Proton Therapy for Early Stage Breast Cancer Less Expensive Than Various Alternative Radiotherapy Techniques

Patients with early stage breast cancer may benefit from accelerated partial breast irradiation (APBI) using proton therapy versus whole breast irradiation (WBI), in terms of duration of treatment and cost.

In a cost analysis study based on typical patient characteristics, researchers used Medicare reimbursement codes to analyze allowable charges for eight different types of partial and whole breast irradiation therapies and treatment schedules available to early stage breast cancer patients. Combined, these represent approximately 98% of the treatment alternatives available to these patients. The cost of proton therapy when used for APBI, introduced to decrease overall treatment time and toxicity, was estimated at USD 13,833. Comparatively, WBI using intensity-modulated radiation therapy (IMRT) resulted in the highest US Medicare charges at USD 19,599. The average charges across the eight treatment regimens were USD 12,784; thus, proton costs were similar to that of other types of radiation.

The findings were presented at the inaugural North America meeting of the Particle Therapy Cooperative Group (PTCOG) recently held at MD Anderson Proton Therapy Center (Houston, TX, USA). “It is often suggested that trials of proton APBI are irrelevant due to the modality's presumed high cost, but our data shows that this perception is false. Correcting this perpetual assumption is an important step in helping patients obtain the necessary health coverage to participate in clinical research,” said Valentina Ovalle, MD, postdoctoral research fellow and lead investigator. “Further, we anticipate that because charges vary proportionately across payers, the estimated Medicare reimbursement costs likely reflect relative charges to other third-party payers.”

Early breast cancer stage I or II is the most common invasive breast cancer in the US. With treatment, these patients generally have a good prognosis. Standard treatment approaches typically include breast-conserving surgery (BCS) followed by radiotherapy for the entire breast—five days per week, for up to six weeks, including one week of “boost” radiation to the area where the initial tumor was removed.

The role of APBI for early stage breast cancer is still being evaluated, but its intent is to deliver a highly effective dose of radiation while greatly reducing treatment time—10 treatments twice per day over one week. Furthermore, on average it spares at least two-thirds of breast tissue from a full dose of radiation. “The biggest drawback to WBI is that it is inconvenient, interrupting lives,” said Eric A. Strom, MD, FACR, study coauthor and professor in radiation oncology. Dr. Strom is lead investigator of a clinical trial sponsored by the US National Cancer Institute on proton APBI.

APBI is delivered via two approaches: brachytherapy and external beam. Proton therapy is offered as a type of external beam APBI, and according to Dr. Strom, is distinctive in its ability to provide the full dose of radiation precisely to the tumor site and nowhere else, eliminating radiation to the remaining breast, lung, and heart. To date, research on proton APBI has shown effective tumor control, limited side effects, and good cosmetic outcomes.

“This cost analysis must be interpreted in light of clinical evidence for proton APBI, which while still in nascent stages, is promising,” said Dr. Ovalle. “The findings counter the presumption that proton APBI is so expensive that even excellent clinical results would be immaterial. If the payment barrier for proton therapy is removed so that current and future research can proceed, the outcomes may ultimately benefit patients, physicians and insurers: better treatments at lower costs.”

Related Links:
MD Anderson Proton Therapy Center