ESTRO PT 2018

Critics correctly point out the deficit on the past of prospective trials, specifically also the lack of Phase I and Phase II studies. In the majority of indications appropriate dose-effect studies or dose escalation dstudies have not been performed for protons. Adopting the effective photon dose in a randomized trial for protons severely limits the endpoints to xoicity reduction only – but will tell us little about the trues potential of tumor control and survival benefit ….However, - is the appropriate answer to jump to Phase III Trials? … compared to finally and carefully performing Phase I and II Trials. If we would have performed a randomized trial in the late 80‘s on skull base chordomas in order to justify further investigation into particles, it would have been a 60 Gy proton versus photon study. .. Likely we would not be sitting here today………..