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Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic Conditions

Charged-particle irradiation with proton or helium ion beams may be considered medically necessary in the following clinical situations:•         primary therapy for melanoma of the uveal tract (iris, choroid, or ciliary body), with no evidence of metastasis or extrascleral extension, and with tumors up to 24 mm in largest diameter and 14 mm in height.

•         postoperative therapy (with or without conventional high-energy x-rays) in patients who have undergone biopsy or partial resection of chordoma or low-grade (I or II) chondrosarcoma of the basisphenoid region (skull-base chordoma or chondrosarcoma) or cervical spine. Patients eligible for this treatment have residual localized tumor without evidence of metastasis.

•         in the treatment of pediatric central nervous system tumors.

Other applications of charged-particle irradiation with proton or helium ion beams are considered investigational. This includes, but is not limited to:

•         pediatric non-central nervous system tumors,

•         clinically localized prostate cancer,

•         non-small-cell lung cancer at any stage or for recurrence,

•         tumors of the head and neck (other than skull-based chordoma or chondrosarcoma).

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