Proton Beam Therapy Clinical Guidelines

PBT is designated medically necessary for a limited set of indications — skull‑base chordomas/chondrosarcomas (postop/localized), uveal melanoma when preferred to brachytherapy, pediatric malignancies, malignancies requiring craniospinal irradiation, Stage IIA seminoma, and select unresectable/localized HCC/intrahepatic cholangiocarcinoma — while many other sites (e.g., most head & neck, esophageal, pancreatic, unoperated prostate, Hodgkin/non‑Hodgkin lymphoma, Stage IIIB NSCLC, retroperitoneal sarcoma, thymic tumors) are considered not medically necessary or experimental. Key requirements: HCC cases require tumor‑board minutes or detailed documentation demonstrating inability to use/meet dosimetric constraints with other modalities, tumor ≤16 cm, preservation of ≥700 cc normal liver, no/limited extra‑hepatic disease, and capability to deliver the prescribed proton regimen (e.g., ≥50 GyE in 22 fractions); PBT solely to reduce secondary malignancy risk is excluded.