authors.forename: Madelon
authors.initials: M
authors.lastname: Pijls-Johannesma
authors.forename: Lisa
authors.initials: L
authors.lastname: Stirk
authors.forename: Alastair J
authors.initials: AJ
authors.lastname: Munro
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ruysscher
authors.forename: Tom
authors.initials: T
authors.lastname: Jefferson
mesh_terms: 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
chemical_list: D011522:Protons