Beam Therapy for Cancer Treatment
Status Summary - March 2008
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primary advantage of proton treatment for cancer is the precision of the proton
beam and control of the dosage delivered to the tumor site. Unlike the standard
radiation treatments that are available almost anywhere in the U.S. and in most
other countries, the proton beam can be delivered directly to the cancer site
with significantly reduced or no damage to surrounding healthy cells, tissue or
organs. This is of particular advantage to prostate cancer patients with contained
disease that has not spread; but many other cancers can also be treated,
including head and neck tumors, eye tumors, certain lung cancers, abdominal cancers,
and breast cancers.
the proton beam treatment is not available except in a very few locations, it
is not well known. It is usually not recommended except in the centers where it
is available or nearby areas where publicity has made it known. For the prostate
cancer victim and others, this is now changing. The recognition of the availability
of the treatment-and acceptance as a viable alternative to surgery, brachytherapy
(seed implant), cryosurgery, and standard radiation treatment-is becoming more
widely known, particularly for prostate cancer patients where the tumor is still
confined to the prostate capsule. More and more cancer patients are discovering
the non-invasive proton beam, as results are made public, and patients that received
the benefits of proton therapy spread the word. Reported results indicate at least
a comparable record to other treatment methods, but without some of the side effects,
such as incontinence and impotency. "The patient feels nothing during treatment…
[and] experiences a better quality of life during and after proton treatment."(i)
long-term reports of treatment history and results have generated a rapid proliferation
of planned "Centers of Excellence" and primary medical institutions that are investing
in the extremely expensive facilities to administer the Proton Beam Therapy. In
2005, there were only three such primary proton beam medical facilities in the
U.S. There are now (March 2008) five such centers with fully operational proton
facilities that are currently treating cancer patients in a hospital environment:
Loma Linda University Medical Center (LLUMC) at Loma Linda, California; Massachusetts
General Hospital (MGH) in Boston; Midwest Proton Radiotherapy Institute at Indiana
University, Bloomington; the M. D. Anderson Cancer Center in Houston, Texas; and
the University of Florida Proton Therapy Institute at Jacksonville, Florida. One
other, the facility at the University of California at Davis, treats eye cancer
only. Worldwide, I have found references to twenty-eight Proton Centers currently
treating patients, but some of these are in a laboratory setting rather than in
a hospital-like environment. As of March 2008, nearly 50,000 proton treatments
had been made worldwide. (ii) (See the Endnote reference and
link for the centers.)
the U. S. centers with dedicated proton treatment, the Loma Linda University Proton
Center has been in operation the longest (since 1990), and for almost ten years
stood alone. Loma Linda currently has the highest patient treatment capability,
and can process between 125 and 175 patient treatments per day. It is significant
that as of March 2008, approximately one-fourth of all cancer patients worldwide
who have been treated with protons were treated at the LLUMC Proton Treatment
Center. In the case of prostate cancer treatments at LLUMC, normally forty-four
or forty five treatments are required for a complete proton-only protocol, at
79.2 to 81.0 Gy (iii) delivered at 1.8 Gy per day.
some cases, where there is a chance that cancer has spread within the prostate
bed, photon (X-ray) treatment is also required and the proton protocol may be
varied. As of March 2008, the LLUMC Proton Center has treated well over 12,000
cancer patients with many types of cancer disease. More than half of these (actually
about 65 percent) were victims of prostate cancer. The Texas and Florida centers
have only been in operation for a short time (since mid-2006), but are now fully
operational. There are minor variations at the different locations, depending
on the facilities and doctors. However, the daily use of protons in the hospital
environment has been proven (at LLUMC and the other active proton centers), and
proton treatment protocols are well established.
the growing recognition, progress, and degree of potential for proton beam treatment,
there are several new centers either under construction or in the advanced planning
stage within the U. S., most requiring an investment of $120 million to $200 million.
University in Hampton, Virginia, is planning a $183 million facility (groundbreaking
has taken place). The 98,000 square foot facility is scheduled to open in 2010,
and will treat approximately 125 patients daily (over 2,000 patients per year).
It will feature four gantry rooms and one fixed beam room. This
will be an increase in the norm; most other new centers have only two or three
is in progress on a private (for profit) Proton Center in Oklahoma City that is
planned to open in 2009.(iv)(v) ; It is
being constructed by ProCure Inc., the developers of the Bloomington, Indiana
We have just learned that Oklahoma City is going to have a second
proton center. A recent announcement states that Oklahoma University Cancer Institute
is to build a proton center on the Health Center campus. The size and cost of
this facility is not known.
University of Pennsylvania is building a large facility near Philadelphia, which
is being partly funded by The Dept. of Defense in partnership with Walter Reed
Army Hospital.(vi) (vii); Construction
of this facility is well underway. The cyclotron, built by IBA of Belgium, arrived
in Philadelphia January 29, 2008.
Seattle Cancer Care Alliance is planning a $120 million center in Seattle, Washington.
A Letter of Intent was signed in February 2008; therefore this facility will probably
not be on-line until late 2010 or 2011.
October 2006 Northern Illinois University announced plans to build a world-class
cancer treatment and research center in that will provide state-of-the-art proton
therapy.(viii) The facility will be known as the Northern
Illinois Proton Treatment and Research Center.
DuPage Hospital of Winfield, Illinois, a suburb of Chicago, is also pursuing development
of a proton center. Barnes-Jewish Hospital in St. Louis, Missouri; Broward General
at Ft. Lauderdale, and Orlando Regional at Orlando, Florida, are planning smaller
units ($20 million; see reference to MIT proton development below) to be brought
on-line in 2009 and later. There are about fourteen others in the proposed, pre-planning,
or design stage in the U. S. and worldwide.(ix) Experts foresee
up to 100 U.S. proton centers within the next few decades. (x)
is quite evident that the Proton Beam Therapy for cancer treatment is a modality
whose time has finally arrived.
There are on-going improvements in the present
technology. LLUMC is now installing robotic positioning systems.
at LLUMC and other locations "Image Guided" and "Active Scanning" proton delivery
devices are being planned that will enable even more accuracy in proton delivery
to target tumors. Some of these are already in use at some locations in Europe.
future promises even more exciting developments. The great hindrance to universal
use of the proton in cancer treatment is the size and cost of the cyclotron or
synchrotron equipment and supporting facilities necessary. The Massachusetts Institute
of Technology (MIT), in collaboration with a private development company, is working
on a comparatively small (room size) accelerator to deliver the proton therapy
to patients. If this development is successful, an even more rapid expansion of
Proton Beam Therapy should almost immediately occur.
to the MIT News Office, "MIT proton treatment could replace X-ray use in radiation
therapy. Scientists at MIT, collaborating with an industrial team, are creating
a proton-shooting system that could revolutionize radiation therapy for cancer.
The goal is to get the system installed at major hospitals to supplement, or even
replace, the conventional radiation therapy now based on x-rays. The fundamental
idea is to harness the cell-killing power of protons…. Worldwide, the use of radiation
treatment now depends mostly [approximately 90 percent] on beams of x-rays, which
do kill cancer cells but can also harm many normal cells that are in the way.
What the researchers envision -- and what they're now creating -- is a room-size
atomic accelerator costing far less than the existing proton-beam accelerators
that shoot subatomic particles into tumors, while minimizing damage to surrounding
normal tissues. They expect to have their first hospital system up and running
in late 2007." (xi) Note, this date was obviously optimistic;
it is apparent that this machine will not be available until 2008 or later. One
recent search found that the MIT technology was licensed to Still River Systems
of Littleton, Massachusetts. The trade name given to the MIT-Still River systems
device is "Clinatron-250™."
has happened many times in the history of modern technology development, there
are others concurrently working on the idea of a smaller, less expensive proton
accelerator. The University of California Davis Cancer Center is actively engaged
with a similar project. In the Fall/Winter 2006 "Synthesis" (Volume 9, No. 2),
there is the following:"UC Davis Cancer Center and Lawrence Livermore National
Laboratory join forces to make proton-beam therapy available to every major cancer
story goes on to describe the coordinated efforts of UC Davis and the Lawrence
Livermore Laboratory to develop the machine:
and cost have been the obstacles. A 90,000-square-foot building - bigger than
many hospitals - is needed to house a state-of-the-art proton-beam accelerator.
And the machines carry price tags of up to $150 million. But these barriers may
be about to topple. Researchers from Lawrence Livermore National Laboratory and
UC Davis Cancer Center are working on a subscale prototype of a "miniaturized"
proton-beam accelerator. Led by George Caporaso of Livermore's Physics and Advanced
Technologies Directorate, the research team aims to deliver a final machine that
will be small enough to fit in a typical radiation oncology suite, powerful enough
to treat cancer anywhere in the body and priced at about $10 to $15 million. The
lab is currently seeking commercial partners to help construct a full-scale model."
the new technology transfer pact, Lawrence Livermore National Laboratory has licensed
the technology to TomoTherapy, Incorporated of Madison, Wisconsin, through
an agreement with the Regents of the University of California.
I suspect that the final cost of such machines may be closer to $20-$30 million.
This is of course much less than the cost of the current large-scale proton facilities,
and is more within the range of possibilities for most large metropolitan hospitals.
I also think that these new systems will probably incorporate the "scanning" method
of beam delivery.
into the future are more exciting developments, such as using carbon ions or antiprotons,
in the never-ending pursuit of new tools to fight cancer.
a Web site called ACT, Advanced Cancer Therapy, "Committed to Increasing Knowledge
of Advanced Cancer Therapies Using Particle Beams to Terminate Cancer Cells:"
particles are used in advanced particle beam cancer therapy? Up to now the particle
of choice was the proton, the nucleus of a hydrogen atom. 40+ proton beam therapy
centers exist and have to date treated more than 50,000 patients worldwide.
recent years research in Germany and in Japan has shown that carbon ions can have
a much higher biological impact on cancer cells than protons and can therefore
successfully treat tumors normally deemed "radio-resistant". Carbon ion treatments
have yielded significantly improved treatment results in many types of tumors.
But up to now only 3000 patients have received Carbon ion treatments.
known to most of us only from science fiction, have already been shown to offer
yet another increase of effective dose in the target area, have the potential
to further decreasing the impact on healthy tissue in front of the tumor, and
additionally would allow watching in real time where exactly inside the body the
treatment is administered." (xiii)
One such project
is in the not-so-distant future. In July 2007, Touro University announced plans
to build a center for particle therapy cancer treatment in California that will
offer both proton and carbon ion therapy. Upon completion, it would be the first
such center in the United States, and would be part of the school's future $1.2
billion health science research campus on Mare Island in the San Francisco Bay
Association for Proton Therapy; Accessed October 2006.
(ii) Oncolink. A Web Site. Abramson Cancer Center of the University
of Pennsylvania. Article,
Cancer Treatment Information. Accessed February 2007.
(iii) Gy: Gray: a unit of absorbed dose of ionizing radiation
equal to an energy of one joule per kilogram of irradiated material - abbreviation
(iv)KFOR-TV; Oklahoma City, OK. AP
News Release. Accessed Aug 2006.
Business Wire, April 9, 2007. Procure Begins Construction on … First
Proton Therapy Cancer Center. Accessed March 2008.
Health Care; accessed March 2007.
(vii) University of
Pennsylvania Health System.
Release. Northern Illinois University.
(x) Dr. James Slater [Loma Linda Univ. Medical Center]. Article
:HEALTH: "More U.S.
Hospitals Offering Proton Beam Therapy" News USA. A Web Site. Accessed October
MIT New Office' a Web Site article. "MIT
Proton Treatment …"; August, 2006. Accessed February 2007.
Synthesis, A Publication of the UC Davis Cancer Center. Accessed August 2007.
(xiii) Advanced Cancer Therapy.
A Web site. Accessed August 2007..