It has the infrastructure and knowledge to deliver this therapy safely, and its neutron therapy facility is regularly used for patients from Europe.
To the Editor: The clinical fast neutron therapy programme in South Africa (SA) should be discontinued because:
(i) Many experimental and clinical studies show an increase in serious late normal tissue complications with neutron therapy, (1,2) which can be reduced in part by using the technology described in the letters by Laramore (3) and Sauerwein et al.
(ii) Continuation of the neutron therapy programme cannot be supported based on the results of Phase III studies.
(iii) Due to the disappointing outcome of patients treated with fast neutron therapy, all such facilities--except for 2 in the USA--have been discontinued in England, Europe, Canada and the USA.
(iv) There are few peer-reviewed publications in the PubMed database on clinical studies of fast neutron therapy over the last 10 years.
Clinical studies of neutron therapy in the 1950s showed an increase in severe late toxicity.
(1,2) Neutron therapy sites were shut down in England, Europe, Canada and the USA, except for two USA-based sites.
Those who favour this continuation of the neutron therapy programme in South Africa argue that it is useful in some specific sites, specifically salivary gland tumours and sarcomas.
Neutron therapy advocates also argue for its use in patients with advanced cancer on the premise that the patients will die before they have the opportunity to develop complications.
The strong negative view of the radiation oncology research community towards neutron therapy is reflected in the almost complete absence of any publications in peer-reviewed journals on neutron therapy since 2000.
The proven toxicity of neutron therapy and the availability of other treatment approaches, indicates that the continuation of neutron therapy in South Africa is not justified in terms of patient care or clinical research, as well as our need to be fiscally responsible.