Proton Therapy in LMICs: Is the Need Justified?

Proton therapy in Asia Pacific: current resources, international disparities and steps forward

The burden of cancer in Asia Pacific, a region home to over four billion people, is growing. Because of sheer demographics alone, the Asia Pacific region arguably has the highest number of patients who can benefit from protons over conventional x-rays. However, only 39 out of 113 proton facilities globally are in Asia Pacific, and 11 of them are in low- and middle-income countries where 95% of the regional population reside. We draw attention to present resource distribution of proton therapy in Asia Pacific, highlight disparities in access, and suggest steps forward.

Encouraging early outcomes with image guided pencil beam proton therapy for cranio-spinal irradiation: first report from India

BACKGROUND

To report our experience with image guided pencil beam proton beam therapy (PBT) for craniospinal irradiation (CSI).

MATERIALS AND METHODS

Between January 2019 and December 2021, we carried out a detailed audit of the first forty patients treated with PBT. We had recorded acute toxicities, reporting early outcomes and discuss limitations of current contouring guidelines during CSI PBT planning.

RESULTS

Median age of the patient cohort was 8 years, and histologies include 20 medulloblastoma, 7 recurrent ependymoma, 3 pineoblastoma, 3 were germ cell tumors and remaining 7 constituted other diagnoses. Forty percent patients received concurrent chemotherapy. Median CSI dose was 23.4 Gy (Gray; range 21.6-35 Gy). Thirty-five patients (87.5%) completed their CSI without interruption, 5 required hospital admission. No patient had grade 2/ > weight loss during the treatment. Forty-five percent (18) developed grade 1 haematological toxicities and 20% (8) developed grade 2 or 3 toxicities; none had grade 4 toxicities. At median follow up of 12 months, 90% patients are alive of whom 88.9% are having local control. Special consideration with modification in standard contouring used at our institute helped in limiting acute toxicities in paediatric CSI patients.

CONCLUSION

Our preliminary experience with modern contemporary PBT using pencil beam technology and daily image guidance in a range of tumours suitable for CSI is encouraging. Patients tolerated the treatment well with acceptable acute toxicity and expected short-term survival outcome. In paediatric CSI patients, modification in standard contouring guidelines required to achieve better results with PBT.

Inequality in Accessibility of Proton Therapy for Cancers and Its Economic Determinants: A Cross-Sectional Study

Background

Cancer is a leading cause of death in the world, and the estimated new cancer cases were 19 million and the estimated cancer deaths were around 10 million worldwide in 2020. Proton therapy (PT) is a promising treatment for cancers; however, only few patients with cancer received PT due to limited number of PT centers worldwide, especially in low- and middle-income countries.

Methods and Results

Cross-sectional country level data were collected from publicly available information. Lorenz curves and Gini coefficient were used to assess the inequality in accessing to PT, and zero-inflated Poisson models were used to investigate the determinants of number of PT facilities in each country. The Gini coefficients were 0.96 for PT centers and 0.96 for PT chambers, which indicated high level of inequality. Total GDP had a significant impact on whether a country had a practical PT center, whereas total GDP and GDP per capita had significant impacts on the number of PT centers.

Conclusion

Extremely high inequality exists in accessibility of PT centers among all countries in the world. Economic development was the most important factor determining the adoption of PT; thus, with the growth in global economics, more PT centers can be expected in near future.