Proton Beam Radiation Therapy: Balancing Evidence-Based Use with the Bottom Line (Part 3 of a Multipart Investigation)

specific-use controversies (especially regarding prostate cancer), proton beam radiation therapy (PBRT) remains a much sought-after technology for certain cancer centers, as well as some institutions that don’t even have any direct health care affiliations. As reported in Part 3 of this series in the April 25th issue, the current PBRT club consists of only seven members providing clinical care with a few other facilities either already under construction or being considered so for the future, often depending more on financing than medical science. OT requested interviews over several weeks from various institutions to discuss how PBRT was being utilized in today’s competitive health care environment Interestingly some of those centers without the technology declined to discuss the matter at all, as did the granddaddy of proton therapy centers, Loma Linda University Medical Center. For example, after learning from several sources about a proposed consortium among several prominent academic cancer centers in New York City, I hoped to speak with Simon N. Powell, MD, PhD, Chair of the Department of Radiation Oncology at Memorial Sloan-Kettering Cancer Center (MSKCC), to learn more about the concept—which seemed to be a very cost-effective and collegial attempt at making this expensive technology available to more patients without any single institution incurring the crushing costs—as well as to find out where MSKCC might refer its patients who could benefit from proton therapy. Via the Cancer Center’s Public Affairs Office, though, Dr. Powell declined to be interviewed, saying that it was too early and premature to discuss either PBRT or the consortium. Dr. Powell’s counterpart at Roswell Park Cancer Institute, Michael R. Kuettel, MD, PhD, MBA, President of the American College of Radiation Oncology (ACRO), also declined, replying through Public Affairs that he was not an expert on proton beam radiation therapy and that any questions regarding ACRO’s position would have to be submitted in writing for review by the association’s board. Johns Hopkins Cancer Center said it would not refer any prostate cancer patients for proton therapy, but did send some pediatric sarcoma patients to Massachusetts General Hospital for a specific clinical trial. I called Jerry D. Slater, MD, Professor and Chairman of the Department of Radiation at Loma Linda, home of the James M. Slater, MD, Proton Treatment and Research Center, named for his father, and operating since 1990. I was told that Dr. Slater was unreachable until more than week after this article was to be submitted, and then asked the public affairs department for another expert. They insisted on a list of specific questions, which I sent, but no one followed up by the deadline.