Journal of Cancer Research and Therapeutics Medknow Publications on behalf of the Association of Radiation Oncologists of India (AROI) ISSN: 0973-1482 EISSN: 1998-4138 Vol. 5, Num. 1, 2009, pp. 58-58

Journal of Cancer Research and Therapeutics, Vol. 5, No. 1, January-March, 2009, pp. 58

Letter To Editor

The enigma of proton therapy for head and neck cancers

Kazi R

Head and Neck Unit, Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ
Correspondence Address:Head and Neck Unit, Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, rehan_kazi@yahoo.com

Code Number: cr09015

Sir,

Particle therapy in clinical practice: Is there enough evidence to justify the current surge in interest J Can Res Ther 2008;4:54-6. This was an excellent review article by the author; he has very succinctly captured the enigma of current proton therapy for head and neck cancers. ^[1] I agree entirely with the author when he says that there is remarkably little published literature demonstrating the superiority of proton therapy over conventional forms of x-ray therapy in spite of the fact that proton beams, and even ions, have been employed in radiotherapy for decades. ^[1],[2],[3] There could be a number of reasons for this, as rightly pointed out by the experienced author. ^[1] We do require well-designed phase II trials and adequately powered phase III trials to provide objective information on the efficacy and toxicity of proton therapy as compared with best conventional therapy. ^[2],[3],[4] Whilst randomized controlled trials (RCT) may be possible in number of research areas, in this field it may be rather difficult to organize. There is no doubt that we must establish achievable endpoints for evaluating emerging and potentially exciting technologies, but we must do so within an ethical framework. ^[1] The author is entirely correct when he states that while it may not be possible to perform an RCT at every site, at least the Hadron Therapy Groups must make a collective effort to set up a consortium-based database. ^[1],[2] There is no questioning the potential that India has in this respect. As pointed out by the author, we do present a very interesting paradox, with a mix of some of the richest and some of the poorest people in the world, as well as a burgeoning middle class with the wealth and the desire to explore all treatment options. ^[1] Proton and other particle therapies need to be more rigorously explored to determine their true effectiveness, especially in the Indian setting.

Once again, the author and the JCRT need to be congratulated for this fine effort!

References

1.	Jalali R. Particle therapy in clinical practice: Is there enough evidence to justify the current surge in interest? J Can Res Ther 2008;4:54-6.  Back to cited text no. 1  [PUBMED]
2.	Jalali R. Conduct of clinical trials in developing world. Lancet 2007;370:562.  Back to cited text no. 2
3.	Glimelius B, Montelius A. Proton beam therapy: Do we need the randomised trials and can we do them? Radiother Oncol 2007;83:105-9.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.	Suit H, Kooy H, Trofimov A, Farr J, Munzenrider J, DeLaney T, et al . Should positive phase III clinical trial data be required before proton beam therapy is more widely adopted? No. Radiother Oncol 2008;86:148-53.  Back to cited text no. 4

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