Proton beam therapy indications in the Kingdom of Saudi Arabia: A SARO clinical practice guideline.

objectivesTo update the national guidelines for proton therapy to reflect the evolving literature. The Saudi Particle Therapy Centre is making efforts to establish proton therapy services in the Kingdom of Saudi Arabia.

methodsThe Saudi Particle Therapy Center collaborated with the Saudi Association of Radiation Oncology to formulate a panel of radiation oncologists with proton therapy experience to refine and update our previous publication. The recommendation level was based on the overall evidence using a 4-grade scale following the World Health Organization quality of evidence recommendations. These updates focus on summarizing the literature and the level of recommendation for each disease site. The Panel identified key clinical questions to ensure that the guidelines were evidence-based, followed by a comprehensive literature review of PubMed, EMBASE, and other academic databases.

resultsThe Panel reported that the body of evidence favored proton therapy for specific indications, including ocular tumors, skull and spine tumors, oropharyngeal cancer, hepatocellular carcinoma, specific genetic syndromes and mutations, pediatric rhabdomyosarcoma, pediatric central nervous system malignancies, tumors of the paranasal sinuses/nasal cavity, and for re-irradiation of all sites when curative treatment was intended. In addition, proton therapy may be considered at other sites when photon therapy exceeds the acceptable dose constraints for critical structures.

conclusionThe Panel did not recommend the routine use of proton therapy for all cancers. Each case should be assessed individually following a multidisciplinary review and expert consultation while accounting for financial, logistical, and patient-specific factors.