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 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.
Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, LA 70803, USA. newhauser@lsu.edu.|Department of Physics, Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, LA 70809, USA. newhauser@lsu.edu.
Wayne D
WD
Newhauser
Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, LA 70803, USA. rzhang@marybird.com.|Department of Physics, Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, LA 70809, USA. rzhang@marybird.com.|Departments of Radiation Physics and Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. rzhang@marybird.com.|The University of Texas Graduate School of Biomedical Sciences, Houston, TX 77030, USA. rzhang@marybird.com.
Rui
R
Zhang
Departments of Radiation Physics and Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. bandnerdtmi@gmail.com.|The University of Texas Graduate School of Biomedical Sciences, Houston, TX 77030, USA. bandnerdtmi@gmail.com.|Department of Physics, Abilene Christian University, ACU Box 27963, Abilene, TX 79699, USA. bandnerdtmi@gmail.com.
Timothy G
TG
Jones
Departments of Radiation Physics and Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Giebeler.Annelise@scrippshealth.org.|The University of Texas Graduate School of Biomedical Sciences, Houston, TX 77030, USA. Giebeler.Annelise@scrippshealth.org.
Annelise
A
Giebeler
Departments of Radiation Physics and Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. pt06@aub.edu.lb.|The University of Texas Graduate School of Biomedical Sciences, Houston, TX 77030, USA. pt06@aub.edu.lb.
Phillip J
PJ
Taddei
Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356043, Seattle, WA 98195, USA. trawets@uw.edu.
Robert D
RD
Stewart
Departments of Radiation Physics and Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. aklee@mdanderson.org.
Andrew
A
Lee
Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, LA 70803, USA. ovassiliev@marybird.com.|Department of Physics, Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, LA 70809, USA. ovassiliev@marybird.com.
Oleg
O
Vassiliev