The use of proton beam therapy (PBT) is increasing in the United States, according to a study published in JAMA Oncology.

Researchers observed an increase in PBT use between 2004 and 2018, particularly for cancers in which the effectiveness of PBT is still under investigation.

The study included 5,919,368 patients from the National Cancer Database who were newly diagnosed with cancer between 2004 and 2018. Researchers used the American Society of Radiation Oncology’s 2017 Model Policies to classify these patients into 2 groups. 

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Group 1 had health insurance coverage that recommended PBT treatment. These patients had ocular tumors, head and neck cancer, central nervous system cancer, hepatocellular carcinoma, skull and spine tumors, and rhabdomyosarcoma. 

Group 2 had insurance coverage that recommended PBT treatment only if certain requirements were met. These patients had prostate, lung, breast, esophagus, pelvic (including colorectal, anal, uterine, cervical, and testicular) cancers, abdominal (including stomach, pancreas, and kidney) tumors, and thoracic lymphomas. Patients in group 2 were treated while clinical evidence for medical necessity was accruing.


In the overall cohort, PBT use increased from 0.4% in 2004 to 1.2% in 2018 (annual percent change [APC], 8.12%; P <.001). 

In group 1, PBT use increased from 0.4% in 2010 to 2.2% in 2018 (APC, 21.97; P <.001). In group 2, PBT use increased from 0.03% in 2014 to 0.1% in 2018 (APC, 30.57; P <.001). 

In group 1, the use of PBT increased significantly between 2010 and 2018 across all cancer types. The most rapid increase was seen for head and neck cancers (APC, 52.0%).

In group 2, the use of PBT increased for all cancers except prostate cancer. From 2010 to 2018, PBT targeted to the breast increased from 0.0% to 0.9% (APC, 51.95%; P <.001), and PBT targeted to the lung increased from 0.1% to 0.7% (APC, 28.06%; P <.001). 

PBT targeted to the prostate decreased from 1.4% in 2011 to 0.8% in 2014 (APC, −16.48%; P = .03) but then rebounded to 1.3% in 2018 (APC, 12.45; P <.001).

“The findings of this study suggest that PBT uptake varies by indication group and is most commonly used to treat cancers for which PBT effectiveness is still under study,” the researchers concluded.

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Nogueira LM, Jemal A, Yabroff KR, et al. Assessment of proton beam therapy use among patients with newly diagnosed cancer in the US, 2004-2018. JAMA Netw Open. Published online April 27, 2022. doi:10.1001/jamanetworkopen.2022.9025