Facts about Proton Cancer Treatment

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Facts about Proton Cancer Treatment

The Cutting Edge Therapy that Eradicates Cancer with Minimal Side Effects

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Facts about Proton Cancer Treatment

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Facts about Proton Cancer Treatment

Table of Contents

What is Proton Cancer Treatment?.........pg. 4 Applications of Proton Therapy......pg. 4 History of Proton Therapy.......pg. 6 Advocates for Proton Therapy........pg. 6 How Does It Work?...........pg. 9 Benefits and Effectiveness of Proton Therapy........pg. 10 Proton Therapy Treatment Centers............pg. 12 Conclusion................pg. 13

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Facts about Proton Cancer Treatment

What is Proton Cancer Treatment? Proton cancer treatment therapy is a type of particle therapy that uses a beam of protons to irradiate diseased tissue. It is most often used in the treatment of cancer. A proton is a subatomic particle that has a positive electric charge of one elementary charge. You may remember protons from high school physics class; these are the same particles that constitute the beam that targets diseased tissue in the body. Proton therapy uses ionizing radiation to target a tumor with a beam of protons. These charged particles damage the DNA of the cancer cells, ultimately causing their death or interfering with their ability to proliferate (a process that leads the spread of cancer in the body). Cancerous cells are particularly vulnerable to attacks on DNA because of their high rate of division and their reduced abilities to repair damage to their DNA. Because protons have a relatively large mass, they have little lateral side scatter within the bodys tissue. This means that the beam does not broaden very much and stays focused on the tumor it is targeting without affecting the tissue it must pass through along the way. The proton beam delivers only low-dose side effects to the tissue surrounding the cancer as well, something that traditional radiation therapy does not do. Conventional radiation therapy uses X-ray beams composed of both primary protons and secondary electrons that deposit their energy along the path of the beam, not just to the targeted tumor. The X-ray beam also delivers radiation to healthy tissues surrounding the cancer. These healthy cells can become damaged along with the cancer cells, a side effect which has long lasting physical effects on the body. Ill be going over some of the benefits of proton therapy later on in this ebook, but I think you can see how having a radiotherapy treatment that targets only the cancer cells and does not damage healthy surrounding tissue has vast advantages. Applications of Proton Therapy Proton therapy treatments can be broken into two broad categories. The first are for disease sites that favor the delivery of a higher dose of radiation, also known as dose escalation. In many instances,
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Facts about Proton Cancer Treatment

proton dose escalation has been shown to achieve a higher probability of a cure than conventional radiotherapy. The types of cancers successfully treated with dose escalation proton therapy as compared with conventional X-ray radiotherapy include, but are not limited to, ocular tumors, skull base and paraspinal tumors, and unresectable sarcomas, which are rare, malignant tumors found almost anywhere in the body. A high dose of a precisely targeted proton beam has seen thousands of patients survive these types of cancers. The second broad class of treatments are those where the increased precision of proton therapy is used to reduce unwanted side effects by limiting the dose to normal, healthy, surrounding tissue. In these instances, there is no expectation of an increased probability of curing the disease but rather the emphasis is on the reduction of the integral radiation dose to the normal tissue, thus reducing unwanted side effects. Cancers such as pediatric neoplasms and prostate cancer are examples of when this kind of treatment is most appropriate. In the case of pediatric treatments, there is convincing clinical data showing the advantage of sparing developing organs using protons, thus reducing long-term damage to the child. Prostate cancer diagnoses each year far exceed those of the other diseases Ive mentioned above, which has led many proton therapy treatment facilities to devote a majority of their treatment slots to prostate cancer patients. Currently, roughly 26 percent of proton therapy treatments worldwide are for prostate cancer. About 2,355,000 men in the United States are living with diagnosed prostate cancer, exceeding all other cancers, among men, by over 1 million. With numbers like these, it is no wonder so many proton therapy centers have placed a special emphasis on treating prostate cancer. Lastly, proton beams can be given in relatively low doses to surface cancers while giving higher doses to tumors that are deep within the body, allowing doctors to prescribe the appropriate doses of treatment precisely for the each individual case. Proton therapy is a non-invasive treatment that does not require surgery to remove the cancer, which makes it an ideal treatment for inoperable tumors. Tumors in and around the skull, spine, and deep within the body have been successfully treated with proton beam therapy.
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Facts about Proton Cancer Treatment

History of Proton Therapy Robert R. Wilson, Ph.D., made the first suggestion that energetic protons could be used effectively as a treatment method for cancer in 1946. Wilson was an American physicist who was a group leader of the Manhattan Project. After World War II, Wilson accepted an appointment at Harvard University. During his time with Harvard, he published a paper called, Radiological Use of Fast Protons. It was this paper that essentially founded the field of proton therapy. Wilson brought forth the idea that protons could be used to deliver an increased dose of radiation to a tumor while simultaneously decreasing the exposure of surrounding healthy tissue radiation. This is proton therapy in a nutshell. The first attempts to use proton radiation to treat patients began in the 1950s and were conducted in nuclear physics research facilities. These early applications were limited to only a few areas of the body. Proton accelerators, at the time, werent designed for treating patients because their energies werent high enough to treat tumors found deep within the body. Another stumbling block was the lack of imaging technology to accurately see or locate many tumors. It wasnt until the late 1970s that imaging advancements, coupled with the development of sophisticated computers and improved accelerator and treatment delivery technology made proton therapy more viable for routine medical applications, i.e. cancer treatment. The worlds first hospital-based proton therapy center was built in 1990 at the Loma Linda University Medical Center in Loma Linda, California. Today, there are proton therapy facilities around the world that have been developed in conjunction with established medical centers, such as the MD Anderson Cancer Center at the University of Texas, one of the nations leaders in proton therapy, and the Northeast Proton Therapy Center at Massachusetts General Hospital. There are currently 37 proton therapy centers throughout the United States and around the world, many of which Ill be describing to you at the end of this ebook. Advocates for Proton Therapy Today, proton therapy has taken a foothold in the world of cancer treatment. There are doctors working at renowned medical facilities
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Facts about Proton Cancer Treatment

who have dedicated their lives and research to eradicating cancers using proton beam therapy. With that, thousands of cancer survivors who beat their disease thanks to proton treatment have become advocates for the method. There is an ever growing number of proton therapy supporters in both the medical world and in the world of cancer survivors. One family, the Ralstons, learned first hand the benefits and effectiveness of proton therapy treatment when their 2-year old son, Jacob, was diagnosed with Ewings sarcoma, a rare cancer that occurs primarily in the bone or soft tissue. Jacob had a tumor in his spine and although surgery removed the tumor and saved his spine, his treatment plan included 14 rounds of chemotherapy and radiation to give him the best chance of beating the cancer. The Ralstons jumped into action researching options and zeroed in on proton therapy. The family decided to pursue treatment at the MD Anderson Cancer Center because they knew that the precise radiation delivered by the proton beam would have little to no effect on Jacobs spine, something they did not have the same guarantee with if they used traditional radiation therapy. Proton therapy targeted the radiation within the width of a human hair in order to spare Jacobs healthy surrounding spinal tissue. In the case of Jacob, the precision of the proton beam allowed the Center to give the maximum dose to the tumor while protecting his lungs, heart, and esophagus. Jacob, now approaching his 5th birthday, is living the life of a normal kid and his time in the hospital, spent being treated for a life-threatening form of cancer, is becoming a distant memory. The Ralstons has since become staunch advocates for proton therapy. A doctor at the MD Anderson Center and professor at the University of Texas, Dr. James D. Cox, calls the use of proton therapy to treat cancerous tumors one of the key technological advances of my lifetime. Dr. Cox has seen cancer treatment advance from giving radiation to large areas of the body at a time when doctors couldnt determine the exact location of a tumor to today, where proton therapy can accurately target cancer and spare healthy surrounding tissue from radiation side effects. Organizations such as the National Association for Proton Therapy (NAPT) have been advocating the advantages of proton therapy for years. The NAPT has devoted itself to spreading the word about the
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Facts about Proton Cancer Treatment

effectiveness of proton therapy and its advantages over traditional Xray radiation. One advantage, NAPT points out, is that because physicians cant adequately conform X-ray radiation patterns to cancer sites, healthy tissues may receive a similar dose and become damaged. Consequently, a less-than-desired dose is frequently used to reduce damage to healthy tissues and avoid unwanted side effects, but then the cancer itself isnt being treated with a more aggressive dosage that actually can eradicate it with fewer treatments. Doctors find themselves in a Catch-22 with X-ray therapy, a situation made avoidable by the use of proton beam therapy. In fact, the NAPT calls protons a superior form of radiation therapy. There are hundreds of doctors working all around the world researching how proton therapy can treat cancer and who are applying the therapy to cancer patients. They have devoted their professional lives to not only treating patients with cancer and moving them closer to a cure, but to advocating proton therapy as a viable cancer treatment options. Doctors such as Nancy Tarbell, M.D., a radiation oncologist at Massachusetts General Hospital and C.C. Wang, a professor of radiation oncology and dean of academic clinical affairs at Harvard Medical School, are but two of the advocates for proton therapy working in the United States today. These two professionals conducted a study in 2008 that found that proton therapy patients may actually be 50 percent less likely to develop secondary cancers than patients treated with traditional radiation. The study found that while 6.4 percent of the studys patients treated with proton therapy developed secondary cancers, 13.1 percentmore than twice as manyof its traditional radiation patients developed secondary cancers. Because proton therapy minimally radiates bordering healthy tissue, its targeted beam radiation reduces the occurrence of side effects for patients, including the development of secondary cancers. Its one more reason to justify protons, Dr. Tarbell said of the study.

How Does It Work?

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Facts about Proton Cancer Treatment

So far, Ive spoken about subatomic particles, beams of energy, and eradicated cancers, but how does proton therapy actually work? What technology is used to treat tumors? Is it safe? Is it effective? The best way to understand how proton therapy works is to look at the physics and engineering behind the proton accelerator, called a synchrotron, and the beam delivery system that work in conjunction to eliminate cancerous cells. After all, this treatment was the brainchild of a physicist. Each proton begins its journey at an injector located within an electric field, known as the ion source. Within fractions of a second, hydrogen atoms are separated into negatively charged electrons and positively charged protons. The protons are then sent through a vacuum tube within a pre-accelerator. In a matter of microseconds, the protons energy reaches seven million electron volts. Proton beams stay in the vacuum tube as they enter the synchrotron, where acceleration increases their energy to a total of 70 million to 250 million electron volts, enough to place them at any depth within the body. Once they leave the synchrotron, the protons move through a beam-transport system comprised of a series of magnets that shape, focus, and direct the proton beam to the appropriate treatment room. Having specific treatments rooms is the standard operating practice for proton therapy treatment centers. At the Loma Linda Center, for example, there is one room that contains a stationary beam with two branches. One branch is for irradiating eye tumors and the other branch for tumors in the central nervous system, head, and neck. The other three treatment rooms in the facility have gantries, wheels that are 35 feet in diameter and weigh approximately 90 tons, which revolve around the patient to direct the proton beam precisely where it is needed. The machine at the MD Anderson Cancer Center weighs 196 tons and features a gantry that can revolve 360 degrees, allowing the beam to be delivered at any angle. Proton beam technology has come a long way since the 1950s! While a patient lies comfortably on a bed, protons come through a nozzle and a shaping device, called an aperture, shapes the bean while another device, called a compensator, spreads the protons into three dimensions and conforms it to the depth of the tumor. Proton therapy facilities use computers to control the dose and accuracy of
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Facts about Proton Cancer Treatment

the proton beam. This helps insure that the patient receives the prescribed proton treatment. At maximum energy, a proton beam travels 125,000 miles per second, equivalent to two-thirds the speed of light. From the hydrogen canister to the patient, a proton typically travels 313,000 miles. During the whole procedure, the patient feels no pain or discomfort. Proton therapy can take anywhere from one day to seven weeks, depending on the tumor site. The length of treatment time will also decrease over time as heavier doses begin to increase. Benefits and Effectiveness of Proton Therapy A recent study by researchers at the University of Florida found that proton therapy is a viable treatment for prostate cancer. The study analyzed the medical records of 211 men with the disease who were treated with protons. The doctors found the therapy to be safe, effective, and helpful in reducing side effects associated with other treatments. These doctors were not alone in their findings either. In a separate report from the Massachusetts General Hospital, doctors concluded that proton therapy was a viable option for prostate cancer treatment, thus concluding that men suffering from the disease will be able to make their own treatment choices, based upon the quality of life they wish to have, without fear of compromising their chance for a cure. I give you these studies to show that clinical research has been conducted that looks into the efficacy and benefits of proton cancer therapy. It is a treatment option that is gaining in popularity every day because it is the most precise and advanced form of radiation treatment available. Because it primarily radiates the tumor site, healthy surrounding tissue and organs are left intact. Conventional Xray radiation often radiates healthy tissue in its path and surrounding the tumor site. The side effects from proton therapy are minimal to none compared with conventional forms of radiation. Patients dont experience pain or discomfort during treatment sessions. There may be side effects during or after treatment, such as skin irritation, tiredness, and hair loss in the area being treated, but these are generally minor, less
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Facts about Proton Cancer Treatment

frequent, and less severe than the side effects that can result from standard X-ray radiation therapy. The body is able to much more easily tolerate the treatment than standard radiation therapy. Even in high dose treatments, there are very few side effects. Because proton therapy has been in use for over 40 years, it is considered a mature treatment technology. With that said, there are certainly side effects inherent in any form of radiation therapy and these must be understood before proceeding with treatment. Understanding how radiation (whether proton or X-ray) reacts with tumors and normal tissue is still imperfect in the medical field. However, studies continually show that proton radiation has significantly fewer side effects than other forms of radiation treatment. Proton therapy is most effective in treating tumors that are localized and have not spread to distant areas of the body. To date, nearly 35,000 people have received proton therapy in the U.S. since 1990. Almost 70,000 people worldwide have received the treatment. Experts conservatively estimate that about 250,000 cancer patients in the United States could benefit from proton therapy. The therapy has been used to treat nearly every part of the body; prostate, brain, lung, head, neck, base of the skull, gastrointestinal, eye, bladder, esophagus, liver, and breast. Children, sarcoma patients, and lymphoma patients have been treated successfully with proton therapy as well. When compared to the standard forms of cancer treatment, i.e. chemotherapy and X-ray therapy, proton therapy far out marks them in terms of efficacy and reduction of side effects. Here is a rundown of the benefits of proton therapy as compared to chemotherapy and X-ray therapy: Three-dimensional energy distribution Radiation is controlled while inside the body Few side effects Mild minor side effects (such as nausea) Little to no impact on patient energy level
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Facts about Proton Cancer Treatment

Minimal risk of impotency as a result of prostate cancer treatment Painless treatment (X-ray radiation is considered a painless treatment) High treatment dosage (both chemotherapy and X-ray radiation can come in high doses) High treatment dosage with minimal risk to healthy tissues and organs As you can see, there are few places where chemotherapy or X-ray treatments meet proton therapy treatment in terms of efficacy and side effects. It is, in a sense, in a league of its own when it comes to targeting tumors precisely with little to no side effects. Proton therapy offers an effective cancer treatment that also results in a better quality of life during and after treatment. Proton Therapy Treatment Centers If you are considering proton therapy as a cancer treatment option or would like to learn more about the revolutionary work going on at prestigious universities, hospitals, and centers around the United States and the world, then check out these phenomenal proton treatment centers that are not only doing cutting edge work but also saving the lives of thousands of patients:

The University of Florida Proton Therapy Institute; Jacksonville, Florida. Year of first treatment: 2006. James M. Slater, M.D. Proton Treatment and Research Center; Loma Linda University Medical Center, Loma Linda, California. Year of first treatment: 1990 (the first hospital based facility in the U.S.). The University of Texas MD Anderson Cancer Centers Proton Center; Houston, Texas. Year of first treatment: 2006. Pioneered the extremely precise form of proton therapy known as pencil beam scanning, which uses a proton beam millimeters wide and is effective in treating complex tumors. Francis H. Burr Proton Center at Massachusetts General
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Facts about Proton Cancer Treatment

Hospital; Boston, Massachusetts. Year of first treatment: 2001. Continuation of the Harvard Cyclotron Laboratory/MGH treatment program that began in 1961.

Roberts Proton Therapy Center; University of Pennsylvania, Philadelphia, Pennsylvania. Year of first treatment: 2010. ProCure Proton Therapy Center at the INTEGRIS Cancer Campus; Oklahoma City, Oklahoma. Year of first treatment: 2009. This is the first of a number of planned ProCure facilities. Hampton University Proton Therapy Institute; Hampton, Virginia. Year of first treatment: 2010. CDH Proton Center: Warrenville, Illinois. Year of first treatment: 2010. Second ProCure facility opened. Indiana University Health Proton Therapy Center: Bloomington, Indiana. Year of first treatment: 2004.

As you can see, many facilities have only opened in the last few years, while others have been doing work for decades or come from a lineage of proton therapy research and application. As of June 2011, there were a total of 37 proton therapy centers in Canada, China, England, France, Germany, Italy, Japan, Korea, Poland, Russian, South Africa, Sweden, Switzerland, and the United States. One hindrance to universal use of proton therapy is the size and cost of the cyclotron or synchrotron equipment necessary for treatment. Several industrial teams, such as ProCure, are working on the development of comparatively small accelerator systems to deliver proton therapy to patients. Conclusion As with any major medical decision, patients must decide if proton therapy is right for them. With so many treatment options out there, from surgery to chemotherapy to traditional radiation to, of course, proton therapy, every cancer patient needs to research each option and weigh the pros and cons of treatment. What works for one cancer patient might not work for another, even if they have tumors in the same part of the body.
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Facts about Proton Cancer Treatment

While proton therapy might not be for everyone, it does offer a viable option that has been proven to have far fewer and less severe side effects than traditional radiation therapy. Centers around the United States and the world are on the cutting edge of proton therapy for the treatment of cancers. Developments like the pencil beam scan have made protons an even more effective means of eradicating cancer while leaving healthy tissue in the body free from harm. Proton therapy is based on tried and true physics and though its been around for several decades, the treatment continues to offer an exciting option for those suffering from cancer.

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