Current practice in proton therapy delivery in adult cancer patients across Europe

Makbule Tambas*, Hans Paul van der Laan, Roel J H M Steenbakkers, Jerome Doyen, Beate Timmermann, Ester Orlandi, Morten Hoyer, Karin Haustermans, Petra Georg, Neil G Burnet, Vincent Gregoire, Valentin Calugaru, Esther G C Troost, Frank Hoebers, Felipe A Calvo, Joachim Widder, Fabian Eberle, Marco van Vulpen, Philippe Maingon, Tomasz SkóraDamien C Weber, Kjell Bergfeldt, Jiri Kubes, Johannes A Langendijk

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND AND PURPOSE: Major differences exist among proton therapy (PT) centres regarding PT delivery in adult cancer patient. To obtain insight into current practice in Europe, we performed a survey among European PT centres.

MATERIALS AND METHODS: We designed electronic questionnaires for eight tumour sites, focusing on four main topics: 1) indications and patient selection methods; 2) reimbursement; 3) on-going or planned studies, 4) annual number of patients treated with PT.

RESULTS: Of 22 centres, 19 (86%) responded. In total, 4233 adult patients are currently treated across Europe annually, of which 46% consists of patients with central nervous system tumours (CNS), 15% head and neck cancer (HNC), 15% prostate, 9% breast, 5% lung, 5% gastrointestinal, 4% lymphoma, 0.3% gynaecological cancers. CNS are treated in all participating centres (n = 19) using PT, HNC in 16 centres, lymphoma in 10 centres, gastrointestinal in 10 centres, breast in 7 centres, prostate in 6 centres, lung in 6 centres, and gynaecological cancers in 3 centres. Reimbursement is provided by national health care systems for the majority of commonly treated tumour sites. Approximately 74% of centres enrol patients for prospective data registration programs. Phase II-III trials are less frequent, due to reimbursement and funding problems. Reasons for not treating certain tumour types with PT are lack of evidence (30%), reimbursement issues (29%) and/or technical limitations (20%).

CONCLUSION: Across European PT centres, CNS tumours and HNC are the most frequently treated tumour types. Most centres use indication protocols. Lack of evidence for PT and reimbursement issues are the most reported reasons for not treating specific tumour types with PT.

Original languageEnglish
Pages (from-to)7-13
Number of pages7
JournalRadiotherapy and Oncology
Early online date11-Dec-2021
Publication statusPublished - Feb-2022


  • Proton therapy
  • Adult patients
  • Patient selection
  • Model-based approach
  • Reimbursement
  • Clinical studies
  • Europe
  • HEAD

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