AQuAS has performed a systematic review of the scientific literature. Meta-analyses, systematic reviews and evidence-based documents were searched, trying to find publications with one of the following topics: local control of a tumour, global survival, metastasis-free survival, toxicity and secondary effects, and cost-effectiveness assessment. The authors have checked the following databases, selecting the publications from 2013 onwards: Medline, Scopus, the Cochrane Library Plus, ISI Web of Knowledge, TRIP database, National Health Service Evidence, National Health Service Centre for Reviews and Dissemination, Health Technology Assessment Database, National Health Service Economic Evaluation Database and Database of Abstracts of Reviews of Effects.
The search has resulted in selecting 19 publications. The studies demonstrated different results depending on the type of cancer and the criteria used for the assessment. Proton therapy only had a global benefit in the treatment of medulloblastoma (in all age groups), when compared with other types of radiotherapy. Notwithstanding the abovementioned, the proton therapy showed gains in some features analyzed in other pediatric cancers (efficacy, effectiveness and safety), in skull base tumours (efficacy and effectiveness) and in the uveal melanoma (efficacy, effectiveness and safety). However, many authors pointed out the need for more high-quality and rigorous studies to extract valid conclusions.
In conclusion, proton therapy did not show more efficacy, effectiveness, cost-effectiveness and safety than the photon or ion therapies in most cancer types, but did demonstrate better global results for medulloblastoma, whereas in some other conditions it proved benefits for at least one analyzed feature (as seen above). These conclusions are similar to those reported in the 2014 HTA report, and the AQuAS supports further studies with higher-quality scientific evidence to be undertaken in order to establish solid recommendations for clinical practice.
The use of the proton therapy should be supported in cases where there is enough evidence (particularly in children’s tumours), and clinical results should be collected to allow the completeness of evidence.
See the full report in Spanish (with summary in English) here.
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