Proton beam RT not exempt from evidence-based medicine

In May 2008 (p. 44), ONI reviewed an article by Herman Suit, MD, and colleagues in which they argued that randomized trials of proton beam therapy vs standard radiotherapy are not needed prior to a wider use of proton beam therapy (Radiotherapy and Oncology 86:148-153, 2008). In an ONI reader poll, 81% disagreed with Dr. Suit, as does Dr. Robert Parker, of SUNY Stony Brook, in his letter below.

I absolutely DO NOT find Dr. Suit et al’s argument against the need for comparative studies of proton beam vs photon beam radiation therapy convincing. While proton beam theoretically offers better therapy, this must be validated in clinical trials. I would also make the same argument for other “advances” in radiotherapy such as IMRT (intensity-modulated radiation therapy).

As the economics of healthcare become more stressed and come under greater scrutiny, physicians must work to make sure that any new technology introduced offers an outcome advantage. Despite Dr. Suit’s comment that we wouldn’t be having this discussion if proton beam RT weren’t so expensive, the fact remains that it is, and this expense cannot be ignored.

While we should not make decisions on the cost of a therapy alone, we should understand its cost-effectiveness or “cost-appropriateness” when deciding whether a therapy is appropriate to bring “on line.” An adherence to evidence-based medicine requires that there is evidence of benefit.

Robert I. Parker, MD, FAAP
Professor and Vice Chair of Pediatrics for Academic Affairs Director, Pediatric Hematology/Oncology
Associate Director, Stony Brook University Cancer Center
SUNY at Stony Brook

We welcome further discussion of this issue. Please send your comments to ONI News Editor Shalmali Pal: Shalmali.Pal@cmpmedica.com