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Proton therapy for esophageal cancer: very little information to support a news release’s claims of benefit

New study finds that proton therapy has fewer side effects in esophageal cancer patients

Our Review Summary

Treatment room at the Maryland Proton Treatment Center.

Treatment room at the Maryland Proton Treatment Center.

Proton therapy has been shown to be a significant improvement over other forms of radiation therapy for a select group of conditions including: intracranial arteriovenous malformations (AVMs); ocular tumors, including intraocular/uveal melanoma; and skull-based tumors (e.g., chordomas or chondrosarcomas). Its value in other tumor types and conditions has not been demonstrated in a randomized clinical trial. The University of Maryland (UMD) release claims that proton therapy, also known as proton beam therapy, causes fewer toxic side effects when used to treat esophageal cancer patients. However, that’s about all we learn from this news release. The release doesn’t touch on many important questions, such as how many fewer side effects proton beam therapy causes, whether those side effects actually reduce health risk for patients, or whether proton therapy is more effective at treating the cancer. The release also doesn’t address cost or even describe the study that forms the basis for the claims.

 

Why This Matters

The National Cancer Institute reports that more than 35,000 people in the United States were living with esophageal cancer in 2012. Radiation therapy to treat cancer can cause a wide array of negative side effects, which can affect both quality of life and long-term health. Anything that can be done to limit those side effects is worth covering. But there’s another reason to pay close attention to emerging research on proton therapy: money. According to a Wall Street Journal article published May 26, 16 proton therapy centers are under construction in the United States — at a cost of up to $200 million each. That’s on top of more than a dozen such centers that have already been built. However, there are a lot of questions about whether proton therapy offers better health outcomes than other radiation therapy techniques. Or, as a 2014 article in Modern Healthcare put it, “Hospitals investing in proton-beam radiation therapy centers are gambling on clinical evidence that is still years away to justify their plunge into the expensive technology.” HealthNewsReview has written about proton therapy at length, and for good reason: an unproven treatment technique that involves human lives, human health, and billions of dollars in industry investment is a subject worth following.

 

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

The release mentions that UMD is currently building a proton beam center that will cost $200 million. However, there’s no information about the actual cost of treatment with proton therapy compared with other radiation treatment techniques. Proton therapy is significantly more expensive. The American Cancer Society noted in 2013 that “Medicare pays about $19,000 for a full dose of standard radiation therapy for prostate cancer, but it pays nearly double for proton therapy – more than $32,000.”

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The release states in the opening paragraph that “patients treated with proton therapy experienced significantly less toxic side effects than patients treated with older radiation therapies.” But it never offers detailed information on what that means. For example, the release later states that proton therapy resulted “a significantly lower number of side effects, including nausea, blood abnormalities, and loss of appetitite.” How much less likely were patients that received proton therapy to experience these side effects? Did they not experience any of these side effects, or did the benefits vary from patient to patient? What type of blood abnormalities are they talking about? Frustratingly, the release goes on to list a wide range of possible side effects from radiation therapy, but then says that “proton therapy did not make a difference in all of these side effects, but had significant effects on several.” Which ones?

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

By focusing on proton therapy advantages, and offering little information on which side effects proton therapy does not ameliorate, the release effectively glosses over the fact that proton therapy can still cause a wide array of significant adverse side effects associated with radiation therapy.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

The release gives readers virtually no information about the study it’s reporting on. The release tells readers that the study involved “nearly 600 patients,” and that it “compared two kinds of X-ray radiation with proton therapy.” That’s it. It’s not clear how many patients received proton therapy versus the other types of radiation therapy, or even what the other two kinds of X-ray radiation therapy were. In addition, we don’t know if this was a clinical trial, if it was a double-blind study, or if it was comparing proton therapy treatment with historical data on X-ray radiation therapies. And because the release is based on a conference presentation rather than a journal article, it’s difficult (or impossible) for readers to look this information up.

Does the news release commit disease-mongering?

Satisfactory

No disease mongering here.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The University of Maryland release does note that UMD is poised to open its own proton therapy later this year, and that the 110,000 square-foot center cost $200 million to build. The release also lists Mayo Clinic and the MD Anderson Cancer Center as partners in the research being reported. But the release doesn’t note that both Mayo and MD Anderson have also built large, expensive proton therapy centers. In other words, all three institutions have invested heavily in proton therapy and have a strong financial incentive to promote its benefits. There is no information in the release on how the study was funded.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

The release does discuss alternative cancer therapies, such as Gammapod and selective internal radiation therapy — but neither of those therapies is used on esophageal cancer. In fact, the list of therapies included in the release muddies the water for readers: it’s not clear why it’s there. However, the release does not discuss longstanding treatment options for esophageal cancer, such as surgery and chemotherapy. This is particularly problematic because esophageal cancer treatment often involves chemotherapy and radiation therapy, or chemotherapy, radiation therapy and surgery. Discussing radiation therapy in isolation may give readers a skewed picture of treatment options — particularly for Stage II, III, and IV esophageal cancer.

Does the news release establish the availability of the treatment/test/product/procedure?

Not Satisfactory

There are at least a dozen centers in the United States that currently offer proton therapy for cancer treatment, but that’s not clear from the information in the release. The only treatment center mentioned in the release is the one that UMD plans to open this fall. What’s more, proton therapy is repeatedly characterized as “new” — when it has been a subject of widespread discussion (and reporting) for years.  Additionally, most insurers still consider proton beam therapy to be “not medically necessary” under usual circumstances except for a small number of conditions noted earlier.

Does the news release establish the true novelty of the approach?

Not Satisfactory

Proton therapy has garnered widespread attention for years because it is reported to cause fewer side effects than other treatments. This study was looking specifically at side effects of proton therapy’s use when treating esophageal cancer, which may be a novel application for the technology. However, the story doesn’t make that sufficiently clear. Is this the first time that researchers have analyzed the effects of proton beam therapy on esophageal cancer? Or is it adding to a body of research on this condition? The story could have earned a Satisfactory rating by clarifying that point.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Not Satisfactory

This is a close call. While he release does avoid the type of dramatic language (e.g., “Breakthrough!”) that we typically associate with unjustifiable language, we think the cumulative effect of so much positive/promotional language in this release (e.g. “innovative, precise approach,”  “newest and highly precise,” “precisely direct[s] radiation to the most difficult-to-reach tumors,” “can really make a difference in cancer patients’ lives”), totally detached from any consideration of evidence, rises to the level of unjustified.

 

Total Score: 1 of 10 Satisfactory

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