Plenary lecture: Proton therapy in the USA: When advanced technology and economic reality collide – Anthony Zietman, Massachusetts General Hospital, USA

Host: Adrian Crellin, NHS England


Room: Hall 1A

Proton therapy is the latest and most advanced evolution of radiation therapy and, if progress is an arrow, proton therapy sits at the tip. It offers radiation delivery with unparalleled accuracy and the chance to eradicate discrete cancers with minimal damage to the surrounding tissues. There has been a huge level of interest globally, and two nations, the US and Japan, have been prodigious early adopters. The rest of the world is now coming aboard but, as they do, it would be well to take stock of the turbulent US experience, which, to some degree, has defined how not to go about it. The size and cost of proton therapy units vastly exceeds that of any other medical device previously developed, and the downstream consequences of the necessary levels of investment were not appreciated. The failure to develop an evidence base has led to payment “blow-back” by insurers, and the original prostate cancer economic model has collapsed. Many US facilities are either in, or are facing, bankruptcy. Many of the key research questions remain unaddressed because of a lack of organization and the urgent need for over-extended institutions simply to survive. We thus have only theoretical demonstration of any advantage to this therapy. It is possible that the situation will be made easier by the development of cheaper, single-gantry proton machines, or by device miniaturization but, in the US, this may be too little, too late. This talk will describe the evolution of this situation and give an appraisal of Britain’s position. It will also chart a research strategy that the UK may adopt in order to maximize this modality’s potential. Proton therapy stands at a “tipping point”. It must organize a robust evidence-base in order to move forward, or else it will slip backwards and be regarded as a moment of madness in the march of medicine.