BACKGROUND AND PURPOSE: Major differences exist among proton therapy (PT) centres regarding PT delivery in adult cancer patient. To obtain insight into current practice in Europe, we performed a survey among European PT centres. MATERIALS AND METHODS: We designed electronic questionnaires for eight tumour sites, focusing on four main topics: 1) indications and patient selection methods; 2) reimbursement; 3) on-going or planned studies, 4) annual number of patients treated with PT. RESULTS: Of 22 centres, 19 (86%) responded. In total, 4233 adult patients are currently treated across Europe annually, of which 46% consists of patients with central nervous system tumours (CNS), 15% head and neck cancer (HNC), 15% prostate, 9% breast, 5% lung, 5% gastrointestinal, 4% lymphoma, 0.3% gynaecological cancers. CNS are treated in all participating centres (n = 19) using PT, HNC in 16 centres, lymphoma in 10 centres, gastrointestinal in 10 centres, breast in 7 centres, prostate in 6 centres, lung in 6 centres, and gynaecological cancers in 3 centres. Reimbursement is provided by national health care systems for the majority of commonly treated tumour sites. Approximately 74% of centres enrol patients for prospective data registration programs. Phase II-III trials are less frequent, due to reimbursement and funding problems. Reasons for not treating certain tumour types with PT are lack of evidence (30%), reimbursement issues (29%) and/or technical limitations (20%). CONCLUSION: Across European PT centres, CNS tumours and HNC are the most frequently treated tumour types. Most centres use indication protocols. Lack of evidence for PT and reimbursement issues are the most reported reasons for not treating specific tumour types with PT.

Center for Proton Therapy Paul Scherrer Institute ETH Domain Switzerland

Danish Centre for Particle Therapy Aarhus University Hospital Aarhus Denmark

Department of Particle Therapy University Hospital Essen West German Proton Therapy Centre Essen Germany

Department of Radiation Oncology Centre Antoine Lacassagne University of Côte d'Azur Nice France

Department of Radiation Oncology Comprehensive Cancer Center Vienna Medical University of Vienna Austria

Department of Radiation Oncology GROW School for Oncology and Developmental Biology Maastricht University Medical Centre The Netherlands

Department of Radiation Oncology University of Navarra Madrid Spain

Department of Radiation Oncology UZ Leuven Belgium

Department of Radiotherapy and Radiooncology University Hospital Marburg Marburg Ion Beam Therapy Center Germany

Depatment of Oncology Motol University Hospital and Proton Therapy Center Czech Prague Czech Republic

HollandPTC Delft The Netherlands

Institut Curie Radiation Oncology Department Paris and Proton Center Orsay France

Maria Skłodowska Curie National Research Institute of Oncology Department of Radiotherapy Kraków Poland

MedAustron Ion Therapy Center Austria

OncoRay National Center for Radiation Research in Oncology Faculty of Medicine and University Hospital Carl Gustav Carus Technische Universität Dresden Helmholtz Zentrum Dresden Rossendorf Germany; Department of Radiotherapy and Radiation Oncology Faculty of Medicine and University Hospital Carl Gustav Carus Technische Universität Dresden Germany; Helmholtz Zentrum Dresden Rossendorf Institute of Radiooncology OncoRay Dresden Germany; National Center for Tumor Diseases Heidelberg Germany

Proton Beam Therapy Centre The Christie NHS Foundation Trust Manchester UK

Radiation Oncology Clinical Department National Center for Oncological Hadrontherapy Pavia Italy

Radiation Oncology Department Centre Léon Bérard Lyon France

Skandion Clinic Uppsala Sweden

Sorbonne University AP HP Sorbonne University Hôpitaux Universitaires La Pitié Salpêtrière Paris France

University of Groningen University Medical Center Groningen Department of Radiation Oncology The Netherlands

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