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by bonsai_spool 141 days ago
> What do you mean by 'any evidence that works better Than alternatives'?

I mean exactly that, clinical trials demonstrating that proton therapy is superior to radiation therapy. This is not a question about the physics but about how patients respond (and whether the expense of delivering proton therapy outweighs the expected marginal benefits).
1 comments
somethingsome 141 days ago
As a non expert, I can't pronounce myself on the subject, I found this recent study:

https://www.mdanderson.org/newsroom/research-newsroom/proton...

But on the subject of discoveries and practical uses, the IBA cyclotrons are also used for other purposes than proton therapy: cleaning exotic fruits from dangerous substances and personalized medicine.

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bonsai_spool 141 days ago
This may be one of the good cases, then. I'm not an expert in cancer but I am a biologist and physician. The head and neck cancer (here) and various pediatric indications get the most attention but it has felt that proton therapy has been seeking an indication for almost 40 years now.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

The study was designed to show non-inferiority, which doesn't preclude their ability to show an improvement. It would be helpful to see other studies before determining that proton therapy is better (or even non-inferior) to radiation therapy. It's certainly much more expensive, which shows up in the study as many subjects being denied insurance coverage.

Edit: This is now in the weeds, but the per-protocol participants didn't fare better than the intention-to-treat participants, which one might expect since insurance approval lead to dozens of subjects changing treatment arms.

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somethingsome 141 days ago
In Europe at least, many insurances cover it if you have the right criterias.

From my visits, they mostly focus on children that have some very nasty cancers, the IBA hospitals are all designed with children in mind (to avoid stressing them), and from my memory, a unique hospital is often enough to treat a whole country for the kind of cancer they target.

Now, if it is on par with classical radiotherapy BUT it gives less subsequent problems, it might be worth the cost as subsequent problems can be as expensive or even more than the original treatment. It becomes an actuarial issue to know where is the tradeoff.

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bonsai_spool 141 days ago
Yes, all of your points are presented as arguments to pay for this (children, comorbodities, specialization, specific cancers)
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somethingsome 141 days ago
I think we agree in general, I don't disagree that maybe Proton therapy is not better than radiotherapy, it might but we lack some evidence.

I only argue that if they are equal in quality of treatment and the 'total cost' is the evaluation parameter, it is way more complex than the treatment itself, and it could be justified to use proton therapy, even if more expensive.

Nice talk anyways :)

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