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Proton Beam Radiation Therapy (AmeriHealth Administrators)
09.00.49n

Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract. The Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition.

This policy only applies to members for whom AmeriHealth​ Administrators serves as the claims administrator and whose group has not enrolled in the UM vendor program.  For those groups who have been given the option to enroll in the UM vendor program, this policy is no longer applicable upon their renewal effective date. Individual member benefits must be verified before/prior to providing services.​​

MEDICALLY NECESSARY

Proton beam radiation therapy is considered medically necessary and, therefore, covered for the curative treatment of any of the following ​conditions when metastatic disease is not present:
  • ​Base of the skull, primary tumors (e.g., chordomas, chondrosarcomas)
  • B​Misspelled Wordenign or malignant tumors or hematologic malignancies in children aged 21 years and younger treated with curative intent
  • Cancer syndromes such as Neurofibromatosis Type 1 (NF-1), Li-Misspelled WordFraumeni, ataxia telangiectasia (with deleterious ATM mutations), hereditary retinoblastoma, Lynch syndrome, or hereditary breast or ovarian cancer (with BRCA 1/2 mutations)​
  • Esophageal cancer
  • Hepatocellular cancer or intrahepatic Misspelled Wordcholangiocarcinoma
  • ​Primary malignant or benign CNS tumors excluding IDH wild-type glioblastoma Misspelled Wordmultiforme​
  • Mediastinal lymphomas
  • Nasopharynx, nasal cavity, paranasal sinuses, or other accessory sinuses cancer
  • Misspelled WordNonmetastatic primary tumors requiring Misspelled Wordcraniospinal irradiation (e.g., Misspelled Wordmedulloblastoma)
  • Primary malignant or benign bone tumors
  • Primary malignant pleural mesothelioma
  • Primary ocular tumors including intraocular/uveal melanomas
  • Primary spine or spinal cord tumors where organs at risk tolerance will be exceeded with photon treatments
  • Re-irradiation with curative intent where cumulative critical structure dose will exceed tolerance dose
  • Retroperitoneal sarcomas
  • ​A single kidney or transplanted pelvic kidney with treatment of an adjacent target volume​
  • Thoracic sarcomas
  • Misspelled WordThymoma and Misspelled Wordthymic carcinoma
  • Misspelled WordUnresected T3, T4, or node positive head and neck cancers
NOT MEDICALLY NECESSARY

For the following indications, the available evidence currently does not support a definitive benefit of proton beam radiation therapy over photons. As such, proton beam radiation therapy for the curative treatment of the following cancers is considered not medically necessary and, therefore, not covered:
  • ​Adrenal cancers
  • Anal cancer
  • Bladder cancer
  • Breast cancer
  • Cervical cancer
  • Colon cancer
  • Cutaneous tumors with cranial nerve invasion to the base of skull, cavernous sinus, and/or brainstem
  • Endometrial cancer
  • Extrahepatic Misspelled Wordcholangiocarcinoma
  • Leptomeningeal disease
  • Liver metastases being treat with curative intent (i.e., Misspelled Wordoligomet​astases)
  • Lung cancer
  • Gastric cancer
  • Glioblastoma, IDH wild-type
  • ​Head and neck cancers requiring ipsilateral radiation treatment (e.g., oral cavity, salivary gland)
  • Hodgkin’s lymphoma​
  • ​Metastatic tumors
  • Mucosal melanoma
  • Multiple myeloma
  • Non-Hodgkin's lymphoma
  • Ovarian cancer
  • Pancreatic cancer
  • Pelvic or proximal thigh where use of protons results in significant dose reduction to genitalia
  • Prostate cancer (Intact and postoperative)
  • Rectal cancer
  • ​All skin cancers
EXPERIMENTAL/INVESTIGATIONAL

Proton beam radiation therapy is considered experimental/investigational and, therefore, not covered for all other indications including the following because the safety and/or effectiveness of this service cannot be established by review of the available published peer-reviewed literature:
  • T1-T2N0M0 laryngeal cancer
REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the health care professional's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.​

Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, proton beam radiation therapy is covered under the medical benefits of the C​Misspelled Wordompany’s products when the medical necessity criteria listed in this medical policy are met.

Services that are experimental/investigational are a benefit contract exclusion for all products of the Company. Therefore, they are not eligible for reimbursement consideration.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

There are several proton beam therapy systems approved by the FDA for administering proton beam radiation.

Description

Proton beam radiation therapy is a type of radiation therapy that utilizes protons to deliver ionizing damage to a target. Protons are positively charged, subatomic particles that deposit the bulk of their radiation energy at the end of their range of penetration (i.e., into the tumor). This peak of energy deposition is referred to as the Bragg peak. Proton beam radiation therapy allows for targeted dosing of proton radiation to a particular tumor site, with minimal dose delivery to surrounding normal tissue, theoretically offering an advantage over the delivery of photons (i.e., gamma-rays, X-rays, conventional electromagnetic radiation therapy), which deposit their energy along a more disseminated distribution.

This dose-targeting advantage of proton beam radiation therapy may be an improvement over conventional radiation therapy because conventional treatment modalities do not provide adequate local tumor control. Local tumor response depends on the dose of radiation delivered, and delivery of an adequate radiation dose to the tumor is limited by the proximity of vital radiosensitive tissues or structures. However, advances in photon-based radiation therapy, such as 3-D conformal radiation therapy, intensity-modulated radiation therapy, and stereotactic body radiotherapy, do allow for improved targeting of conventional radiation therapy.

Proton beam radiation therapy can best treat tumors that are localized and have not spread to distant areas of the body, tumors that are not amenable to surgical excision or other conventional forms of radiation treatment (e.g., tumors in close proximity to vital organs and structures), and tumors that are difficult or dangerous to treat with surgery (e.g., tumors of the eye, head, neck). Proton beam radiation therapy is being used to treat pediatric tumors in or near the brain and when it is necessary to lessen the risk for secondary tumors due to the individual's potentially long lifespan after radiation treatment, which involves risk for radiation-induced malignancies.

Proton beam radiation therapy has been used in the treatment of two general categories of tumors or abnormalities. The first category includes tumors located near vital organs, such as intracranial lesions or those along the axial skeleton, e.g., uveal melanoma, brain tumors, Misspelled Wordchordomas, and other chondrosarcomas at the base of the skull and along the axial skeleton. The second category currently under investigation involves tumors with a high rate of recurrence despite maximal doses of conventional radiation therapy, e.g., stages C or D1 of locally advanced prostate cancer (without metastases; and not stage T4).

Current evidence supports the use of proton beam radiation therapy in the treatment of Misspelled Wordchordomas and chondrosarcomas of the base of the skull, uveal melanoma, localized Misspelled Wordunrese​ctable hepatocellular carcinoma (HCC), and stage IIA seminoma.

For previously untreated prostate cancer, head and neck cancer, and preoperative and definitive treatment of esophageal cancer, current evidence indicates that proton beam radiation therapy is no more effective than other forms of radiation therapy (e.g., IMRT).

For all other conditions, further research is needed on proton beam radiation therapy to establish its safety and effectiveness.

References

Abdel-Wahab M, Mahmoud O, Merrick G, et al. ACR Appropriateness Criteria® external beam radiation therapy treatment planning for clinically localized prostate cancer. J Am Coll Radiol. 2012 Apr;9(4):233-8.

Adeberg S, Harrabi SB, Bougatf N, et al. Intensity-modulated proton therapy, volumetric-modulated arc therapy, and 3D conformal radiotherapy in anaplastic astrocytoma and glioblastoma: a dosimetric comparison. Strahlenther Onkol. 2016;192(11):770-779.

Al-Mefty O, Borba LAB. Skull base chordomas a management challenge. J Neurosurg. 1997;86(2):182-9.

Allen AM, Pawlicki T, Dong L, et al. An evidence based review of proton beam therapy: the report of ASTRO's emerging technology committee. Radiother Oncol. 2012;103(1):8-11.

American Society for Radiation Oncology (ASTRO). Model Policy: Proton Beam Therapy (PBT). 2022. Available at: https://www.astro.org/ASTRO/media/ASTRO/Daily Practice/PDFs/ASTROPBTModelPolicy.pdf​​. Accessed April 1, 2024.​

Amichetti M, Amelio D, Cianchetti M, et al. A systematic review of proton therapy in the treatment of chondrosarcoma of the skull base. Neurosurg Rev. 2010; 33(2):155-165.

Amichetti M, Cianchetti M, Amelio D, et al. Proton therapy in chordoma of the base of the skull a systematic review. Neurosurg Rev. 2009;32(4):403-16.

Anand A, BuesM, RuleWG, et al: Scanning proton beam therapy reduces normal tissue exposure in pelvic radiotherapy for anal cancer. Radiother Oncol. 117:505-508, 2015.

Arvold ND, Niemierko A, Broussard GP, et al. Projected second tumor risk and dose to neurocognitive structures after proton versus photon radiotherapy for benign meningioma. Int J Radiat Oncol Biol Phys. 2012;83(4):e495-e500.

Athar BS, Paganetti H. Neutron equivalent doses and associated lifetime cancer incidence risks for head & neck and spinal proton therapy. Phys Med Biol. 2009; 54(16):4907-4926.

Barker FG II, Butler WE, Lyons S, et al. Dose-volume prediction of radiation-related complications after proton beam radiosurgery for cerebral arteriovenous malformations. J Neurosurg. 2003;99(2):254-63.

Bechrakis NE, Foerster MH. Neoadjuvant proton beam radiotherapy combined with subsequent endoresection of choroidal melanomas. Int Ophthalmol Clin. 2006;46(1):95-107.

Bekelman JE, Schultheiss T, Berrington De Gonzalez A. Subsequent malignancies after photon versus proton radiation therapy. Int J Radiat Oncol Biol Phys. 2013; 87(1):10-12.

Benk VA, Adams JA, Shipley WU, et al. Late rectal bleeding following combined X-ray and proton high dose irradiation for patients with stages T3-T4 prostate cancer. Int J Radiat Oncol Biol Phys. 1993;26(3):551-7.

Berrington de Gonzalez A, Gilbert E, Curtis R, et al. Second solid cancers after radiation therapy: a systematic review of the epidemiologic studies of the radiation dose-response relationship. Int J Radiat Oncol Biol Phys. 2013; 86(2):224-233.

Bhattasali O, Holliday E, Kies MS, et al. Definitive proton radiation therapy and concurrent cisplatin for unresectable head and neck adenoid cystic carcinoma: a series of 9 cases and a critical review of the literature. Head Neck. 2016;38(S1):E1472-E1480.

Bishop AJ, Greenfield B, Mahajan A, et al. Proton beam therapy versus conformal photon radiation therapy for childhood craniopharyngioma: multi-institutional analysis of outcomes, cyst dynamics, and toxicity. Int J Radiat Oncol Biol Phys. 2014;90(2):354-361.

Blanchard P, Garden AS, Gunn GB, et al. Intensity-modulated proton beam therapy (IMPT) versus intensitymodulated photon therapy (IMRT) for patients with oropharynx cancer – a case matched analysis. Radiother Oncol. 2016;120(1):48-55.

Blanco Kiely JP, White BM. Robust Proton Pencil Beam Scanning Treatment Planning for Rectal Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys. 2016;95(1):208-15.

Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Charged particle (proton or helium ion) irradiation for uveal melanoma and for chordoma or chondrosarcoma of the skull base or cervical spine. 1996; Volume 11, Tab 1.

Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Proton Beam Therapy for Non-Small-Cell Lung Cancer. 2010; Volume 25, Tab 7.

Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Proton beam therapy for prostate cancer. TEC Assessments 2010;Volume 25, Tab 10.

Boskos C, Feuvret L, Noel G, et al. Combined proton and photon conformal radiotherapy for intracranial atypical and malignant meningioma. Int J Radiat Oncol Biol Phys. 2009; 75(2): 399-406.

Bouchard M, Amos RA, Briere TM, et al. Dose escalation with proton or photon radiation treatment for pancreatic cancer. Radiother Oncol. 2009;92(2):238-243.

Brada M, Pijls-Johannesma M, De Ruysscher D. Current clinical evidence for proton therapy. Cancer J. 2009;15(4):319-24.

Bradley JA, Dagan R, Ho, MW, et al. Initial report of a prospective dosimetric and clinical feasibility trial demonstrates the potential of protons to increase the therapeutic ratio in breast cancer compared with photons. Int J Radiat Oncol Biol Phys. 2016 May;95(1):411-421.

Brenner DJ, Hall EJ. Secondary neutrons in clinical proton radiotherapy: a charged issue. Radiother Oncol. 2008; 86(2):165-70.

Bush DA, Cheek G, Zaheer S, et al. High-dose hypofractionated proton beam radiation therapy is safe and effective for central and peripheral early-stage non-small cell lung cancer: results of a 12-year experience at Loma Linda University Medical Center. Int J Radiat Oncol Biol Phys. 2013;86(5):964-968.

Bush DA, McAllister CJ, Loredo LN, et al. Fractionated proton beam  radiotherapy for acoustic neuroma. Neurosurgery. 2002;50(2):270-3.

Cella L, Conson M, Pressello MC, et al. Hodgkin’s lymphoma emerging radiation treatment techniques: trade-offs between late-night radio-induced toxicities and secondary malignant neoplasms. Radiat Oncol. 2013;8:22.

Chan AW, Liebsch NJ. Proton radiation therapy for head and neck cancer. J Surg Oncol. 2008; 97(8):697700.

Chang JY, Jabbour SK, De Ruysscher D, et al. Consensus statement on proton therapy in early-stage and locally advanced non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2016;95(1):505-516.

Chang JY, Komaki R, Lu C, et al. Phase 2 study of high-dose proton therapy with concurrent chemotherapy for unresectable stage III nonsmall cell lung cancer. Cancer. 2011; 117(20):4707-4713.

Chang JY, Verma V, Li M, et al. Proton beam radiotherapy and concurrent chemotherapy for unresectable Stage III non-small cell lung cancer. JAMA Oncol. 2017;3(8):e172032.

Chang JY, Zhang X, Wang X, et al. Significant reduction of normal tissue dose by proton radiotherapy compared with three-dimensional conformal or intensity-modulated radiation therapy in Stage I or Stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2006;65(4):1087-1096.

Char DH, Kroll S, Phillips TL, et al. Late radiation failures after iodine 125 brachytherapy for uveal melanoma compared with charged-particle (proton or helium ion) therapy. Ophthalmology. 2002; 109(10):1850-1854.

Chera BS, Rodriguez C, Morris CG, et al. Dosimetric comparison of three different involved nodal irradiation techniques for stage II Hodgkin’s lymphoma patients: conventional radiotherapy, intensity-modulated radiotherapy, and three-dimensional proton radiotherapy. Int J Radiat Oncol Biol Phys. 2009;75(4):1173-1180.

Chung CS, Yock TI, Nelson K, et al. Incidence of second malignancies among patients treated with proton versus photon radiation. Int J Radiat Oncol Biol Phys. 2013; 87(1):46-52.

Ciezki JP, Hsu IC, Abdel-Wahab M, et al. American College of Radiology Appropriateness Criteria(®)--locally advanced (high-risk) prostate cancer. Clin Oncol (R Coll Radiol). 2012;24(1):43-51.

Ciulla TA, Danis RP, Klein SB, et al. Proton therapy for exudative age-related macular degeneration: a randomized, sham-controlled clinical trial. Am J Ophthalmol. 2002;134(6):905-906.

Clivio A, Kluge A, Cozzi L, Köhler C, Neumann O, Vanetti E, Wlodarczyk W, Marnitz S Intensity modulated proton beam radiation for brachytherapy in patients with cervical carcinoma. Int J Radiat Oncol Biol Phys. 2013;87(5):897-903.

Coeh JJ, Zietman AL, Rossi CJ, et al. Comparison of high-dose proton radiotherapy and brachytherapy in localized prostate cancer: a case-matched analysis. Int J Radiat Oncol Biol Phys. 2012;82(1):e25-e31.

Coen JJ, Bae K, Zietman AL, et al. Acute and late toxicity after dose escalation to 82 GyE using conformal proton radiation for localized prostate cancer: initial report of American College of Radiology Phase II study 03-12. Int J Radiat Oncol Biol Phys. 2011; 81(4):1005-1009.

Coen JJ, Paly JJ, Niemierko A, et al. Long-term quality of life outcome after proton beam monotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2012;82(2):e201-209.

Colaco RJ, Nichols RC, Huh S, et al. Protons offer reduced bone marrow, small bowel, and urinary bladder exposure for patients receiving neoadjuvant radiotherapy for resectable rectal cancer. J Gastrointest Oncol. 2014;5:3-8.

Conway RM, Poothullil AM, Daftari IK, et al. Estimates of ocular and visual retention following treatment of extralarge uveal melanomas by proton beam radiotherapy. Arch Ophthalmol. 2006; 124(6):838–843.

Cotter SE, McBride SM, Yock TI. Proton radiotherapy for solid tumors of childhood. Technol Cancer Res Treat. 2012;11(3):267-278.

Courdi A, Caujolle JP, Grange JD, et al. Results of proton therapy of uveal melanomas treated in Nice. Int J Radiat Oncol Biol Phys. 1999;45(1):5-11.

Cox JD. Dose escalation by proton irradiation for adenocarcinoma of the prostate. Int J Radiat Oncol Biol Phys. 1995;32(1):265-6.

Cozzi L, Fogliata A, Lomax A. A treatment planning comparison of 3D conformal therapy, photon therapy, and proton therapy for treatment of advanced head and neck tumors. Radiother Oncol. 2001;61(3):287-97.

Cuaron JJ, Chon B, Tsai H, et al. Early toxicity in patients treated with postoperative proton therapy for locally advanced breast cancer. Int J Radiat Oncol Biol Phys. 2015;92(2):284-291.

Dahm P, Brasure M, Ester E et al.  Therapies for clinically localized prostate cancer: Comparative Effectiveness Review Number 230. September 2020. Available at:​ https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/prostate-cancer-therapies-report.pdf. Accessed on Feb 21, 2022. 

Damato B, Kacperek A, Chopra M, et al. Proton beam radiotherapy of choroidal melanoma: the Liverpool-Clatterbridge experience. Int J Radiat Oncol Biol Phys. 2005;62(5):1405-11.

Damato B, Kacperek A, Chopra M, et al. Proton beam radiotherapy of iris melanoma. Int J Radiat Oncol Biol Phys. 2005;63(1):109-15.

Damato B, Lecuona K. Conservation of eyes with choroidal melanoma by a multimodality approach to treatment an audit of 1632 patients. Ophthalmology. 2004;111(5):977-83.

De Boer P, van de Schoot AJAJ, Westerveld H, Smit M, Buist MR, Bel A, Rasch CRN, Stalpers LJA. Target tailoring and proton beam therapy to reduce small bowel dose in cervical cancer radiotherapy : A comparison of benefits. Strahlenther Onkol. 2018;194(3):255-263.

De Ruysscher D, Mark Lodge M, Jones B, et al. Charged particles in radiotherapy: a 5-year update of a systematic review. Radiother Oncol. 2012;103(1):5-7.

Debus J, Schulz-Ertner D, Schad L, et al. Stereotactic fractionated radiotherapy for chordomas and chondrosarcomas of the skull base. Int J Radiat Oncol Biol Phys. 2000; 47(3):591-596.

Dědečková K, Móciková H, Marková J, et al. T011: Proton radiotherapy for mediastinal Hodgkin lymphoma: single institution experience (abstract). Haematologica. 2016;101(Suppl 5):12-13.

DeLaney TF, Liebsch NJ, Pedlow FX, et al. Long-term results of Phase II study of high dose photon/proton radiotherapy in the management of spine chordomas, chondrosarcomas, and other sarcomas. J Surg Oncol. 2014;110(2):115-22.

Dendale R, Lumbroso-Le Rouic L, Noel G, et al. Proton beam radiotherapy for uveal melanoma results of Curie Institut-Orsay proton therapy center (ICPO). Int J Radiat Oncol Biol Phys. 2006;65(3):780-7.

Dennis ER, Bussière MR, Niemierko A, et al. A comparison of critical structure dose and toxicity risks in patients with low grade gliomas treated with IMRT versus proton radiation therapy. Tech Cancer Res Treat. 2013;12(1):1-9.

Desjardins L, Lumbroso-Le Rouic L, Levy-Gabriel C, et al. Combined proton beam radiotherapy and transpupillary thermotherapy for large uveal melanomas a randomized study of 151 patients. Ophthalmic Res. 2006;38(5):255-60.

Dionisi F, Avery S, Lukens JN, et al: Proton therapy in adjuvant treatment of gastric cancer: Planning comparison with advanced x-ray therapy and feasibility report. Acta Oncol. 2014; 53:1312-1320.

Duttenhaver JR, Shipley WU, Perrone T, et al. Protons or megavoltage X-rays as boost therapy for patients irradiated for localized prostatic carcinoma. An early phase I/II comparison. Cancer. 1983;51(9):1599-604.

Eaton BR, MacDonald SM, Yock TI, et al. Secondary malignancy risk following proton radiation therapy. Front Oncol. 2015; 5:261.

Efstathiou JA, Trofimov AV, Zietman AL. Life, liberty, and the pursuit of protons an evidence-based review of the role of particle therapy in the treatment of prostate cancer. Cancer J. 2009;15(4):312-8.

Egger E, Schalenbourg A, Zografos L, et al. Maximizing local tumor control and survival after proton beam radiotherapy of uveal melanoma. Int J Radiat Oncol Biol Phys. 2001;51(1):138-47.

Egger E, Zografos L, Schalenbourg A, et al. Eye retention after proton beam radiotherapy for uveal melanoma. Int J Radiat Oncol Biol Phys. 2003;55(4):867-80.

Esmaeli B, Yin VT, Hanna EY, et al. Eye-sparing multidisciplinary approach for the management of lacrimal gland carcinoma. Head Neck. 2016;38(8):1258-1262.

Fang P, Mick R, Deville C, et al. A case-matched study of toxicity outcomes after proton therapy and intensitymodulated radiation therapy for prostate cancer. Cancer. 2015;121(7):1118-1127.

Feuvret L, Noel G, Calugaru V, et al. Chondromyxoid fibroma of the skull base differential diagnosis and radiotherapy two case reports and a review of the literature. Acta Oncol. 2005;44(6):545-53.

Filippi AR, Ciammella P, Piva C, et al. Involved-site image-guided intensity modulated versus 3D conformal radiation therapy in early stage supradiaphragmatic Hodgkin lymphoma. Int J Radiat Oncol Biol Phys. 2014;89(2):370-375.

Fitzek MM, Linggood RM, Adams J, Munzenrider JE. Combined proton and photon irradiation for craniopharyngioma long-term results of the early cohort of patients treated at Harvard Cyclotron Laboratory and Massachusetts General Hospital. Int J Radiat Oncol Biol Phys. 2006;64(5):1348-54.

Fitzek MM, Thornton AF, Harsh G, et al. Dose-escalation with proton/photon irradiation for Daumas-Duport lower-grade glioma results of an institutional phase I/II trial. Int J Radiat Oncol Biol Phys. 2001;51(1):131-7.

Fitzek MM, Thornton AF, Rabinov JD, et al. Accelerated fractionated proton/photon irradiation to 90 cobalt gray equivalent for glioblastoma multiforme: results of a phase II prospective trial. J Neurosurg. 1999; 91(2):251260.

Fukumitsu N, Sugahara S, Nakayama H, et al. A prospective study of hypofractionated proton beam therapy for patients with hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2009; 74(3):831-836.

Funk RK, Tryggestad EJ, Kazemba BD, et al. Dosimetric comparison of IMRT vs. pencil-beam scanning proton therapy for distal esophageal cancer. Proceedings to the 54th Annual Meeting for the Particle Therapy Cooperative Group (PTCOG) and the 2nd Annual Meeting of PTCOG- North America. Int J Particle Therapy. 2015 Summer;2(1):360-361.

Fuss M, Hug EB, Schaefer RA, et al. Proton radiation therapy (PRT) for pediatric optic pathway gliomas: comparison with 3D planned conventional photons and a standard photon technique. Int J Radiat Oncol Biol Phys. 1999;45(5):1117-1126.

Gardner BG, Zietman AL, Shipley WU, et al. Late normal tissue sequelae in the second decade after high dose radiation therapy with combined photons and conformal protons for locally advanced prostate cancer. J Urol. 2002;167(1):123-6.

Georg D, Hopfgartner J, Gòra J, et al. Dosimetric considerations to determine the optimal technique for localized prostate cancer among external photon, proton, or carbon-ion therapy and high-dose-rate or low-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys. 2014;88(3):715-722.

Gragoudas ES, Egan KM, Seddon JM, et al. Intraocular recurrence of uveal melanoma after proton beam irradiation. Ophthalmology. 1992;99(5):760-6.

Gragoudas ES, Lane AM, Regan S, et al. A randomized controlled trial of varying radiation doses in the treatment of choroidal melanoma. Arch Ophthalmol. 2000;118(6):773-8.

Gragoudas ES, Li W, Goitein M, et al. Evidence-based estimates of outcome in patients irradiated for intraocular melanoma. Arch Ophthalmol. 2002;120(12):1665-71.

Gray PJ, Paly JJ, Yeap BY, et al. Patient-reported outcomes after 3-dimensional conformal, intensity-modulated, or proton beam radiotherapy for localized prostate cancer. Cancer. 2013;119(9):1729-1735.

Greenberger BA, Pulsifer MG, Ebb DH, et al. Clinical outcomes and late endocrine, neurocognitive, and visual profiles of proton radiation for pediatric low-grade gliomas. Int J Radiat Oncol Biol Phys. 2014;89(5):10601068.

Grutters JP, Kessels AG, Pijls-Johannesma M, et al. Comparison of the effectiveness of radiotherapy with photons, protons and carbon-ions for non-small cell lung cancer a meta-analysis. Radiother Oncol. 2010; 95(1):32-40.

Gudjonsson O, Blomquist E, Nyberg G, et al. Stereotactic irradiation of skull base meningiomas with high energy protons. Acta Neurochir (Wien). 1999;141(9):933-40.

Gunn GB, Blanchard P, Garden AS, et al. Clinical outcomes and patterns of disease recurrence after intensity modulated proton therapy for oropharyngeal squamous carcinoma. Int J Radiat Oncol Biol Phys. 2016;95(1):360-367.

Guyer DR, Mukai S, Egan KM, et al. Radiation maculopathy after proton beam irradiation for choroidal melanoma. Ophthalmology. 1992;99(8):1278-85.

Hanks GE. A question filled future for dose escalation in prostate cancer. Int J Radiat Oncol Biol Phys. 1995;32(1):267-9.

Harrabi SB, Bougatf N, Mohr A, et al. Dosimetric advantages of proton therapy over conventional radiotherapy with photons in young patients and adults with low-grade glioma. Strahlenther Onkol. 2016;192(11):759-769.

Harsh GR, Thornton AF, Chapman PH, et al. Proton beam stereotactic radiosurgery of vestibular schwannomas. Int J Radiat Oncol Biol Phys. 2002;54(1):35-44.

Hart KB, Porter AT. A rational approach to the treatment of prostate cancer with radiation therapy Lessons for the future. Semin Oncol. 1997;24(6):745-55.

Hasegawa T, Ishii D, Kida Y, et al. Gamma Knife surgery for skull base chordomas and chondrosarcomas. J Neurosurg. 2007; 107(4):752-757.

Hashimoto T, Tokuuye K, Fukumitsu N, et al. Repeated proton beam therapy for hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2006; 65(1):196-202.

Hata M, Miyanaga N, Tokuuye K, et al. Proton beam therapy for invasive bladder cancer: a prospective study of bladderpreserving therapy with combined radiotherapy and intra-arterial chemotherapy. Int J Radiat Oncol Biol Phys. 2006;64(5):1371-9.

Hata M, Tokuuye K, Sugahara S, et al. Proton beam therapy for hepatocellular carcinoma patients with severe cirrhosis. Strahlenther Onkol. 2006; 182(12):713-720.

Hata M, Tokuuye K, Sugahara S et al. Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus. Cancer. 2005; 104(4):794-801.

Hauswald H, Rieken S, Ecker S, et al. First experiences in treatment of low-grade glioma grade I and II with proton therapy. Radiation Oncol. 2012;7:189.

Hazard LJ, Jensen RL, Shrieve DC. Role of stereotactic radiosurgery in the treatment of brain metastases. Am J Clin Oncol. 2005;28(4):403-10.

Hoffman KE, Yock TI. Radiation therapy for pediatric central nervous system tumors. J Child Neurol. 2009;24(11):1387-1396.

Holliday E, Bhattasali O, Kies M, et al. Postoperative intensity-modulated proton therapy for head and neck adenoid cystic carcinoma. Int J Particle Ther. 2016;2(4):543-543.

Holliday EB, Esmaeli B, Pinckard J, et al. A multidisciplinary orbit-sparing treatment approach that includes proton therapy for epithelial tumors of the orbit and ocular adnexa. Int J Radiat Oncol Biol Phys. 2016;95(1):344352.

Holliday EB, Frank SJ. Proton radiation therapy for head and neck cancer: a review of the clinical experience to date. Int J Radiat Oncol Biol Phys. 2014; 89(2):292-302.

Holliday EB, Garden AS, Rosenthal DI, et al. Proton therapy reduces treatment-related toxicities for patients with nasopharyngeal cancer: a case-match control study of intensity-modulated proton therapy and intensity-modulated photon therapy. Int J Particle Ther. 2015;2(1):19-28.

Holliday EB, Kocak-Uzel E, Feng L, et al. Dosimetric advantages of intensity-modulated proton therapy for oropharyngeal cancer compared with intensity-modulated radiation: a case-matched control analysis. Med Dosim. 2016;41(3):189-194.

Hong TS, Ryan DP, Borger DR, et al. A Phase ½ and biomarker study of preoperative short course chemoradiation with proton beam therapy and capecitabine followed by early surgery for resectable pancreatic ductal adenocarcinoma. Int J Radiat Biol Phys. 2014;89(4):830-838.

Hong TS, Wo JY, Yeap BY, et al. Multi-institutional Phase II study of high-dose hypofractionated proton beam therapy in patients with localized, unresectable hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol. 2016;34(5):460-468.

Hoppe BS, Flampouri S, Henderson RH, et al. Proton therapy with concurrent chemotherapy for non-small-cell lung cancer: technique and early results. Clin Lung Cancer. 2012; 13(5):352-358.

Hoppe BS, Flampouri S, Zaiden R, et al. Involved-node proton therapy in combined modality therapy for Hodgkin’s lymphoma: results of a phase 2 study. Int J Radiat Oncol Biol Phys. 2014;89(5):1053-1059.

Hoppe BS, Mamalui-Hunter M, Mendenhall NP, et al. Improving the therapeutic ratio by using proton therapy in patients with stage I or stage II seminoma. Am J Clin Oncol. 2013; 36(1):31-37.

Hoppe BS, Michalski JM, Mendenhall NP, et al. Comparative effectiveness study of patient-reported outcomes after proton therapy or intensity-modulated radiotherapy for prostate cancer. Cancer. 2014; 120(7):10761085.

Hoppe BS, Tsai H, Larson G, et al. Proton therapy patterns-of-care and early outcomes for Hodgkin lymphoma: results from the Proton Collaborative Group Registry. Acta Oncol. 2016;55(11):1378-1380.

Horn S, Fournier-Bidoz N, Pernin V, et al. Comparison of passive-beam proton therapy, helical tomotherapy and 3D conformal radiation therapy in Hodgkin’s lymphoma female patients receiving involved-field or involved site radiation therapy. Cancer Radiother. 2016;20(2):98-103.

Horwich A, Fossa SD, Huddart R, et al. Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma. Brit J Cancer. 2014; 110 (1): 256-263.

Houweling AC, Crama K, Visser J, et al. Comparing the dosimetric impact of interfractional anatomical changes in photon, proton and carbon ion radiotherapy for pancreatic cancer patients. Phys Med Biol. 2017;62(8):3051-3064.

Hsiung-Stripp DC, McDonough J, Masters HM, et al. Comparative treatment planning between proton and xray therapy in pancreatic cancer. Med Dosim. 2001;26(3):255-259.

Hug EB, Fitzek MM, Liebsch NJ, Munzenrider JE. Locally challenging osteo and chondrogenic tumors of the axial skeleton results of combined proton and photon radiation therapy using three-dimensional treatment planning. Int J Radiat Oncol Biol Phys. 1995;31(3):467-76.

Hug EB, Loredo LN, Slater JD, et al. Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg. 1999;91:432-9.

Hug EB, Muenter MW, Archambeau JO, et al. Conformal proton radiation therapy for pediatric low-grade astrocytomas. Strahlenther Onkol. 2002;178(1):10-17.

Hug EB, Slater JD. Proton radiation therapy for chordomas and chondrosarcomas of the skull base. Neurosurg Clin N Am. 2000;11(4):627-38.

Hug EB, Sweeney RA, Nurre PM, et al. Proton radiotherapy in management of pediatric base of skull tumors. Int J Radiat Oncol Biol Phys. 2002;52(4):1017-24.

Hutcheson K, Lewin JS, Garden AS, et al. Early experience with IMPT for the treatment of oropharyngeal tumors: acute toxicities and swallowing-related outcomes. Int J Radiat Oncol Biol Phys. 2013; 87(2 Suppl):S605.

Igaki H, Tokuuye K, Okumura T, et al. Clinical results of proton beam therapy for skull base chordoma. Int J Radiat Oncol Biol Phys. 2004;60(4):1120-6.

Isacsson U, Lennermäs, Grusell E, et al. Comparative treatment planning between proton and x-ray therapy in esophageal cancer. Int J Radiat Oncol Biol Phys. 1998;41(2):441-450.

Ishikawa H, Hashimoto T, Moriwaki T, et al. Proton beam therapy combined with concurrent chemotherapy for esophageal cancer. Anticancer Res. 2015;35(3):1757-1762.

Jiang ZQ, Yang K, Komaki R, et al. Long-term clinical outcome of intensity-modulated radiotherapy for inoperable non-small cell lung cancer: The MD Anderson experience. Int J Radiat Oncol Biol Phys. 2012; 83(1):332339.

Jørgensen AYS, Maraldo MV, Brodin NP, et al. The effect on esophagus after different radiotherapy techniques for early stage Hodgkin’s lymphoma. Acta Oncolog. 2013;52(7):1559-1565.

Kagan AR, Schulz RJ. Proton-beam therapy for prostate cancer. Cancer J. 2010;16(5):405-9.

Kim S, Shen S, Moore DF, et al. Late gastrointestinal toxicities following radiation therapy for prostate cancer. Europ Urol. 2011;60(5):908-916.

Kim YJ, Cho KH, Pyo HR, et al. A phase II study of hypofractionated proton therapy for prostate cancer. Acta Oncol. 2013;52(3):477-485.

Kirsch DG, Tarbell NJ. New technologies in radiation therapy for pediatric brain tumors the rationale for proton radiation therapy. Pediatr Blood Cancer. 2004;42(5):461-4.

Kjellberg RN. Stereotactic Bragg peak proton beam radiosurgery for cerebral arteriovenous malformations. Ann Clin Res. 1986;18:17-19.

Kjellberg RN, Hanamura T, Davis KR, et al. Bragg-peak proton-beam therapy for arteriovenous malformations of the brain. N Engl J Med. 1983;309:269-74.

Kjellberg RN, Shintani A, Frantz AG, Kliman B. Proton-beam therapy in acromegaly. N Engl J Med. 1968;278:689-95.

Kodjikian L, Roy P, Rouberol F, et al. Survival after proton-beam irradiation of uveal melanomas. Am J Ophthalmol. 2004;137(6):1002-10.

Kollmeier MA, Fidaleo A, Pei X, et al. Favourable long-term outcomes with brachytherapy-based regimens in men ≤60 years with clinically localized prostate cancer. BJU Int. 2013; 111(8):1231-1236.

Konski A, Speier W, Hanlon A, et al. Is proton beam therapy cost effective in the treatment of adenocarcinoma of the prostate? J Clin Oncol. 2007;25(24):3603-08.

Kotecha R, Yamada Y, Pei X, et al. Clinical outcomes of high-dose-rate brachytherapy and external beam radiotherapy in the management of clinically localized prostate cancer. Brachytherapy. 2013; 12(1):4449.

Koyama S, Tsujii H. Proton beam therapy with high-dose irradiation for superficial and advanced esophageal carcinomas. Clin Cancer Res. 2003; 9(10 Pt 1):3571-3577.

Kozak KR, Adams J, Krejcarek SJ, et al. A dosimetric comparison of proton and intensity-modulated photon radiotherapy for pediatric parameningeal rhabdomyosarcomas. Int J Radiat Oncol Biol Phys. 2009;74(1):179-186.

Kozak KR, Kachnic LA, Adams J, et al. Dosimetric feasibility of hypofractionated proton radiotherapy for neoadjuvant pancreatic cancer treatment. Int J Radiat Oncol Biol Phys. 2007; 68(5):1557-1566.

Kuban D, Pollack A, Huang E, et al. Hazards of dose escalation in prostate cancer radiotherapy. Int J Radiat Oncol Biol Phys. 2003;57(5):1260-8.

Lee RY, Nichols Jr RC, Huh SN, et al. Proton therapy may allow for comprehensive elective nodal coverage for patients receiving neoadjuvant radiotherapy for localized pancreatic head cancers. J Gastrointest Oncol. 2013;4(4):374-379.

Leroy R, Benahmed N, Hulstaert F, et al. Proton therapy in children: a systematic review of clinical effectiveness in 15 pediatric cancers. Int J Radiat Oncol Biol Phys. 2016;95(1):267-278.

Lewinshtein D, Gulati R, Nelson PS et al. Incidence of second malignancies after external beam radiotherapy for clinical stage I testicular seminoma. BJU International. 2012; 109(5):​706-712.

Li W, Gragoudas ES, Egan KM. Tumor basal area and metastatic death after proton beam irradiation for choroidal melanoma. Arch Ophthalmol. 2003;121(1):68-72.

Liao Z, Lee JJ, Komaki R, et al. Bayesian adaptive randomization trial of passive scattering proton therapy and intensity-modulated photon radiotherapy for locally advanced non-small cell lung cancer. J Clin Oncol. 2018;36(18):1813-1822.

Liao ZX, Lee JJ, Komaki R, et al. Bayesian randomized trial comparing intensity modulated radiation therapy versus passively scattered proton therapy for locally advanced non-small cell lung cancer. J Clin Oncol. 2016; 34(15_suppl), 8500.

Lin LL, Kirk M, Scholey J, Taku N, Kiely JB, White B, Both S. Initial Report of Pencil Beam Scanning Proton Therapy for Posthysterectomy Patients With Gynecologic Cancer. Int J Radiat Oncol Biol Phys. 2016;95(1):181-9.

Lin SH, Komaki R, Liao Z, et al. Proton beam therapy and concurrent chemotherapy for esophageal cancer. Int J Radiat Oncol Biol Phys. 2012;83(3):e345-351.

Lin SH, Merrell KW, Shen J, et al. Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer. Radiother Oncol. 2017;123(3):376-381.

Linton OR, Moore MG, Brigance JS, et al. Proton therapy for head and neck adenoid cystic carcinoma: initial clinical outcomes. Head & Neck. 2015;37(1):117-124.

Lodge M, Pijls-Johannesma M, Stirk L, et al. A systematic literature review of the clinical and cost-effectiveness of hadron therapy in cancer. Radiother Oncol. 2007;83(2):110-22.

Lukens JN, Mick R, Demas KL, et al. Acute toxicity of proton versus photon chemoradiation therapy for pancreatic adenocarcinoma: a cohort study. Int J Radiat Biol Phys. 2013;87(2 Suppl):S311.

Lumbroso L, Desjardins L, Levy C, et al. Intraocular inflammation after proton beam irradiation for uveal melanoma. Br J Ophthalmol. 2001;85(11):1305-8.

Lumbroso-Le Rouic L, Delacroix S, Dendale R, et al. Proton beam therapy for iris melanomas. Eye. 2006;20(11):1300-5.

Luu QT, Loredo LN, Archambeau JO, et al. Fractionated proton radiation treatment for pediatric craniopharyngioma. Cancer J. 2006;12(2):155-9.

MacDonald SM, Patel SA, Hickey S, et al. Proton therapy for breast cancer after mastectomy: early outcomes of a prospective clinical trial. Int J Radiat Oncol Biol Phys. 2013;86(3):484-490.

MacDonald SM, Safai S, Trofimov A, et al. Proton radiotherapy for childhood ependymoma: initial clinical outcomes and dose comparisons. Int J Radiat Oncol Biol Phys. 2008;71(4):979-986.

MacDonald SM, Trofimov A, Safai S, et al. Proton radiotherapy for pediatric central nervous system germ cell tumors: early clinical outcomes. Int J Radiat Oncol Biol Phys. 2011;79(1):121-129.

Maemura K, Mataki Y, Kurahara H, et al. Comparison of proton beam radiotherapy and hyper-fractionated accelerated chemoradiotherapy for locally advanced pancreatic cancer. Pancreatology. 2017;17(5):833-838.

Makishima H, Ishikawa H, Terunuma T, et al. Comparison of adverse effects of proton and x-ray chemoradiotherapy for esophageal cancer using an adaptive dose-volume histogram analysis. J Radiat Research. 2015;56(3):568-576.

Maraldo MV, Brodin NP, Aznar MC, et al. Doses to head and neck normal tissues for early stage Hodgkin lymphoma after involved node radiotherapy. Radiother Oncol. 2014;110(3):441-447.

Maraldo MV, Brodin NP, Aznar MC, et al. Estimated risk of cardiovascular disease and secondary cancers with modern highly conformal radiotherapy for early-stage mediastinal Hodgkin lymphoma. Ann Oncol. 2013;24(8):2113-2118.

Marks LB, Yorke ED, Jackson A, et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys. 2010;76(3 S);S10-S19.

Marnitz S, Wlodarczyk W, Neumann O, et al. Which technique for radiation is most beneficial for patients with locally advanced cervical cancer? Intensity modulated proton therapy versus intensity modulated photon treatment, helical tomotherapy and volumetric arc therapy for primary radiation – an intraindividual comparison. Radiat Oncol. 2015; 10: 91.

Matloob SA, Nasir HA, Choi D. Proton beam therapy in the management of skull base chordomas: systematic review of indications, outcomes, and implications for neurosurgeons. Br J Neurosurg. 2016:1-6.

Mayahara H, Murakami M, Kagawa K, et al. Acute morbidity of proton therapy for prostate cancer the Hyogo Ion Beam Medical Center experience. Int J Radiat Oncol Biol Phys. 2007;69(2):434-43.

Mazonakis M, Berris T, Lyraraki E et al. Radiation therapy for stage IIA and IIB testicular seminoma: peripheral dose calculations and risk assessments. Physics in Medicine and Biology. 2015; 60(6):2375-2390.

McAllister B, Archambeau JO, Nguyen MC, et al. Proton therapy for pediatric cranial tumors preliminary report on treatment and disease-related morbidities. Int J Radiat Oncol Biol Phys. 1997;39(2):455-60.

McDonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001; 345(10):725-730.

McDonald MW, Liu Y, Moore MG, et al. Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy. Radiat Oncol. 2016;11(32).

McDonald MW, Zolali-Meybodi O, Lehnert SJ, et al. Reirradiation of recurrent and second primary head and neck cancer with proton therapy. Int J Radiat Oncol Biol Phys. 2016;96(4):808-819.

Mehdorn HM, Grote W. Non-invasive follow-up of patients with intracranial arteriovenous malformations after proton-beam radiation therapy. Acta Neurochir. 1988;42:98-102.

Mendenhall NP, Hoppe BS, Nichols RC, et al. Five-year outcomes from 3 prospective trials of image-guided proton therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2014; 88(3):596-602.

Merchant TE. Proton beam therapy in pediatric oncology. Cancer J. 2009;15(4):298-305.

Merchant TE, Hua CH, Shukla H, et al. Proton versus photon radiotherapy for common pediatric brain tumors: comparison of models of dose characteristics and their relationship to cognitive function. Pediatr Blood Cancer. 2008;51(1):110-117.

Michalski JM, Winter K, Purdy JA, et al. Toxicity after three-dimensional radiotherapy for prostate cancer with RTOG 9406 dose level IV. Int J Radiat Oncol Biol Phys. 2004;58(3):735-42.

Mishra KK, Quivey JM, Daftari IK, et al. Long-term Results of the UCSF-LBNL randomized trial: charged particle with helium ion versus iodine-125 plaque therapy for choroidal and ciliary body melanoma. Int J Radiat Oncol Biol Phys. 2015;92(2):376-383.

Mizumota M, Yamamoto Y, Takano S, et al. Long-term survival after treatment of glioblastoma multiforme with hyperfractionated concomitant boost proton beam therapy. Pract Radiat Oncol. 2015;5(1):e9-e16.

Moeller BJ, Chintagumpala M, Philip JJ, et al. Low early ototoxicity rates for pediatric medulloblastoma patients treated with proton radiotherapy. Radiat Oncol. 2011;6:58.

Mohan R, Grosshans D. Proton therapy – present and future. Adv Drug Deliv Rev. 2017; 109:26-44.

Mori S and Chen GTY. Quantification and visualization of charged particle range variations. Int J Radiat Oncol Biol Phys. 2008;72(1):268-277.

Mori S, Wolfgang J, Lu H-M, et al. Quantitative assessment of range fluctuations in charged particle lung irradiation. Int J Radiat Oncol Biol Phys. 2008;70(1):253-261.

Moteabbed M, Geyer A, Drenkhahn R, et al. Comparison of whole-body phantom designs to estimate organ equivalent neutron doses for secondary cancer risk assessment in proton therapy. Phys Med Biol. 2012; 57(2):499-515.

Moyers MF, Miller DW, Bush DA, et al. Methodologies and tools for proton beam design for lung tumors. Int J Radiat Oncol Biol Phys. 2001;49(5):1429-1438.

Munzenrider JE, Gragoudas ES, Seddon JM, et al. Conservative treatment of uveal melanoma probability of eye retention after proton treatment. Int J Radiat Oncol Biol Phys. 1988;15(3):553-8.

Murphy ES, Suh JH. Radiotherapy for vestibular schwannomas: a critical review. Int J Radiat Oncol Biol Phys. 2011; 79(4):985-997.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Bone Cancer. Version 2.2024. [NCCN Web site]. Available at: http://www.nccn.org/professionals/physician_gls/pdf/bone.pdf. Accessed April 1, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 4.2024. [NCCN Web site]. Available at: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed April 1, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology- Central Nervous System Cancers. Version 1.2024. [NCCN Web site]. Available at: http://www.nccn.org/professionals/physician_gls/pdf/cns.pdf. Accessed April 1, 2024..

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. Version 3.2024. [NCCN Web site]. Available at: http://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf. Accessed April 1, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers. Version 4.2024. [NCCN Web site]. Available at:http://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed April 1, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer. Version 7.2024. [NCCN Web site]. Available at: http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Accessed April 1, 2024..

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 4.2024. [NCCN Web site]. Available at:http://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed April 1, 2024.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Testicular Cancer. Version 1.2024. [NCCN Web site]. Available at: https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf. Accessed April 1, 2024.​

National Institute for Health and Clinical Excellence (NICE). Improving outcomes for people with brain and other CNS tumours --- evidence review. June 2006. Available at http://www.nice.org.uk/guidance/csgbraincns/resources/improving-outcomes-for-people-with-brain-and-other-cns-tumour​s-the-manual2. Accessed April 1, 2024.

Nguyen PL, Aizer A, Assimos DG, et al. ACR Appropriateness Criteria(R) Definitive External-Beam Irradiation in stage T1 and T2 prostate cancer. Am J Clin Oncol. 2014;37(3):278-288.

Nichols Jr RC, George TJ, Zaiden Jr RA, et al. Proton therapy with concomitant capecitabine for pancreatic and ampullary cancers is associated with a lower incidence of gastrointestinal toxicity. Acta Oncologica. 2013;52(3):498-505.

Nichols Jr RC, Huh SN, Prado KL, et al. Protons offer reduced normal-tissue exposure for patients receiving postoperative radiotherapy for resected pancreatic head cancer. Int J Radiat Oncol Biol Phys. 2012;83(1):148-163.

Niedzielski JS, Yang J, Mohan R, et al. Differences in normal tissue response in the esophagus between proton and photon radiation therapy for non-small cell lung cancer using in vivo imaging biomarkers. Int J Radiat Oncol Biol Phys. 2017;99(4):1013-1020.

Nihei K, Ogino T, Ishikura S, et al. Phase II feasibility study of high-dose radiotherapy for prostate cancer using proton boost therapy First clinical trial of proton beam therapy for prostate cancer in Japan. Jpn J Clin Oncol. 2005;35(12):745-52.

Nilsson S, Norlen BJ, Widmark A. A systematic overview of radiation therapy effects in prostate cancer. Acta Oncologica. 2004;43(4):316-81.

Noel G, Feuvret L, Calugaru V, et al. Chordomas of the base of the skull and upper cervical spine. One hundred patients irradiated by a 3D conformal technique combining photon and proton beams. Acta Oncol. 2005;44(7):700-8.

Noel G, Habrand JL, Helfre S, et al. Proton beam therapy in the management of central nervous system tumors in childhood. Preliminary experience of the Centre de Protontherapie d'Orsay. Med Pediatr Oncol. 2003;40(5):309-15.

Noel G, Habrand JL, Jauffret E, et al. Radiation therapy for chordoma and chondrosarcoma of the skull base and the cervical spine. Prognostic factors and patterns of failure. Strahlenther Onkol. 2003;179(4):241-8.

Noel G, Habrand JL, Mammar H, et al. Combination of photon and proton radiation therapy for chordomas and chondrosarcomas of the skull base the Centre de ProtonthD'Orsay experience. Int J Radiat Oncol Biol Phys. 2001;51(2):392-8.

Noel G, Habrand JL, Mammar H, et al. Highly conformal therapy using proton component in the management of meningiomas. Preliminary experience of the Centre de Protontherapie d'Orsay. Strahlenther Onkol. 2002;178(9):480-5.

Ojerholm E, Kirk ML, Thompson RF, et al. Pencil-beam scanning proton therapy for anal cancer: a dosimetric comparison with intensity-modulated radiotherapy. Acta Oncol. 2015;54(8):1209-17.

Olsen DR, Bruland OS, Frykholm G, Norderhaug IN. Proton therapy a systematic review of clinical effectiveness. Radiother Oncol. 2007;83(2):123-32.

Park SS, Daftari I, Phillips T, et al. Three-year follow-up of a pilot study of ranibizumab combined with proton beam irradiation as treatment for exudative age-related macular degeneration. Retina. 2012;32(5):956-966.

Patel SH, Wang Z, Wong WW, et al. Charged particle therapy versus photon therapy for paranasal sinus and nasal cavity malignant diseases: a systematic review and meta-analysis. Lancet Oncol. 2014;15(9):1027-1038.

Peeler CR, Mirkovic D, Titt U, et al. Clinical evidence of variable proton biological effectiveness in pediatric patients treated for ependymoma. Radiother Oncol; 2016; 121(3):395-401.

Phan J, Sio TT, Nguyen TP, et al. Reirradiation of head and neck cancer with proton therapy: outcomes and analyses. Int J Radiat Oncol Biol Phys. 2016;96(1):30-41.

Pijls-Johannesma M, Grutters J, Verhaegen F, et al. Do we have enough evidence to implement particle therapy as standard treatment in lung cancer? A systematic literature review. Oncologist. 2010;15(1):93-103.

Plastaras JP, Vogel J, Elmongy H, et al. First clinical report of pencil beam scanned proton therapy for mediastinal lymphoma. Int J Radiat Oncol Biol Phys. 2016;96(2 Suppl):E497.

Prayongrat A, Xu C, Li H, et al. Clinical outcomes of intensity modulated proton therapy and concurrent chemotherapy in esophageal carcinoma: a single institutional experience. Adv Radiat Oncol. 2017;2(3):301-307.

Raldow AC, Hong TS. Will There Be a Clinically Significant Role for Protons in Patients With Gastrointestinal Malignancies? Semin Radiat Oncol. 2018;28(2):125-130.

Ramakrishna NR, Harper B, Burkavage R, et al. A comparison of brain and hippocampal dosimetry with protons or intensity modulated radiation therapy planning for unilateral glioblastoma. Int J Radiat Oncol Biol Phys. 2016;96(2 Suppl):e134-e135.

Richie JP. Editorial Comment. Re: Incidence of second malignancies after external beam radiotherapy for clinical stage I testicular seminoma. J of Urology. 2012;188(6):2231-2232.

Romesser PB, Cahlon O, Scher E, et al. Proton beam radiation therapy results in significantly reduced toxicity compared with intensity-modulated radiation therapy for head and neck tumors that require ipsilateral radiation. Radiother Oncol. 2016;118(2):286-292.

Ronson BB, Schulte RW, Han KP, et al. Fractionated proton beam irradiation of pituitary adenomas. Int J Radiat Oncol Biol Phys. 2006;64(2):425-34.

Rossi CJ. Conformal proton beam therapy of prostate cancer update on the Loma Linda University medical center experience. Strahlenther Onkol. 1999;175(Suppl 2):82-4.

Rossi CJ Jr, Slater JD, Reyes-Molyneux N, et al. Particle beam radiation therapy in prostate cancer Is there an advantage? Semin Radiat Oncol. 1998;8(2):115-23.

Rowe J, Grainger A, Walton L et al. Risk of malignancy after gamma knife stereotactic radiosurgery. Neurosurgery. 2007; 60(1):60-65.

Rundle P, Singh AD, Rennie I. Proton beam therapy for iris melanoma a review of 15 cases. Eye. 2007;21(1):79-82.

Russo AL, Adams, JA, Weyman EA, et al. Long-term outcomes after proton beam therapy for sinonasal squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2016;95(1):358-376.

Sachsman S, Flampouri S, Li Z, et al. Proton therapy in the management of non-Hodgkin lymphoma. Leuk Lymphoma. 2015;56(9):2608-2612.

Sachsman S, Hoppe BS, Mendenhall NP, et al. Proton therapy to the subdiaphragmatic region in the management of Hodgkin lymphoma. Leuk Lymphoma. 2015;56(7):2019-2024.

Sachsman S, Nichols Jr RC, Morris CG, et al. Proton therapy and concomitant capecitabine for non-metastatic unresectable pancreatic adenocarcinoma. Int J Particle Therapy. 2014;1(3):692-701.

Schild ST, Rule WG, Ashman JB, et al. Proton beam therapy for locally advanced lung cancer: a review. World J Clin Oncol. 2014;5(4):568-575.

Schulte RW, Slater JD, Rossi CJ Jr., Slater JM. Value and perspectives of proton radiation therapy for limited stage prostate cancer. Strahlenther Onkol. 2000;176(1):3-8.

Seifert V, Stolke D, Mehdorn HM, Hoffmann B. Clinical and radiological evaluation of long-term results of stereotactic proton beam radiosurgery in patients with cerebral arteriovenous malformations. J Neurosurg. 1994;81:683-9.

Sejpal S, Komaki R, Tsao A, et al. Early findings on toxicity of proton beam therapy with concurrent chemotherapy for nonsmall cell lung cancer. Cancer. 2011;117(13):3004-3013.

Sheets NC, Goldin GH, Meyer AM, et al. Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer. JAMA. 2012; 307(15):1611-1620.

Shih HA, Arvold ND, Niemierko A, et al. Second tumor risk and projected late effects after proton vs. intensity modulated photon radiotherapy for benign meningioma: a dosimetric comparison. Int J Radiat Oncol Biol Phys. 2010; 78(3):S272.

Shih HA, Sherman JC, Nachtigall LB, et al. Proton therapy for low-grade gliomas: results from a prospective trial. Cancer. 2015;121(10):1712-1719.

Shipley WU, Verhey LJ, Munzenrider JE. Advanced prostate cancer the results of a randomized comparative trial of high dose irradiation boosting with conformal photons compared with conventional dose irradiation using protons alone. Int J Radiat Oncol Biol Phys. 1995;32(1):3-12.

Silander H, Pellettieri L, Enblad P, et al. Fractionated, stereotactic proton beam treatment of cerebral arteriovenous malformations. Acta Neurol Scand. 2004;109(2):85-90.

Simone II CB, Kramer K, O’Meara WP et al. Predicted rates of secondary malignancies from proton versus photon radiation therapy for stage I seminoma. Int J Radiat Oncol Biol Phys. 2012; 82(1):242-249.

Sio TT, Lin H-K, Shi Q, et al. Intensity modulated proton therapy versus intensity modulated photon radiation therapy for oropharyngeal cancer: first comparative results of patient-reported outcomes. Int J Radiat Oncol Biol Phys. 2016;95(4):1107-1114.

Slater JD. Clinical applications of proton radiation treatment at Loma Linda University review of a fifteen-year experience. Technol Cancer Res Treat. 2006;5(2):81-9.

Slater JD, Rossi CJ, Yonemoto LT, et al. Conformal proton therapy for early-stage prostate cancer. Urology. 1999;53(3):978-84.

Slater JD, Rossi CJ, Yonemoto LT, et al. Proton therapy for prostate cancer the initial Loma Linda University experience. Int J Radiat Oncol Biol Phys. 2004;59(2):348-52.

Slater JD, Yonemoto LT, Rossi CJ Jr, et al. Conformal proton therapy for prostate carcinoma. Int J Radiat Oncol Bio Phys. 1998;42(2):229-304.

Spatola C, Privitera G, Raffaele L, et al. Clinical application of proton beams in the treatment of uveal melanoma The first therapies carried out in Italy and preliminary results (CATANA Project). Tumori. 2003;89(5):502-509.

Spratt DE, Pei X, Yamada J, et al. Long-term survival and toxicity in patients treated with high-dose intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2013; 85(3):686-92.

Steneker M, Lomax A, Schneider U. Intensity modulated photon and proton therapy for the treatment of head and neck tumors. Radiother Oncol. 2006; 80(2):263-267.

Sugahara S, Oshiro Y, Nakayama H, et al. Proton beam therapy for large hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2010; 76(2):460-466.

Sugahara S, Tokuuye K, Okumura T, et al. Clinical results of proton beam therapy for cancer of the esophagus. Int J Radiat Oncol Biol Phys. 2005; 61(1):76-84.

Suit HD, Goitein M, Munzenrider JE, et al. Definitive radiation therapy for chordoma and chondrosarcoma of base of skull and cervical spine. J Neurosurg. 1982;56:377-85.

Suit HD, Urie M. Proton beams in radiation therapy. J Natl Cancer Inst. 1992;84(3):155-64.

Takaoka EI, Miyazaki J, Ishikawa H, et al. Long-term single-institute experience with trimodal bladder-preserving therapy with proton beam therapy for muscle-invasive bladder cancer. Jpn J Clin Oncol. 2017;47(1):67-73.

Takatori K, Terashima K, Yoshida R, et al. Upper gastrointestinal complications associated with gemcitabineconcurrent proton radiotherapy for inoperable pancreatic cancer. J Gastroenterol. 2014;49(6):1074-1080.

Terashima K, Demizu Y, Jin D, et al. A phase I/II study of gemcitabine-concurrent proton radiotherapy for locally advanced pancreatic cancer without distant metastasis. Radiother Oncol. 2012;103(1):25-31.

Thompson RF, Mayekar SU, Zhai H, et al. A dosimetric comparison of proton and photon therapy in unresectable cancers of the head of pancreas. Medical Physics. 2014;41(8Part1):081711-1-081711-10.

Timmermann B. Proton beam therapy for childhood malignancies: status report. Klin Padiatr. 2010;222(3):127-133.

Tolz A, Shin N, Mitrou E, et al. Late radiation toxicity in Hodgkin lymphoma patients: proton therapy’s potential. J Appl Clinic Med Physics. 2015;16(5):167-178.

Tommasino F and Durante M. Proton radiobiology. Cancers. 2015; 7(1):353-381.

Travis LB, Curtis RE, Faumeni Jr. JF et al. Risk of second malignant neoplasms among long-term survivors of testicular cancer. J Natl Cancer Inst. 1997; 89(19):1429-1439.

Travis LB, Fossa SD, Schonfield SJ, et al. Second cancers among 40,576 testicular cancer patients: focus on longterm survivors. J Natl Cancer Inst. 2005; 97(18);1354-1365.

Trofimov A, Nguyen PL, Coen JJ, et al. Radiotherapy treatment of early-stage prostate cancer with IMRT and protons: a treatment planning comparison. Int J Radiat Oncol Bioly Phys. 2007;69(2):444-453.

Trofimov A, Nguyen PL, Efstathiou JA, et al. Interfractional variations in the setup of pelvic bony anatomy and soft tissue, and their implications on the delivery of proton therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2011;80(3):928-937.

Tseng YD, Cutter DJ, Plastaras JP, et al. Evidence-based review on the use of proton therapy in lymphoma from the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee. Int J Radiat Oncol Biol Phys. 2017;99(4):825-842.

van de Schoot AJ, Visser J, van Kesteren Z, Janssen TM, Rasch CR, Bel A. Beam configuration selection for robust intensity-modulated proton therapy in cervical cancer using Pareto front comparison. Phys Med Biol. 2016;61(4):1780-94.

Vargas C, Fryer A, Mahajan C, et al. Dose-volume comparison of proton therapy and intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70(3):744-51.

Verma V, Iftekaruddin Z, Badar N, et al. Proton beam radiotherapy as part of comprehensive regional nodal irradiation for locally advanced breast cancer. Radiother Oncol. 2017;123(2):294-298.

Verma V, Simone 2nd CB, and Mishra MV. Quality of life and patient-reported outcomes following proton radiation therapy: a systematic review. J Natl Cancer Inst. 2018;110(4):341-353.

Vernimmen FJ, Harris JK, Wilson JA, et al. Stereotactic proton beam therapy of skull base meningiomas. Int J Radiat Oncol Biol Phys. 2001;49(1):99-105.

Wang J, Wei C, Tucker SL, et al. Predictors of postoperative complications after trimodality therapy for esophageal cancer. Int J Radiat Oncol Biol Phys. 2013;86(5):885-891.

Wang XS, Shi Q, Williams LA, et al. Prospective study of patient-reported symptom burden in patients with nonsmall-cell lung cancer undergoing proton or photon chemoradiation therapy. J Pain Symptom Manage. 2016;51(5):832-838.

Wang Z, Nabhan M, Schild SE, et al. Charged particle radiation therapy for uveal melanoma: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys. 2013;86(1):18-26.

Weber DC, Chan AW, Bussiere MR, et al. Proton beam radiosurgery for vestibular schwannoma tumor control and cranial nerve toxicity. Neurosurgery. 2003;53(3):577-86.

Weber DC, Rutz HP, Bolsi A, et al. Spot scanning proton therapy in the curative treatment of adult patients with sarcoma: the Paul Scherrer institute experience. Int J Radiat Oncol Biol Phys. 2007;69(3):865-71.

Weber DC, Rutz HP, Pedroni ES, et al. Results of spot-scanning proton radiation therapy for chordoma and chondrosarcoma of the skull base the Paul Scherrer Institut experience. Oncol Biol Phys. 2005;63(2):401-9.

Wenkel E, Thornton AF, Finkelstein D, et al. Benign meningioma partially resected, biopsied, and recurrent intracranial tumors treated with combined proton and photon radiotherapy. Int J Radiat Oncol Biol Phys. 2000;48(5):1363.

Wilkinson B, Morgan H, Gondi V, et al. Low levels of acute toxicity associated with proton therapy for low-grade glioma: a proton collaborative group study. Int J Radiat Oncol Biol Phys. 2016; 96(2S):E135.

Wilson MW, Hungerford JL. Comparison of episcleral plaque and proton beam radiation therapy for the treatment of choroidal melanoma. Ophthalmology. 1999;106(8):1579-87.

Winkfield KM, Gallotto S, Niemierko A, et al. Proton therapy for mediastinal lymphomas: an 8-year single-institution report. Int J Radiat Oncolo Biol Phys. 2015;93(3 Suppl):E461.

Wo JY, Yeap BY, Delany TF et al. A pilot feasibility study of definitive concurrent chemoradiation with pencil beam scanning proton beam in combination with 5-fluorouracil and mitomycin-c for carcinoma of the anal canal. Journal of Clinical Oncology 36, no. 4_suppl (February 2018) 733-733.​

Wolff HA, Wagner DM, Conradi LC, et al. Irradiation with protons for the individualized treatment of patients with locally advanced rectal cancer. Radiotherapy and Oncology. 2012;102(1): 30-37.

Xi M, Xu C, Liao Z, et al. Comparative outcomes after definitive chemoradiotherapy using proton beam therapy versus intensity modulated radiation therapy for esophageal cancer: a retrospective, single-institutional analysis. Int J Radiat Oncol Biol Phys. 2017;99(3):667-676.

Yonemoto LT, Slater JD, Rossi CJ Jr, et al. Combined proton and photon conformal radiation therapy for local advanced carcinoma of the prostate preliminary results of a phase I/II study. Int J Radiat Oncol Bio Phys. 1997;37(1):21-9.

Yoon M, Kim D, Shin DH, et al. Inter- and intrafractional movement-induced dose reduction of prostate target volume in proton beam treatment. Int J Radiat Oncol Biol Phys. 2008;71(4):1091-1102.

Yu JB, Soulos PR, Herrin J et al. Proton versus intensity-modulated radiotherapy for prostate cancer: patterns of care and early toxicity. J Natl Cancer Inst. 2013;105(1):25-32.

Yuh GE, Loredo LN, Yonemoto LT, et al. Reducing toxicity from craniospinal irradiation using proton beams to treat medulloblastoma in young children. Cancer J. 2004;10(6):386-90.

Zacharatou Jarlskog C, Paganetti H. Risk of developing second cancer from neutron dose in proton therapy as function of field characteristics, organ, and patient age. Int J Radiat Oncol Biol Phys. 2008; 72(1):228-235.

Zelefsky MJ, Pei X, Teslova T, et al. Secondary cancers after intensity-modulated radiotherapy, brachytherapy and radical prostatectomy for the treatment of prostate cancer: incidence and cause-specific survival outcomes according to the initial treatment intervention. BJU Int. 2012; 110(11):1696-701.

Zenda S, Kawashima M, Arahira S, et al. Late toxicity of proton beam therapy for patients with the nasal cavity, para-nasal sinuses, or involving the skull base malignancy: importance of long-term follow-up. Int J Clin Oncol. 2015;20(3):447-54.

Zhang X, Zhao KL, Guerrero TM, et al. Four-dimensional computed tomography-based treatment planning for intensity-modulated radiation therapy and proton therapy for distal esophageal cancer. Int J Radiat Oncol Biol Phys. 2008; 72(1):278-287.

Zietman A. Proton beam and prostate cancer: an evolving debate. Reports of Practical Oncol Radiother. 2013;18(6):338-342.

Zietman Al, Bae K, Slater JD, et al. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from Proton Radiation Oncology Group/American College of Radiology 95-09. J Clin Oncol. 2010;28(7):1106-1111.

Zietman AL. The Titanic and the iceberg prostate proton therapy and health care economics. J Clin Oncol. 2007;25(24):3565-6.

Zietman AL, DeSilvio ML, Slater JD, et al. Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate a randomized controlled trial. JAMA. 2005;294(10):1233-9.

Zorlu F, Gurkaynak M, Yildiz F et al. Conventional external radiotherapy in the management of clivus chordomas with overt residual disease. Neurol Sci. 2000;21(4):203–207.

Zurlo A, Lomax A, Hoess A, et al. The role of proton therapy in the treatment of large irradiation volumes: a comparative planning study of pancreatic and biliary tumors. Int J Radiat Oncol Biol Phys. 2000; 48(1):277-288.​

Coding

CPT Procedure Code Number(s)
THE FOLLOWING CODES ARE USED TO REPRESENT PROTON BEAM RADIATION TREATMENT DELIVERY

 77520, 77522, 77523, 77525

THE FOLLOWING CODES ARE USED TO REPRESENT SERVICES ASSOCIATED WITH PROTON BEAM RADIATION THERAPY

 77014, 77263, 77290, 77293, 77295, 77300, 77301, 77307, 77321, 77331, 77332, 77333, 77334, 77336, 77370, 77387, 77427, 77470
ICD - 10 Procedure Code Number(s)
N/A
ICD - 10 Diagnosis Code Number(s)
See At​tachment A: MEDICALLY NECESSARY ICD10 Diagnosis Codes

See Attachment B: NOT MEDICALLY NECESSARY ICD10 Diagnosis Codes​
HCPCS Level II Code Number(s)
MEDICALLY NECESSARY

 THE FOLLOWING CODES ARE USED TO REPRESENT SERVICES ASSOCIATED WITH PROTON BEAM RADIATION THERAPY

 G6001 Ultrasonic guidance for placement of radiation therapy fields

 G6002 Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy
Revenue Code Number(s)
0333 Radiation therapy


Coding and Billing Requirements

Policy History

10/28/2024
10/28/2024
09.00.49
Medical Policy Bulletin
Commercial
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No