Is There a Place for Proton Therapy?

By Kate McHugh , Ivanhoe Health Correspondent

MIAMI, Fla. (Ivanhoe Newswire) -- In every field, there is an ongoing quest for the latest, greatest and best innovation. Could proton therapy be the next best thing to hit radiation oncology? Or is it over-priced therapy with no proven benefit? The debate raged on at the 18^th annual meeting of the American College of Radiation Oncology in Miami.

For patients with cancer of the central nervous system, treatment options must be explored carefully due to the delicate nature of the area. The newest tool to fight cancer is proton therapy -- machines that accelerate protons to nearly the speed of light and shoot them into tumors.

Some say the therapy is more precise than X-rays used for radiation therapy, meaning fewer side effects and perhaps a higher cure rate.

"Protons hit a target and stop. There’s no exit dose," Jay Loeffler, M.D., from Massachusetts General Hospital in Boston, told Ivanhoe. Dr. Loeffler argued to a room full of his colleagues that patients treated with proton therapy showed a marked reduction in acute and sub-acute side effects compared to radiation therapy. The therapy can be more intense, he said, because it’s so accurate, allowing tumors to be treated more aggressively.

However, doctors at the meeting countered that there is little clinical evidence supporting these claims. With machine costs in the tens of millions, building a proton therapy center can be as much as a $100 million investment, making the device what some call "the world’s most expensive and complex medical device." Some fear when hospitals have made such a costly investment, patients may be guided to use proton therapy when more cost effective alternatives may be available.

Still, Dr. Loeffler argued that proton therapy is the future of treating tumors, and stands to help hundreds of thousands of Americans each year. "Truly localized tumors, those patients will benefit from truly localized therapy," Dr. Loeffler said.

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SOURCE: Ivanhoe interview with Jay Loeffler, M.D., the 18^th annual meeting of the American College of Radiation Oncology, Miami, Fla., Feb. 21-23, 2008

Reader commentary:

"There is much evidence indicating the superior capabilities of Proton Therapy compared to conventional Linear Accelerator (Linac) based Photon Therapy. Most Radiation Oncology centers in the U.S. use Linacs to treat cancer. Because Proton Therapy systems are somewhat new to clinical therapeutic application, and are more expensive and complex to operate than conventional Linac based systems, definitive evidence indicating long term superiority to Linac Photon treatment will take many more years to gather. As with many other new medical breakthroughs in the past, the question is, should patients wait 15 to 20 years to have access to Proton Therapy treatment until long term data is available, or should the very positive preliminary and scientific data that is available now be considered in the decision?  As new systems come on line, and more patients are treated with Proton Therapy, acquired data is becoming more and more compelling.

"During this time when Radiation Oncologists are considering the benefits of Proton Therapy, they and those they would need to support such a project, are too often discouraged to move forward due to the inflated prices they read about in publications and articles. The pricing for the IBA and other single or multi room FDA approved commercial Proton Therapy systems are similar, and range from $30,000,000 to equip a single room system, up to $70,000,000 for a 5 or 6 room system, equating to a per room cost of approximately $17,000,000 for a typical multi room system."

Linda Seidman, RT(R)(T), MBA

Director, Business Development

Eastern Region, USA

IBA Particle Therapy