INTRODUCTION: Proton radiation therapy has become an important modality in improving the therapeutic index for cancer patients. Research extends back decades, but recent advancements have led to increasing adoption, though widespread utilization is limited by necessary technical expertise and the capital investment required to implement the technology. Here, we evaluate modern utilization of proton therapy in the United States by evaluating the National Cancer Database (NCDB) population of patients diagnosed with disease in 2018. METHODS: The NCDB was queried for patients diagnosed in 2018, with conditions grouped into the major disease sites. The proportion of patients treated with radiotherapy overall, with external beam radiotherapy (EBRT), and with proton radiotherapy, were extracted and evaluated using SPSS version 28. RESULTS: Approximately 1.3 million patients who were diagnosed and treated for malignancy in 2018 were included in our analysis. Of these patients, approximately 29.8% received radiotherapy, with approximately 92% of these patients receiving EBRT (27.4% of the entire cohort). Of patients receiving EBRT, approximately 2.2% received proton radiotherapy (Table 1), for a total utilization of 1.9% for all cancer patients diagnosed in 2018. The most common disease sites proportionally treated with proton radiotherapy were peripheral nervous system tumors (21.1% of patients receiving EBRT), bone cancers (11.0%), and cancers of the thymus (8.3%). Rates of proton usage in common malignancies include CNS (5.4%), prostate (3.6%), head and neck (3.1%), breast (1.5%), and lung (1.3%). CONCLUSIONS: The use of proton therapy remains comparatively low for most disease sites amongst patients diagnosed in 2018, given barriers related to limited high level evidence, insurance coverage, and high capital costs. Uncommon disease appears to be treated in greater proportion with proton versus other EBRT.
HSR22-137 Table 1: Proportion of NCDB patients diagnosed with cancer in 2018 and treated with EBRT who received proton therapy.