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Proton beam therapy – Do we need the randomised trials and can we do them?

2007; Elsevier BV; Volume: 83; Issue: 2 Linguagem: Inglês

10.1016/j.radonc.2007.04.009

1879-0887

Bengt Glimelius, Anders Montelius,

Advances in Oncology and Radiotherapy

The first radiation therapy report by the Swedish Council on Technology Assessment in Health Care (SBU) was much appreciated when it was published since it showed that the level of scientific evidence for most radiation therapy practices was at a high level [ 1 SBU – The Swedish Council on Technology Assessment in Health Care. Radiotherapy for cancer. Volume 1. Acta Oncol 1996;35. Google Scholar , 2 SBU – The Swedish Council on Technology Assessment in Health Care. Radiotherapy for Cancer. Volume 2: A critical review of the literature. Acta Oncol 1996;35. Google Scholar ]. In the preparatory discussions prior to the decision to perform the systematic overview of the radiation therapy effects, it was unofficially stated that 'radiotherapy is an expensive treatment that has only minor evidence'. The overview reached the opposite conclusions. The same conclusions, namely that most radiotherapy practices are according to high levels of evidence, were reached in a second report performed more recently [ [3] Ringborg U. Bergqvist D. Brorsson B. et al. The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of radiotherapy for cancer including a prospective survey of radiotherapy practice in Sweden 2001 – summary and conclusions. Acta Oncol. 2003; 42: 357-365 Crossref PubMed Scopus (145) Google Scholar ]. The use of new types of radiation sources like protons and light ions was regarded as expected treatments for the future in both examinations [ 4 Svensson H. Einhorn S. Future developments in radiotherapy. Acta Oncol. 1996; 35: 75-83 Google Scholar , 5 Svensson H. Möller T. Developments in radiotherapy. Acta Oncol. 2003; 42: 430-442 Crossref PubMed Scopus (26) Google Scholar ], based upon favourable dose distributions and increased biological effects. The literature about the use of these beams for therapy was not reviewed, but the scientific evidence for superiority was regarded as low.