Back up the Brinks truck.

Proton therapy haters often cite its associated high costs, unreliable accessibility, and largely theoretical benefits. One of the few randomized trials on the subject was reported this month in JCO. Patients with locally advanced non-small cell lung cancer received either proton or photon radiation with all plans meeting pre-specified planning objectives. The hope was that pneumonitis would be reduced from 15% to 5% with protons while meeting the historic local failure rate of no more than 25%. The results: No difference in rates of local failure (11%) or radiation pneumonitis (6-11%). A positive takeaway is that outcomes improved both since previous trials and even throughout the study period. What does this mean for us? Widely available photon-based radiation techniques have advanced tremendously--to the point that the technology of photon delivery may in many scenarios overcome the small inherent advantages of protons, such as a smaller integral dose. What does this mean for the country? Investment in advancing more widely available technologies would likely have a bigger impact on the care of more people.