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Proton beam therapy utilization in adults with primary brain tumors in the United States

Published:March 14, 2020DOI:https://doi.org/10.1016/j.jocn.2020.03.011

      Highlights

      • There is an increase in patients with brain tumors treated with proton beam in the US.
      • High-grade glioma and medulloblastoma are among the most common histologies treated.
      • Most were 18–29 years old, Caucasian, privately insured, & at academic institutions.

      Abstract

      The utilization of proton beam therapy (PBT) as the primary treatment of adults with primary brain tumors (APBT) was evaluated through query of the National Cancer Database (NCDB) between the years 2004 and 2015. International Classification of Diseases for Oncology code for each patient was stratified into six histology categories; high-grade gliomas, medulloblastomas, ependymomas, other gliomas, other malignant tumors, or other benign intracranial tumors. Demographics of the treatment population were also analyzed. A total of 1,296 patients received PBT during the 11-year interval for treatment of their primary brain tumor. High-grade glioma, medulloblastoma, ependymoma, other glioma, other malignant, and other benign intracranial histologies made up 39%, 20%, 13%, 12%, 13%, and 2% of the cohort, respectively. The number of patients treated per year increased from 34 to 300 in years 2004 to 2015. Histologies treated with PBT varied over the 11-year interval with high-grade gliomas comprising 75% and 45% at years 2004 and 2015, respectively. The majority of the patient population was 18–29 years of age (59%), Caucasian race (73%), had median reported income of over $63,000 (46%), were privately insured (68%), and were treated at an academic institution (70%). This study characterizes trends of malignant and benign APBT histologies treated with PBT. Our data from 2004 through 2015 illustrates a marked increase in the utilization of PBT in the treatment of APBT and shows variability in the tumor histology treated over this time.

      Graphical abstract

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      References

        • Eaton B.R.
        • Esiashvili N.
        • Kim S.
        • Weyman E.A.
        • Thornton L.T.
        • Mazewski C.
        • et al.
        Clinical outcomes among children with standard-risk medulloblastoma treated with proton and photon radiation therapy: a comparison of disease control and overall survival.
        Int J Radiat Oncol Biol Phys. 2016; 94: 133-138
        • Eaton B.R.
        • Chowdhry V.
        • Weaver K.
        • Liu L.
        • Ebb D.
        • MacDonald S.M.
        • et al.
        Use of proton therapy for re-irradiation in pediatric intracranial ependymoma.
        Radiother Oncol. 2015; 116: 301-308
        • Mizumoto M.
        • Oshiro Y.
        • Takizawa D.
        • Fukushima T.
        • Fukushima H.
        • Yamamoto T.
        • et al.
        Proton beam therapy for pediatric ependymoma.
        Pediatr Int. 2015; 57: 567-571
        • Fuss M.
        • Hug E.B.
        • Schaefer R.A.
        • Nevinny-Stickel M.
        • Miller D.W.
        • Slater J.M.
        • et al.
        Proton radiation therapy (PRT) for pediatric optic pathway gliomas: comparison with 3D planned conventional photons and a standard photon technique.
        Int J Radiat Oncol Biol Phys. 1999; 45: 1117-1126
        • Park J.
        • Park Y.
        • Lee S.U.
        • Kim T.
        • Choi Y.K.
        • Kim J.Y.
        Differential dosimetric benefit of proton beam therapy over intensity modulated radiotherapy for a variety of targets in patients with intracranial germ cell tumors.
        Radiat Oncol. 2015; 10: 135
        • Boehling N.S.
        • Grosshans D.R.
        • Bluett J.B.
        • Palmer M.T.
        • Song X.
        • Amos R.A.
        • et al.
        Dosimetric comparison of three-dimensional conformal proton radiotherapy, intensity-modulated proton therapy, and intensity-modulated radiotherapy for treatment of pediatric craniopharyngiomas.
        Int J Radiat Oncol Biol Phys. 2012; 82: 643-652
        • Merchant T.E.
        • Hua C.H.
        • Shukla H.
        • Ying X.
        • Nill S.
        • Oelfke U.
        Proton versus photon radiotherapy for common pediatric brain tumors: comparison of models of dose characteristics and their relationship to cognitive function.
        Pediatr Blood Cancer. 2008; 51: 110-117
        • Combs S.E.
        • Kessel K.
        • Habermehl D.
        • Haberer T.
        • Jakel O.
        • Debus J.
        Proton and carbon ion radiotherapy for primary brain tumors and tumors of the skull base.
        Acta Oncol. 2013; 52: 1504-1509
        • Shih H.A.
        • Sherman J.C.
        • Nachtigall L.B.
        • Colvin M.K.
        • Fullerton B.C.
        • Daartz J.
        • et al.
        Proton therapy for low-grade gliomas: Results from a prospective trial.
        Cancer. 2015; 121: 1712-1719
      1. Therapy TNAfP. Proton Therapy Centers in the U.S. 2019. Accessed on 01/02/2020 at: https://www.proton-therapy.org/map/.

      2. Ferre RD. Proton Therapy Centers in the United States. 2019. Accessed on 01/02/2020 at: https://proton-therapy-centers.com/.

      3. Ostrom QT, Gittleman H, Fulop J, Liu M, Blanda R, Kromer C, Wolinsky Y, Kruchko C, Barnholtz-Sloan JS. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008-2012. Neuro Oncol. 2015;17 Suppl 4:iv1-iv62.

        • Ryckman J.M.
        • Ganesan V.
        • Kusi Appiah A.
        • Zhang C.
        • Verma V.
        National practice patterns of proton versus photon therapy in the treatment of adult patients with primary brain tumors in the United States.
        Acta Oncol. 2019; 58: 66-73
        • Tseng Y.D.
        • Hartsell W.
        • Tsai H.
        • Badiyan S.
        • Wang C.J.
        • Rossi C.
        • et al.
        Proton therapy patterns of care among pediatric and adult patients with CNS tumors.
        Neuro Oncol. 2018; 20: 1556-1557
      4. Surgeons ACo. National Cancer Database. 2019. Accessed on 01/02/2020 at: https://www.facs.org/quality-programs/cancer/ncdb.

      5. (IACR) IAoCR. International Classification of Diseases for Oncology (ICD-0-3). 2019. Accessed on 01/02/2020 at: http://www.iacr.com.fr/index.php?option=com_content&view=category&layout=blog&id=100&Itemid=577.

        • Ho E.S.Q.
        • Barrett S.A.
        • Mullaney L.M.
        A review of dosimetric and toxicity modeling of proton versus photon craniospinal irradiation for pediatrics medulloblastoma.
        Acta Oncol. 2017; 56: 1031-1042
      6. Health NIo. ClinicalTrials.gov Search for Proton, Adult, recruiting, active, and not recruiting studies. 2019. Accessed on 01/02/2020 at: https://clinicaltrials.gov/ct2/results?term=Proton&recrs=a&recrs=d&age_v=&age=1&gndr=&type=&rslt=&Search=Apply.

      7. (PTCOG) PTC-OG. Clinical Trials for Particle Therapy. 2019. Accessed on 01/02/2020 at: https://ptcog.ch/index.php/clinical-protocols.

      8. Services DoHaH. 42 CFR Part 512. Medicare Program; Specialty Care Models to Improve Quality of Care and Reduce Expenditures. 2019. Accessed on 01/02/2020 at: https://www.hhs.gov/sites/default/files/CMS-5527-P.pdf.

        • Bekelman J.E.
        • Denicoff A.
        • Buchsbaum J.
        Randomized Trials of Proton Therapy: Why They Are at Risk, Proposed Solutions, and Implications for Evaluating Advanced Technologies to Diagnose and Treat Cancer.
        J Clin Oncol. 2018; 36: 2461-2464
        • Gupta A.
        • Khan A.J.
        • Goyal S.
        • Millevoi R.
        • Elsebai N.
        • Jabbour S.K.
        • et al.
        Insurance Approval for Proton Beam Therapy and its Impact on Delays in Treatment.
        Int J Radiat Oncol Biol Phys. 2019; 104: 714-723
        • Yolcu Y.
        • Wahood W.
        • Kerezoudis P.
        • Alvi M.A.
        • Habermann E.B.
        • Bydon M.
        Primary central nervous system tumors: comparing two national cancer registries.
        World Neurosurg. 2019;