PREPARING AUSTRALIA FOR PARTICLE THERAPY USING LESSONS FROM ABROAD: Outcomes Review Data and Registry Requirements, Datamining and Modelling Applications

Abstract

Australia is preparing to introduce particle therapy (PT). Following a broad scope review of the literature on PT and its status in Australia, the thesis begins with two systematic reviews of PT clinical outcomes, analysing both tumour control and

toxicity. An updated synthesis of studies published in the past five years underscores both the promising expansion and maturation of PT evidence worldwide and the persistence of evidence gaps, with some eagerly anticipated clinical trial results to come.

The thesis then turns to international endeavours to implement proton beam therapy (PBT) at a national level, using the United Kingdom (UK) experience as a case study. It examines registry design, data interoperability, and mechanisms for long-term follow-up, providing a proven model for sustainable outcomes capture. Bringing this back to an Australian context, an expert consensus process is reported that defines 27 Minimum Data Elements for the Australian Particle Therapy Clinical Quality

Registry (ASPIRE), benchmarked against current international PT registries. It provides a

nationally endorsed blueprint for registry implementation.

Demonstrating the research value of large-scale real-world data, the thesis analyses 495

patients with non-central nervous system (CNS) tumours treated via the UK Proton Overseas

Programme (POP). This represents one of the largest global series of paediatric rhabdomyosarcoma and Ewing sarcoma. It demonstrates encouraging local control and survival with acceptable rates of late toxicity, mainly clustered around optic and hearing

impacts. The translational potential of registry data is further illustrated through the validation

of a XRT-derived predictive model of severe hearing impairment in paediatric PBT cohorts.

Together, these studies demonstrate how systematic evidence appraisal, registry infrastructure, population-level outcomes, and predictive modelling can be integrated to prepare Australia for the clinical introduction of PT.