Access to proton beam therapy: Tumors Treated in the U.S. - - PowerPoint PPT Presentation

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Access to proton beam therapy: Tumors Treated in the U.S. - - PowerPoint PPT Presentation

Mar 10, 2023 175 likes •397 views

Access to proton beam therapy: Tumors Treated in the U.S. (2012-2014) Results and implications of the NAPT survey William F. Hartsell, M.D. Medical Director Northwestern Medicine Chicago Proton Center President, Radiation Oncology

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Access to proton beam therapy: Tumors Treated in the U.S. (2012-2014) Results and implications

  • f the NAPT survey

William F. Hartsell, M.D. Medical Director Northwestern Medicine Chicago Proton Center President, Radiation Oncology Consultants

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Disclosures

Joint venture for Northwestern Medicine Chicago Proton Center Honoraria from IBA 1. Recognize the trends in the numbers

  • f patients treated with protons

2. Discuss the implications of the trends reported in the survey data 3. Discuss the trends in the coding of complexity of treatment

Objectives

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Proton therapy in the United States 2012-2014

  • Background

− Incidence of cancer in US − Incidence by disease types − Utilization of radiation therapy in US

  • Proton therapy

− Overall utilization from 2008-2013

  • NAPT survey

− Methods − Results

  • Implications of survey results
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Cancer Incidence in the United States

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Cancer incidence in the US: 2016 estimates

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Trends in Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2012

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Cancer deaths in the US: 2016 estimates

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Trends in death rates from cancer in the US

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Fast Facts About Radiation Therapy

  • Nearly two-thirds of all cancer patients will receive radiation therapy during

their illness.

  • In 2004, nearly one million patients were treated with radiation therapy.
  • Sixty percent (574,930) had not previously received radiation therapy
  • 88 percent of patients treated with radiation therapy received external

beam treatments from a linear accelerator.

  • 81,580 patients received brachytherapy (seed implant) treatments.
  • 11 percent of patients receiving radiation were treated with more than one

type of radiation therapy.

  • Three cancers – breast cancer, prostate cancer and lung cancer – make up more

than half (56 percent) of all patients receiving radiation therapy.

  • At least 75 percent of the patients are treated with the intent to cure
  • 59 percent of lung cancer patients
  • 50 percent of brain cancer patients

Source: ASTRO website https://www.astro.org/News-and-Media/Media-Resources/FAQs/Fast-Facts-About-Radiation-Therapy/Index.aspx

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WA OR CA ID NV AZ UT MT WY CO NM TX OK KS NE SD ND MN IA MO AR LA MS AL GA FL IL WI MI IN OH KY TN SC NC VA WV PA NY ME VT NH

MA RI CT NJ MD DE

Proton Centers - 2016

1990 2006 2006 2001 2010 2009 2010 2010 2004 2012 2013 2014 2013 2014 1957 2014

Proton Centers – 2015 Survey

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Total proton patients treated per year

Facility 2008 2009 2010 2011 2012 2013

Loma Linda

900* 800* 1000* 1000* 884 945 UCSF 113 87 85 106 124 106 MGH 805 755 697 595 988 795 IU 253 258 255 286 257 239 MDAH 473 700* 1000* 700* 509 837 UFPTI 628 859 832 782 811 813 OKC 21 279 323 422 319 Upenn 433 667 644 Hampton 200 289 278 NMCPC 30 337 473 489 NJ 137 375 Seattle 86 Wash U 1 3172 3480 4178 4762 5561 5927

From PTCOG website

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The NAPT Survey

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NAPT Survey Tool

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NAPT Survey: Aggregated Survey Results

Conditions treated CY 2012 CY 2013 CY 2014* Central Nervous System Tumors 598 639 714 Intraocular Melanomas 250 260 276 Pituitary Neoplasms 50 64 71 Base of Skull or Axial Skeleton 179 239 270 Head and Neck 316 387 576 Lung Cancers 437 490 595 Unresectable Retroperitoneal Sarcoma 16 22 16 Pediatric (Solid Tumors (Up to Age 18)) 685 749 940 Gastrointestinal Tract 170 308 427 Urinary Tract 13 13 24 Female Pelvic Organs 24 29 42 Prostate Cancer 2,336 2,094 2,355 Breast Cancer 93 183 319 Other 210 367 459 Subtotal 5,377 5,844 7,084 Survey respondents 11 13 16

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Prostate

Aggregated Survey Results

500 1000 1500 2000 2500 2012 2013 2014

Prostate

Year treated Number of patients

Prostate 2012 2336 2013 2094 2014 2355

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Pediatric (up to age 18)

Aggregated Survey Results

100 200 300 400 500 600 700 800 900 1000 2012 2013 2014

Pediatrics

Pediatrics 2012 685 2013 749 2014 940

Number of patients Year treated

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“Traditional” proton sites

Aggregated Survey Results

100 200 300 400 500 600 700 800 2012 2013 2014 CNS Intraocular Base of skull

CNS

Intraocular Skull base

2012 598 250 179 2013 639 260 239 2014 714 276 270

Number of patients Year treated

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“Up and coming “sites

Aggregated Survey Results

100 200 300 400 500 600 700 2012 2013 2014 Head & Neck Lung Gastrointestinal Number of patients Year treated

H & N Lung GI 2012 316 437 170 2013 387 490 308 2014 576 595 427

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“Uncommonly treated” sites

Aggregated Survey Results

10 20 30 40 50 60 70 80 2012 2013 2014 Pituitary Retroperitoneal sarcoma Urinary tract Gyne

Pituitary RP sarcoma Urinary tract Gyne

2012 60 16 13 24 2013 64 22 13 29 2014 71 16 24 42

Number of patients Year treated

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Treatment delivery

Levels of Complexity for Treatment Delivery CPT 77520 1,078 1,045 1,416 CPT 77522 58,260 48,876 40,620 CPT 77523 62,321 69,552 95,551 CPT 77525 15,369 20,662 28,741 Subtotal 137,028 140,135 166,840 Survey respondents 9 11 14

Hartsell - Proton therapy numbers

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Conclusions: NAPT survey data

  • The number of patients treated with protons is gradually but steadily

increasing – approximately 7,000 people were treated with protons in the US in 2014

  • The number of patients treated for “traditional” indications for protons –

pediatrics, brain, base of skull tumors, and intraocular melanoma – continues to gradually increase

  • There is a shift to “new” disease sites treated, especially with an increase

in breast, lung, head & neck, gastrointestinal tumors

  • The number of patients with prostate cancer has remained relatively

stable

− Despite additional new centers − Relative frequency has decreased from 43.4% in 2012 to 33.2% in 2014

  • Complexity of treatments in gradually increasing over time
  • Not listed - retreatment – this may be substantial number of patients

Hartsell - Proton therapy

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Acknowledgements

NAPT/ MWE

  • Jason Caron
  • Deborah Godes
  • Heather Garecht
  • Todd Ketch

All centers for contributions to the data

  • Hampton University Proton Therapy Institute
  • Indiana University Health Proton Therapy Center
  • Loma Linda University Medical Center
  • Massachusetts General Hospital
  • MD Anderson
  • Northwestern Medicine Chicago Proton Center
  • ProCure – New Jersey
  • ProCure – Oklahoma City
  • Provision Center for Proton Therapy
  • Seattle Proton Center
  • Scripps
  • University of California San Francisco
  • University of Florida Proton Therapy Institute
  • University of Pennsylvania Health System
  • Washington/Barnes Jewish
  • Willis Knighton