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Proton Therapy

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ST.LOUIS, Mo. (Ivanhoe Newswire) - The latest projections show that ten years from now, 18 million Americans could be living with cancer. But now there's a new machine that may help destroy tumors more efficiently than ever before.

Dr. Jeffrey Bradley, Professor of Radiation Oncology at the Washington University School of Medicine, is anxious to show off his new toy. This mini proton accelerator has been years in the making.

"It's a first of its kind," he told Ivanhoe.

While it looks like something that should be blasting into space, this 50-ton machine that's 12 feet underground will soon be zapping potential killers "beyond what current cancer therapies can."

With traditional therapies like X-ray, a patient's healthy tissues are often hit by radiation. This machine is so precise that doctors can hit tumors with higher doses--without damaging surrounding organs.

"For a tumor that's near the eye, you don't want to spray it with excess radiation," said Dr. Bradley.

Until now, proton beam facilities in the United States would cost more than 150 million dollars and require the space of a football field. This machine cost 75 percent less and fits into a single room. While it could cost up to 20 percent more than traditional treatments, for some patients it could be worth it.

"Less side effects. There should be less side effects because you have less normal tissues that are getting hit," Dr. Bradley said.

Kids who receive radiation for brain tumors are at risk of long term disability and stunted growth.

"Protons are actually ideal for many pediatric patients," he added.

While not everyone will benefit from proton therapy, a machine like this could give more patient more options.

"You might seek it out. As a parent I imagine I would. Now we can provide that," said Dr. Bradley.

Proton therapy is especially useful to treat cancers around the eyes, face, base of the brain and spine.

Over the next few years, more of the machines are expected to pop up across the country. Dr. Bradley said as that happens, treatment will become more affordable. He plans to begin treating his first patients within the next few months.

RESEARCH SUMMARY

PROTON THERAPY: Proton therapy is a type of radiation treatment that uses protons rather than x-rays to treat cancer. A proton is a positively charged particle that is part of an atom, the basic unit of all chemical elements, such as hydrogen or oxygen. At high energy, protons can destroy cancer cells.

Proton therapy was first used for cancer treatments in the United States in 1974 at a physics research laboratory. In 1990, the first U.S. hospital-based proton facility began treating patients. Since then, tens of thousands of people in the United States have received proton therapy. (SOURCE: www.cancer.net)

HOW PROTON THERAPY DIFFERS FROM OTHER RADIATION TREATMENTS: Like standard x-ray radiation, proton therapy is a type of external-beam radiation therapy. It painlessly delivers radiation through the skin from a machine outside the body. Protons, however, can target the tumor with lower radiation doses to surrounding normal tissues—approximately 60 percent lower, depending on the location of the tumor. (SOURCE: www.cancer.net)

HOW IT WORKS: A machine called a synchrotron or cyclotron accelerates (speeds up) the protons. The speed of the protons is a sign of their high energy. The protons travel to a specific depth in the body based on their energy. After the protons reach the desired distance, they deposit the specified radiation dose around the tumor, leaving minimal radiation doses behind. In contrast, x-rays continue to deposit radiation doses in healthy tissues beyond the tumor as they exit the patient's body, potentially causing side effects.

Patients often receive proton therapy in an outpatient setting, meaning that it does not require hospital admission. The number of treatment sessions depends on the type and stage of the cancer. Sometimes, doctors deliver proton therapy in one to five proton beam treatments, generally using larger daily radiation doses. (SOURCE: www.cancer.net)

FIRST OF ITS KIND: After six years of planning, training and waiting, the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine received its new proton beam accelerator last October. Dr. Jeffrey Bradley, Washington University associate professor, Siteman Cancer Center radiation oncologist and director of the Kling Center for Proton Therapy, said the new proton therapy technology, called a superconducting synchrocyclotron proton accelerator, could begin treating cancer patients in October, pending FDA approval. The $20 million system, which arrived at Siteman is the first of its kind in the world because of its small size compared to existing proton beams that are typically housed in football field-sized buildings. This is the first single-room proton therapy unit in the world. The type of equipment is called a synchrocyclotron, and usually, they are large proton generating units that take up several buildings in a hospital. This unit is about the size of your kitchen table. It's small enough that it can rotate around the room and provide treatment at different areas. (SOURCE: www..bizjournals.com)

INTERVIEW

Jeffrey Bradley, M.D., Professor of Radiation Oncology at Washington University School of Medicine, talks about a new machine that could revolutionize the way doctors treat cancer.

What exactly are you building?

Dr. Bradley: We're building a proton therapy facility that is the first of its kind. It's a single room proton therapy facility that is adjacent to our existing radiation, oncology facility that will be for treatment of special cases that need protons to treat their cancer.

What are these special cases?

Dr. Bradley: Protons are primarily used for children mainly or for tumors that are around critical structures, just like around the brain, the base of skull, the eye, and the spinal cord. It's also very useful for types of cancers called sarcomas, chondral sarcoma or osteosarcoma. It's also commonly used now in lung cancer. They're starting to be used in other types of cancers like esophagus cancer, pancreas cancer and things like that. We like to try to treat patients who need protons that can help them beyond what current cancer therapies can.

What makes this so effective?

Dr. Bradley: Protons are unique because they have a mass and a charge so that you can tell the proton machine that you need to treat a tumor at a certain depth beyond the skin. Let's say its five centimeters deep, so the proton machine shoots the protons in to the patient about five centimeters deep and the protons stop. They have a mass and a charge so they can stop, whereas x-rays don't stop. They go from before hitting the patient all the way through the patient and beyond the patient. The advantage of the protons is they stop at a desired depth.

How does radiation and other therapies compare to this?

Dr. Bradley: We use radiation therapy for probably seventy percent of patients who are diagnosed solid tumor type of cancers, so most patients get radiation therapy. We expect patients will still need radiation therapy but some of the patient's radiation therapy may not be ideal, for patients with cancers that are near critical structures. Let's choose the eye for example, for a tumor that's near the eye you don't want to spray the eye with excess radiation therapy. If you had a tool that could pinpoint the radiation more precisely like a proton machine you would like to use it in that patient so that you could spare their vision.

Are there any additional side effect?

Dr. Bradley: There should be less side effects because you have less normal tissues that are getting hit by the radiation beam.

Would you say it is more effective than traditional therapies?

Dr. Bradley: It's probably as effective at killing the cancer. The advantage is it probably causes less side effects to the patient receiving treatment.

Talk about how children can benefit from this?

Dr. Bradley: We treat pediatric patients today that might be anywhere from six months old to eighteen years old. Pediatric patients with cancer get treated all the time, but they have special issues when you're thinking about treating them with radiation therapy because radiation therapy has negative effects on their growth. They don't grow properly, they don't grow symmetrically. If you treat a tumor around their brain, their gland that produces growth hormone and other types of hormones that are necessary for normal growth and maturation don't work. You'd like to try to avoid hitting those critical tissues so that they don't have problems growing up. Protons are actually ideal for many pediatric cancer patients.

What percent of the current patients that you treat now with other treatments would benefit more with this?

Dr. Bradley: We anticipate about twenty five percent of our patients that we currently treat now in our center could benefit from proton therapy.

What are maybe some of the hesitations of using this instead of traditional therapy?

Dr. Bradley: Sometimes proton therapy may not be as advantageous as you might expect it to be. We've done all kinds of plans for many different types of patients that are currently getting treatment and we just ran a proton plan on paper to see if protons would work better. Sometimes there are advantages and disadvantages to using x-rays or protons. It doesn't work out that every patient has an advantage to protons. But there are some marked examples where protons provide a huge advantage. An example might be a patient with prostate cancer. Patients with prostate cancer x-ray treatment plans look pretty much equivalent to proton treatment plans.

How many times does the patient have to go in to the room and how long does it last?

Dr. Bradley: The radiation therapy typically lasts anywhere from four weeks to seven weeks depending on what type of cancer you have. Whether that treatment is given with x-rays or protons, that probably doesn't matter. The duration or the length of treatment over days to months is probably about the same. Treatment times are about the same as well. In a typical x-ray radiation therapy unit treatment takes about fifteen minutes, we expect with our proton machine treatment to take about twenty minutes per day or so.

How much does it cost?

Dr. Bradley: This particular unit costs about twenty five percent of what it costs to put in a larger proton unit. The large ones are a big cyclotron occupying that football field type space and three or four treatment rooms. Ours is a single treatment room with a single proton making unit called the cyclotron. It's about twenty five percent of the cost of a larger facility.

It's cheaper and it's smaller and it is equally as effective?

Dr. Bradley: Yes. I would say it's an advantage. One of the drawbacks in the press to proton therapy today is how expensive it is. It's been sited as one of the problems with healthcare because as technology gets better and treatment gets better, expense goes way up. But imagine if you could build a facility at twenty five percent of the cost of another facility, you make treatment more efficient. It becomes a more efficient treatment and it could be advantageous to cancer therapy in general because it enables other facilities to buy a single room unit at a lower cost and implement proton therapy at their site for a larger number of patients on the whole.

Is it going to cost patients just as much as it would for traditional therapy?

Dr. Bradley: For x-ray radiation therapy, this may cost about ten to twenty percent more. That's a fluctuating situation. With these fifteen units coming on board, protons are really exploding and multiple sites are opening up around the country. With that, Medicare and the other insurance providers are reforming their policies. What the future holds with reimbursement for protons or cost for protons I don't know. But today it's about ten percent more.

What other specific treatments is this good for?

Dr. Bradley: It's known for tumors around the eye, so melanomas that occur on the eye. It's also known for tumors that are in the base of skull. Anything around the spinal cord as well. The spinal cord is a critical structure and it keeps our arms and our legs moving and us to be able to stand up right and walk and things like that. So any tumors around the spinal cord no matter what they are probably would benefit from protons because they can spare the spinal cord from radiation therapy.

How about kids?

Dr. Bradley: Kids especially because of growth and neighboring critical structures. You don't want to treat their spine, you don't want to treat their heart, you don't want to treat their liver, you want to minimize what normal tissues you treat.

Is this something you would use on your own kids?

Dr. Bradley: I was told by one of our pediatric oncologists that most families that come to Children's Hospital and see our pediatric oncology group ask about protons. It's the medical literature now in terms of if you knew your child was getting radiation therapy you would look in to it on the Internet. You would see that protons are used for that so you would probably walk in the door and say okay, what advantage do protons have for our situation. You might seek it out as a parent. I would imagine I would. Now we can provide that. Or we will be able to provide that.

FOR MORE INFORMATION, PLEASE CONTACT:

Judy Martin
Director, Media Relations
(314) 286-0105
martinju@wustl.edu

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