Table 1.

NHS England criteria for commissioning proton beam therapy (PBT) for children, teenagers, and young adults in the treatment of malignant and non-malignant tumours.

(1) A clear indication for radiotherapy; defined as curable; and with a reasonable disease-specific 5-year survival expectation.

(2) Confirmation by a Children’s Principal Treatment Centre (PTC) or TYA PTC multi-disciplinary team (MDT) that treatment with PBT is an option.

(3) Age from birth up to about 25 years of age.

(4) No evidence of distant metastases, with the exception of tumours which remain curable when metastatic (i.e. metastatic intracranial germinomas).

(5) Adequate performance status and medically sufficiently stable to undergo PBT without delay, which may lead to increased risk of recurrence or compromise cure rates.

(6) Exclusion of patients requiring radiotherapy for indications where there is no dosimetric advantage for protons over photons (i.e. TBI, WBRT).

(7) Shared Decision-Making Tool: To be utilised as a framework for discussing radiotherapy with patients and their guardians, including knowns and unknowns regarding benefits and risks for PRT vs PBT.

PRT, photon radiotherapy; TBI, total body irradiation; WBRT, whole-brain radiotherapy.