The American Society for Radiation Oncology (ASTRO)’s evidence-based Model Policy for PBT supports its use for several pediatric (especially brain) tumors, ocular melanoma, lesions at or near the base of the skull such as chordomas and chondrosarcomas, spine tumors, and primary hepatocellular carcinomas treated in a hypofractionated regimen.4

Clinical research is under way for PBT of adult breast, prostate, and lung cancers. The Model Policy supports coverage of PBT for patients enrolled in clinical trials, and patients “with difficult-to-treat, rare, or highly complex cases for which the characteristics of PBT offers advantages over other forms of treatment.”4

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The Model Policy cautions that more research is needed to assess whether or not PBT represents a better option than intensity-modulated radiotherapy or other radiotherapy modalities for prostate cancer.4

RELATED: ASCO Endorses AUA/ASTRO Treatment Guideline Regarding Radiotherapy After Prostatectomy

For prostate cancer and other major common cancer types, like lung and breast cancer, the value of proton beam is “unproven and may not, in most cases, exist as there are excellent alternatives,” according to Dr. Zietman.

“Whether the race to build proton centers all over the country without solid clinical evidence is an example of amazing medical foresight or amazing financial folly” is also unclear, he concluded.


  1. Furlow B. Dosimetric promise versus cost: critics question proton therapy. Lancet Oncol. 2013;14(9):805-806.
  2. Halperin EC. The proton problem. Lancet Oncol. 2013;14(11):1046-1047.
  3. Gold J. Proton beam therapy sparks hospital arms race. National Public Radio. Published May 31, 2013. Accessed November 11, 2014.
  4. Model Policies: Proton Beam Therapy (PBT). American Society for Radiation Oncology. Accessed November 11, 2014.