The aim of PRODECIS is to offer a multi-factorial decision support system for radiation oncologists that helps them selecting the most suitable radiotherapy treatment for individual patients. It does so by comparing dose distribution, clinical consequences and the short- and long-term cost-effectiveness of uploaded proton and photon treatment plans using validated models (Figure 1).
PRODECIS performs in silico planning comparisons combined with normal tissue complication probability (NTCP) and cost-effectiveness models. When the dose distribution of protons shows a dosimetric benefit when compared to photons, this will be translated into a difference in a complication probability, using validated NTCP risk prediction models. A clinical benefit may be a reduction in toxicity in normal tissue with the same local tumour dose or a better local tumour control with the same damage to normal tissue. Using published cost-effectiveness models, an estimate of the expected cost of each treatment is calculated, taking into account short-term (e.g. cost of treatment) and long-term (e.g. medical costs due to long-term toxicity) costs. An advice for proton therapy eligibility is then returned to the medical specialist. Clinical decision support systems for proton therapy, such as PRODECIS, will be crucial to guide clinical practice and requires a cost-effective approach for reimbursement of the associated healthcare costs.