Transforming cancer care in Australia: The dawn of particle therapy

The nearing completion of the Australian Bragg Centre for Proton Therapy and Research marks a transformative leap in cancer care in Australia. Highlighting the precision and potential of particle therapy in reducing long‐term side effects, particularly in paediatric and rare cancers, this editorial underscores Australia's commitment to integrating this innovative modality into national healthcare, despite challenges in accessibility and cost.

Australian Society of Medical Imaging and Radiation Therapy (ASMIRT), and the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM).Australian expertise in particle therapy is undeniable, as reflected in the breadth of research articles in this special edition.These contributions cover a wide range of topics, signifying a deep understanding and proficiency in particle therapy across the country.
However, the pathway to integrating particle therapy into national healthcare is fraught with challenges.The Medical Services Advisory Committee (MSAC) has currently approved a very limited set of reimbursable indications for proton therapy, constraining its application compared to countries like the United States, the United Kingdom, Germany and Japan. 4With over 150,000 Australians diagnosed with cancer annually and about 38% receiving radiation therapy (despite an optimal utilisation target of 52%), just over 440 patients per year are predicted to qualify for proton therapy under the current reimbursement model. 5,6This figure includes a significant portion of paediatric, adolescent and young adult (AYA) cases, leaving only a small percentage of adult patients eligible for this treatment.
The potential for expanding proton therapy indications exists, mirroring international standards and evidence for conditions such as head and neck cancers and re-irradiation scenarios.Yet, the likelihood of a significant broadening of indications in the near term appears slim.This reality underscores a strong desire for particle therapy facilities across Australia's major states, driven by the national healthcare objective of delivering cancer care closer to patients' homes.This is especially critical for First Nations and Torres Strait Islander communities, who face considerable disadvantages due to the vast distances to healthcare facilities.The establishment and operational costs of a particle therapy facility are high, reflecting the advanced training required for clinicians, medical physicists and radiation therapists and the sophisticated technology involved.These financial considerations, coupled with the limited range of current clinical indications, pose significant challenges.Cancer Australia's national assessment suggests that the justification for a particle therapy facility in every major state is untenable, given Australia's population size and the expected range of treatment indications. 7et, the role of radiation therapy in cancer treatment, known for its cost-effectiveness and efficacy compared to say, medical oncology treatments, provides a broader context for evaluating the investment in proton therapy.For example, the cost of a single immunotherapy drug in the US can triple the entire budget for radiation therapy, underscoring the economic viability of investing in particle therapy.
The forthcoming ABCPTR, poised to be Australia's pioneer proton therapy facility, represents more than a national resource; it embodies the potential for enhanced patient outcomes and is accessible to clinicians nationwide through platforms like the Australian Particle Therapy Clinical Quality Registry (ASPIRE) registry.The possibility of expanding access to proton therapy-and potentially to heavy particle therapy-promises to elevate patient care, collaboration and research to unprecedented levels in Australian radiation oncology.
In this special edition of the Journal of Medical Radiation Sciences, the Australian radiation oncology community collectively showcases its significant contributions to the field of particle therapy.Through a diverse range of articles, researchers illustrate the transformative potential of particle therapy, especially for paediatric and rare cancers, by emphasising its precision, efficacy and patient-centred care principles.Australian publications have previously highlighted proton therapy's capacity to minimise radiation exposure and long-term side effects in paediatric patients, addressing the ethical considerations of treatment access and eligibility. 8uilding on this, the creation of the Bragg Consumer Advisory Group (BCAG), as discussed by Penfold M, et al., demonstrates a progressive step towards incorporating patient perspectives into healthcare decision-making, reinforcing the importance of patient engagement. 9Skelton et al. delve into the challenges encountered by families travelling overseas for proton therapy, underscoring the necessity for enhanced support and care coordination. 10Mathew et al. explore the advancements in treating clival chordomas with particle therapy, signalling a shift towards more targeted and effective treatment options within Australia's healthcare infrastructure for this rare cancer. 11Additionally, initiatives like the Victorian Comprehensive Cancer Centre's comparative planning service for photon and proton therapy and the evaluation of fixed-beam and gantry-based proton therapy planning methods used in the treatment of base of skull chordoma highlight the ongoing efforts to enhance local clinical and technical expertise and treatment accessibility. 12,13Wood et al.'s scoping review on the impact of the COVID-19 pandemic on proton therapy services calls for further research to refine patient selection and care strategies. 14Furthermore, Thwaites et al.'s discussion on the integration of carbon ion radiation therapy alongside proton therapy facilities points to the clinical and scientific potential to advance cancer treatment research. 15s we stand on the brink of integrating particle therapy into Australia's healthcare framework, we celebrate the innovation, collaboration and commitment to patient care showcased in this special edition.The introduction of particle therapy in Australia is not merely a technological milestone but a leap towards evidence based, advanced cancer care utilising particle therapy, heralding a new era in oncology treatment that holds promise for improving oncological outcomes and long term quality of life for many Australian patients.

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2024 The Authors.Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.