Proton Beam Therapy versus Photon Radiotherapy for Adult and Pediatric Oncology Patients: A Review of the Clinical and Cost-Effectiveness

( Last Updated : May 20, 2016)
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:



  1. What is the clinical effectiveness of proton beam therapy for the treatment of cancer patients?

  2. What is the cost-effectiveness of proton beam therapy for the treatment of cancer patients?

Key Message

Two systematic reviews of clinical evidence, two systematic reviews of economic evidence, and one primary economic evaluation were identified regarding the clinical and cost-effectiveness of proton beam therapy compared to photon radiotherapy for the treatment of cancer patients. There was limited comparative evidence, with insufficient evidence available for many indications, comparators, and outcomes. Comparable benefits and harms were demonstrated by most studies for the majority of outcomes in prostate, esophageal, lung, and breast cancer, as well as medulloblastoma, and pediatric brain tumours. An increased risk of patient harms was observed for some outcomes in breast, esophageal, prostate and lung cancer. As well, reduced survival was reported for spinal cord gliomas. Reduced harms were reported for some outcomes in patients with medulloblastoma, as well as lung, esophageal, and prostate cancer, and pediatric retinoblastoma. There was insufficient evidence to draw conclusions for recurrent liver and brain cancers, meningioma, head and neck cancers, uveal hemangioma, and for the outcome of secondary malignancies. The identified economic evidence is likely not generalizable to the Canadian context, and may not reflect accurate and up-to-date cost and benefit estimates. Most evaluations reported that PBT was not cost-effective; however, the technology was more likely to be cost-effective in pediatric populations, and under specific circumstances in younger adults, and patients with more advanced disease (e.g., high risk head and neck, lung cancer, and breast cancer patients). Overall, current comparative evidence does not suggest that PBT is superior to photon therapy from a clinical or cost perspective for the majority of indications. There are concerns regarding the quantity, quality and generalizability of the available evidence. Current ongoing studies and future investigation into differences in hard clinical endpoints and long-term outcomes may resolve some of this uncertainty.