Report of the Spanish Network of Agencies for Assessing National Health System Technologies and Performance.
To review and update the scientific evidence published on the efficacy, effectiveness, safety and cost-effectiveness of the protontherapy for the treatment of cancer in different locations.
A systematic review of the scientific literature was undertaken that included scientific publications with the following criteria: systematic reviews, metaanalysis and evidence-based documents. All publications should consider one of the following outcomes: tumor local control, global survival, metastasis-free survival, toxicity and secondary effects, and cost-effectiveness assessment.The following databases were searched: 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. Searches were performed through the keywords of interest and the reference review of the most important articles. Systematic reviews on this issue were selected from 2013.
A total of 19 documents were selected. The protontherapy showed unequal results depending on the cancer type and the criteria used for the evaluation. Protontherapy only had a global benefit in the treatment of meduloblastoma (in any age group)compared with other types of radiotherapy. Notwithstanding the abovementioned, the protontherapy showed benefits in some features analyzed in other pediatric cancers (efficacy, effectiveness, and safety), in skull base tumors (efficacy and effectiveness) and in the uveal melanoma (efficacy, effectiveness, and safety). Many authors pointed out the need of more high-quality and rigorous studies to extract valid conclusions.
Protontherapy did not show more efficacy, effectiveness, cost-effectiveness and safety than the photon or ion therapies in most cancer types. However, protontherapy showed better global results for meduloblastoma; whereas, for several pediatric tumors of the central nervous system, the skull base tumors, and the uveal melanoma, this therapy showed some benefit at least in one of the analyzed features.
In light of these conclusions, similar to those found in the 2014 Health technology assessment report, further studies providing higher quality scientific evidence should be undertaken in order to establish solid reccommendations for clinical practice.
It would be reasonable to choose to use the protontherapy in cases where there is enough evidence (particularly in children’s tumors) along with the recording of clinical results to allow the completeness of evidence. It would also be reasonable to promote the gathering of new evidence from randomized controlled trials or by means of coverage with evidence development schemes.