What are your views on proton treatment for ovarian cancer?
I'm not an expert on proton beam therapy. The data I have seen in certain tumours suggests it might be better than conventional radiotherapy. In ovarian cancer, there is absolutely no evidence for proton beam therapy. In fact, there is very little evidence for radiotherapy. Radiotherapy for ovarian cancer is very rarely used. We don't use it very often because the majority of people who we treat have disease that is in a lot of their tummy.
Your liver, kidneys and intestines are fantastically sensitive to radiotherapy. If you wanted to give enough radiotherapy to make sure you've got all the ovarian cancer, you'd be zapping those other organs and you would do a huge amount of damage. For most women with ovarian cancer, radiotherapy is not appropriate. There are some circumstances where it can be very useful. Women can get a recurrence where the uterus used to be and radiotherapy can be very useful for controlling bleeding. There is also some evidence in a type of ovarian cancer called clear cell carcinoma. They are more sensitive to radiotherapy than chemotherapy and in early clear cell carcinoma where we give localised radiotherapy to where the ovaries used to be after surgery, that can be effective.
The short answer about the proton beam is that there is very little information. In some of the other tumours such as brain tumours, I've seen a little evidence suggesting it may be better but I'm not an expert. Generally radiotherapy in ovarian cancer, we don't use but there may be special circumstances where it might be useful. One thing to say is, there are sometimes questions to which there are no answers.