Diagnosis: thymic cancer
Treatment: Proton beam therapy
The insurer denied proton beam therapy. The health plan's determination is upheld.

This is the case of a female patient who presented with locally advanced thymic cancer. The patient was treated with chemotherapy followed by surgery. Surgical margin was negative. She was recommended adjuvant radiation using Proton beam therapy.

The requested Proton Beam Radiation Therapy (PBRT) is not medically necessary for this patient. Medically necessary treatment is defined as those treatment which are in accordance with generally accepted standard of care in US (United States).
Intensity modulated radiation therapy (IMRT) is the treatment which is in accordance with generally accepted standard of care in US. for thymic cancer.

There is no theoretical advantage with Proton for this rare clinical scenario. There is no proof that Proton beam therapy would improve net health outcomes compared IMRT. This is rare disease and there are not enough publications to support Proton beam in this case. The National Comprehensive Cancer Network (NCCN) guidelines do support Proton beam therapy in this case.