Which patients can be referred?
In the Netherlands, indications for proton therapy are subdivided into ‘standard indications’ and so-called ‘model-based indications’. Patients can only be referred to proton therapy for a treatment with a curative intent.
Standard indications are eligible to be treated with proton therapy. These patients can be referred for proton therapy and the treatment will be reimbursed by your (Dutch) health care insurance.
We treat the following standard indications:
- Pediatric tumors
- Base-of-skull tumors
- Brain tumors with a favorable prognosis without the possibility of high-precision radiation (stereotactic radiotherapy) (about 5-10% are eligible for a treatment with protons)
- Brain tumors in which both the brain and the entire spinal cord must be irradiated (the UMCG Proton Therapy Center is the only center in the Netherlands where the craniospinal axis can be treated with proton therapy)
The so-called model-based indications are not automatically eligible for proton therapy treatment. Referral for proton therapy depends on whether or not a (patient individual) treatment planning comparison study shows a substantial reduction in dose to healthy tissues (∆Dose), which is expected to result in a clinically relevant reduction in the probability of treatment-related complications (∆NTCP).
At the moment you can request a treatment planning comparison study for the following indications:
- Head and neck tumors (about 35% are eligible for proton treatment)
- Tumors of the breast (about 5% are eligible for proton treatment)
- Tumors of the lung and other tumors in and near the lung (approximately 20% are eligible for proton treatment)
We continually strive to expand these indications.
Treatment planning comparison
The treatment planning comparison for model-based indications compares the photon therapy treatment plan, as designed by the referring institute, to the proton therapy plan as designed by us. The outcome is what we call a ∆NTCP-profile, indicating the probability of treatment related complications for both treatment techniques. A patient is eligible for proton therapy if this ∆NTCP-profile satisfies the criteria of the Nationwide Proton Therapy Indication Protocol.
If the planning comparison outcome is POSITIVE (i.e. a clinically relevant reduction in the probability of treatment-related complications), the patient can be referred to us for proton therapy treatment. In this case, the treatment will be reimbursed by your (Dutch) health care insurance.
If the planning comparison outcome is NEGATIVE (i.e. there is no or little expected benefit of treating with proton therapy), the patient is not eligible for proton therapy treatment.