[Proton therapy and the importance of RCT]

The pace of innovation within radiotherapy is high. In recent years, two major innovations have made their appearance in the Netherlands: proton therapy and MRI-guided radiotherapy. Both are, in theory, a promising addition to the arsenal of cancer therapies. Financial incentives, industry pressure, and patient demand for high-tech treatments have led, or are likely to lead, to widespread implementation of these innovations, without clinical evidence of superiority over existing techniques. Using proton therapy, the most advanced of both innovations, this article describes that RCTs are necessary to investigate whether, and for whom, the theoretical benefits of radiotherapy innovations actually translate into clinically relevant benefits. With a good national network from the Dutch Society for Radiotherapy and Oncology (NVRO) with collaborating radiation oncologists and clinical physicists, the Netherlands is in the unique position to perform these important RCTs.