Neutron beam therapy is a form of radiotherapy that is used primarily for the treatment of unresectable or recurrent tumors. This policy does not address boron neutron capture therapy for cancer.

Neutron beam radiotherapy of advanced salivary gland tumors and soft tissue sarcomas is considered medically necessary in cases meeting the criteria below:

• Salivary gland tumors in which disease-free surgical margins are not obtainable or where local recurrence has developed.
  • Tumors classified as T3b or greater (i.e., tumors larger than 4 cm).
• Advanced or recurrent soft tissue sarcomas without nodal involvement or distant metastases.
  • Primary treatment of T2 tumors (i.e., tumors larger than 5 cm).
  • Treatment of tumor recurrence (i.e., T1 or T2 tumors).
• Advanced unresectable adenocarcinoma of the prostate, using neutrons in combination with photon radiotherapy (i.e., mixed-beam therapy)
  • Tumor extends into or beyond the prostatic capsule (i.e., tumors classified C or T3);
  • Tumor extends into neighboring tissues (i.e., tumors classified D or T4).

BlueCard/National Account Issues

The National Cancer Institute has established technical standards for neutron beam radiotherapy facilities. The positive results reported in the literature were from facilities meeting these standards. Plans may wish to consider using these standards in selecting the site where the therapy is rendered.

2002 Update
 
This policy is based on 1987 and 1992 TEC Assessments (1, 2). A search of the literature was completed through the MEDLINE database for the period of January 1996 through October 2002. No published data were identified that suggest additional indications beyond those listed in the policy statement. Therefore, the policy statement is unchanged.

References:

1. Technology Evaluation & Coverage 1987: p. 141
2. TEC Evaluations 1992: p. 191

Neutron Beam Radiotherapy
Radiotherapy, Neutron Beam