Authors' objectives:

Comparative evaluation to assess the place of proton and neutron therapy in relation to other cancer treatment modalities, in terms of local control rates, and 5-year survival, at the request of the Hospital Board of the French Ministry of Social Affairs, Health and Urban Affairs.

Authors' results and conclusions: Proton therapy is indicated in clearly delimited tumors adjacent to a functionally important radiosensitive structure which must be spared (melanomas of the choroid, tumors of the base of the skull (chordomas, chondrosarcomas)). Neutron therapy can treat certain salivary gland tumors (cylindromas or adenoid cystic carcinomas), inoperable low-grade soft tissue sarcomas, stage C and D1 prostate cancer and certain radioresistant tumors: hyposia-related radioresistance of large carcinomas, post-irradiation radioresistance, tumors with long doubling times and tumors with a high repair capacity. No advantage has been demonstrated for neutron therapy over conventional radiotherapy in CNS tumors. Cost of equipment:4 linear accelerators for conformational radiotherapy: 8 million dollars; proton therapy: 16 million dollars: Lifespan: cyclotron: 25-30 years: linear accelerator: 10-12 years. Only one supplier of cyclotrons. The cost of treatment by proton therapy is 2- to 3-fold higher than that of conformational radiotherapy. Economic evaluation is only indicated in tumors in which proton therapy has been shown to be more effective. A comparative trial of Iodine 125 and protons could be conducted in uveal melanoma. Comparative clinical trials must be conducted to define the role of proton therapy or neutron therapy in other tumors, in a strictly limited number of centers (rare tumors, high investment costs), in tumors selected on the basis of recent data, and with real cost analysis of the two techniques.

Authors' recommendations: Other output or dissemination activity: To date, there are only three centers in France allowed to use these devices. There is no current consideration to increase the number of these centers.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.has-sante.fr/

Year Published: 1995

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: L'Agence Nationale d'Accreditation d'Evaluation en Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: sh.leerobin@has-sante.fr

Contact Email: sh.leerobin@has-sante.fr

Copyright: Agence Nationale pour le Developpement de l'Evaluation Medicale