Reacción a "Reaction to the Health Ministry's announcement of the purchase of ten proton therapy machines, financed by the Amancio Ortega Foundation."

The Government's announcement of the purchase of 10 proton therapy machines for the National Health System, partially financed by a donation from the Amancio Ortega Foundation, makes me think of a phrase that, for me, sums up the situation: it is a great opportunity for Spain.

In fact, this project is taking place (a) in parallel and not in competition with a synergic modernisation of the conventional radiotherapy machines, (b) after two pioneering private centres were installed and are in operation in Madrid, (c) to which is added another public project in Santander and (d) in a dynamic of treatment and cost optimisation.

It should be remembered that, when all these centres are operational, proton therapy will continue to benefit only a limited number of clinical indications (less than 2 % of patients treated annually with radiotherapy in Spain). The remaining treatments, properly performed with photons, also constitute the state of the art of radiotherapy, with high quality, precision and level of development. It is necessary to evaluate which patients will benefit from protons and, thanks to the existence of these centres, to progressively expand the indications with clinical trials. These trials are already underway internationally, and should be conducted with the support of scientific societies such as the Spanish Society of Radiation Oncology (SEOR) and the Spanish Society of Medical Physics (SEFM), and the corresponding ethical committees.

Spain will be at the forefront of the world in terms of the number of existing centres per inhabitant and, given its territorial distribution, will facilitate regional access to them. It should be borne in mind that a large part of the treatments, particularly in the case of paediatric patients, require 5 to 7 weeks of on-site presence, with the necessary family accompaniment.

However, when the scope of the project is analysed, this is not really an excessive number. Most centres will have only one treatment room (there are single-room and multi-room projects). The number of rooms per inhabitant is and will continue to be higher in several other developed countries, including the Netherlands and the United States.

This type of initiative is a catalyst for a chain of positive events: multidisciplinary and multicentre clinical trials are promoted, in combination with the other disciplines in the fight against cancer (surgery, chemotherapy, immunotherapy, etc.), tools are developed that benefit the whole of radiotherapy (calculation models, measurements, patient positioning) and research is promoted (for example in radiobiology), which will serve as a basis for future clinical improvements in treatments.

The crucial issue in promoting the high-tech facility is the availability and training of professionals: doctors, physicists, technicians who will be directly involved in its operation, but also the whole oncology community who will participate in the appropriate selection of patients. It is estimated that more than 300 professionals will have to be trained in the time remaining until these centres are up and running (between 3 and 4 years). Our centre is already participating in this training and we are at the disposal of any institution to share our experience, not only of these 3 years of activity in the Spanish context, but also of our previous experience.