Proton Therapy- Conditions We Treat
How We Select Patients
Proton therapy can be used to treat any condition that can be treated with traditional radiotherapy. However, in some scenarios, it is more advantangeous than others. Therefore, we select patients with conditions who will benefit the most from proton therapy. The MOH-approved list of indications provides a guideline for the selection of patients for proton therapy.
List of Conditions We Treat With Proton Therapy
Fortunately, the Ministory of Health has made a provision for treatment outside of this list; proton therapy providers may convene an ethics board discussion to facilitate this. We currently have an active workflow at Singapore Advanced Medicine for this purpose.
Head and neck
Nasopharynx, oropharynx, paranasal sinus
Children
Brain, sarcoma
Sarcoma
Soft tissue and bone sarcoma, chordomas
Lung
Lung cancer, thymoma, lymphoma
Brain
Glioma, meningioma,
Gastrointestinal
Liver, biliary, pancreatic, esophagus
Re-irradiation
Recurrent tumours
Brain tumor
For all patients:
- Ependymoma
- Pituitary adenoma
- Acoustic neuroma
- Base of skull meningioma
- Locally advanced cancers undergoing concurrent chemoradiation therapy
For patients younger than 25 years old:
- Retinoblastoma
- Medulloblastoma
- Chordoma/ chondrosarcoma base of skull or spine
- Ependymoma
- Craniopharyngioma
- Intracranial germ cell tumour
- Primitive neuroectodermal tumours
- Esthesioneuroblastoma
- Neuroblastoma
- Pineal parenchymal tumours (not pineoblastoma)
- Glioma
Proton therapy (right) decreases the overall dose to the brain compared to traditional radiotherapy (left)
Head and Neck Cancers
- Advanced (e.g., T4) and/or unresectable head and neck cancers
- Oropharyngeal cancer
- Cancers of the paranasal sinuses and other accessory sinuses
- Salivary gland cancer for patients younger than 25 years old
- Locally advanced cancers undergoing concurrent chemoradiation therapy
Proton therapy (right) decreases the dose to the oral cavity, which lowers the risk of requiring a feeding tube during radiotherapy.
Digestive Tract Cancers
Bone and Soft Tissue Cancers
For all patients:
- Base of skull chordoma
- Base of skull chondrosarcoma
- Spinal and paraspinal bone and soft tissue sarcoma
- Non-metastatic retroperitoneal sarcomas
- Locally advanced cancers undergoing concurrent chemoradiation therapy
For patients younger than 25 years old:
- Ewing sarcoma
- Spinal/ paraspinal bone and soft tissue sarcoma
- Rhabdomyosarcoma: orbit, parameningeal, head and neck, pelvis
- Pelvic sarcoma
- Osteosarcoma
Lymphoma and Thymoma
Requires a specialised tumour board to approve
Childhood Cancers
Two of our radiation oncologists were paediatric proton therapy trained in the United States:
Central and peripheral nervous system:
- Retinoblastoma
- Medulloblastoma
- Chordoma/ chondrosarcoma base of skull or spine
- Ependymoma
- Craniopharyngioma
- Intracranial germ cell tumour
- Primitive neuroectodermal tumours
- Esthesioneuroblastoma
- Neuroblastoma
- Pineal parenchymal tumours (not pineoblastoma)
- Glioma
Musculoskeletal
- Ewing sarcoma
- Spinal/ paraspinal bone and soft tissue sarcoma
- Rhabdomyosarcoma: orbit, parameningeal, head and neck, pelvis
- Pelvic sarcoma
- Osteosarcoma
Salivary gland cancer
