DISP-33. Approaches to Utilization of Proton Radiotherapy in Primary and Secondary Brain Tumors as a Scarce Resource: A Qualitative Analysis of Physician Perspectives

PURPOSE Proton radiotherapy offers the opportunity to potentially spare healthy tissue and increase survival in some primary and secondary brain tumors in adults. Specifically, data has shown proton radiotherapy to be more beneficial than traditional photon therapy in leptomeningeal carcinomatosis. Treatment options are limited in neuro-oncology, and proton radiotherapy is a scarce resource. If proton radiotherapy is thought to be beneficial, then there may be an ethical obligation to increase access for a vulnerable patient population. If outcomes are not significantly different, however, then expanding access may not be justifiable given the high level of resource utilization required for proton use. METHODS This is a qualitative analysis of interviews from neuro-oncologists, medical oncologists, and radiation oncologists, exploring their perspectives on proton use in adult brain tumors. Interviews were analyzed using a framework analysis, and key themes and quotations were identified. RESULTS We interviewed 12 physicians from 8 academic institutions in the Midwest. There was a spectrum of opinions regarding the value of and experiences with proton radiotherapy. Most participants referred patients for proton radiotherapy, most commonly citing reduced toxicity as the indication, driven by evidence in adult brain tumors and more so by extrapolation of proton research in other cancers. A slight majority of participants felt it was important to overcome barriers to access proton radiotherapy and that more research was indicated. CONCLUSION Participant perspectives on proton use in adult brain tumors are varied and with some uncertainty. Our data recommends investing in regional rather than institutional centers, collaborating with biomedical companies to reduce costs, and to consider expanding access for advanced photon radiotherapy given that this may be a relatively easier method for wider adoption. More research is needed to demonstrate the beneficial and detrimental effects of proton radiotherapy and how this compares to advanced photon radiotherapy techniques.