Proton Beam therapy or proton therapy delivers a tightly targeted beam of protons to a cancer tumour, in particular targeting a particular 'depth' and thus minimising any damage to healthy tissues before and certainly after the tumour, while also limiting scatter. Research shows that side-effects are less at 90 days, with identical levels of survival to standard radiotherapy.
Proton beam therapy - more effect, less damage
Proton Beam therapy delivers more cancer-killing energy to the tumour, but does little or no damage to healthy tissue before or behind the tumour, and the experts at MD Anderson say it ’scatters’ side ways, nothing like as much as standard radiotherapy (and even modern versions of radiotherapy, like stereotactic radiation).
As such it is perfect for certain child brain tumours such as medullablastoma, or any tumour where damage can occur to surrounding organs - like prostate, lung, liver, oesophagus etc. There are new, small station Proton Beam Therapy units springing up across America, and Britain originally aimed to have 6 - 3 private (Rutherford centres) and 3 NHS - by 2023..
Why is Proton Beam Therapy so much better than standard radiotherapy?
(i) Protons of a given energy have a defined range of penetration. Thus the energy can be adjusted during treatment not to go beyond the tumour; and healthy tissues closer to the surface of the body will receive far less radiation than with standard radiotherapy.
(ii) Protons have a relatively large mass and have little side “scatter” in the tissue.
All in all Proton Beam Therapy is felt by the originators at MD Anderson to be far safer than standard radiotherapy.
Aysha’s Treatment – just two hours from London
August 2014 saw a man hunt across Europe – or rather, a young boy hunt. Ashya King’s parents, Brett and Naghmeh King, took him out of NHS care ‘before their radiotherapy killed him or left him a cabbage’. Their 5-year old son had a particular type of brain cancer - a medullablastoma growing in the cerebellum. After making a dash to the family home in Spain, they were found; but a judge ruled they could take their son to a hospital that had a state-of-the-art Proton Beam machine, just two hours from London. In Prague, Czechoslovakia.
With no such centre in the UK at the time, in the end the NHS footed the bill. The parents were delighted with the treatment and declared their son to have a complete ’all clear’ in March 2015.
Proton Beam Therapy - the most advanced radiation available?
I’m sure MD Anderson won’t mind me quoting directly from their website: The MD Anderson Proton Therapy Center offers the most advanced radiation available to treat cancers of the prostate, lung, head and neck, liver, oesophagus and brain, as well as for the treatment of lymphoma, paediatric cancers and other rare cancers. Our cancer specialists are international cancer experts and leaders in the research and treatment of cancer. We pioneered the innovative, extremely precise form of proton therapy known as pencil beam scanning, and our center is part of MD Anderson Cancer Center, which has been ranked as one of the nation’s top two cancer centers by U.S. News & World Report every year since 1990.
So they seem pretty confident in it. What clearly drew Aysha’s parent to the therapy was the smiling female doctor on the website who says: “Proton Therapy allows us to help children with cancer go on to live happy and healthy lives with fewer treatment-related side-effects”.
Surely not? You mean ordinary radiotherapy has side-effects?? icon magazine was once thrown out of Bath and Cardiff Hospitals because an oncologist there, said this was not true. To be fair, modern stereotactic radiotherapy provides radiotherapy treatment from several different directions each focussing on the target tumour. The claim is that because each line of attack uses a lower dose (but the total delivered to the tumour is the same), each line of attack damages healthy tissue less but the success of the treatment is maintained..
Proton beam vs Radiotherapy - is there any research?
The specialist unit at MD Anderson has a great many patient studies since the first treatment in 2006. Never-the-less, the US National Cancer Institute reports several current Clinical Trials studying the benefits and side-effects of Radiotherapy vs Proton Therapy (1).
One 2020 study (2) of 1483 patients aged 18-93, taken at 90 days after treatment concluded that "Proton chemoradiotherapy was associated with significantly reduced acute adverse events that caused unplanned hospitalizations, with similar disease-free and overall survival."
Proton beam therapy - lung and prostate cancer
In America, Proton Beam Therapy is used for a number of cancers because it causes less damage to tissues before and surrounding. The NCI actually states that Proton Beam 'stops at the tumour' so there is no damage after. Not surprisingly, ’high precision’ proton beam therapy is increasingly used in America for prostate cancer. Less scatter means less nerve damage and less erectile disfunction. Stopping at the tumour means less damage to the rectum.
Lung cancer and some tumours that cannot be treated fully with surgery - like gastrointestinal, central nervous system and head and neck cancers - are also being increasingly treated with Proton Beam Therapy.
The mess in the UK that NICE and the NHS created over Proton Beam Therapy
Back in 2015, it was announced that the UK was to get three privately funded canters by 2023. The NHS stated that it would have three as well. And then there's still Prague. The USA and Germany also have increasing numbers of centres.
The UK Government basically failed to launch its three centres. Worse, when Professor Karol Sikora launched the three privately funded Rutherford Cancer Centres to the UK, Oncologists were told stereotactic radiotherapy inside their hospitals was just as good as this expensive upstart.
The Rutherford Centres simply had little business and shut down. All through the Covid pandemic, when cancer treatment in the UK faced delays, lack of staff and patients felt the MHS in some areas of the UK had fallen to pieces, the Rutherford Centres remained shut, devoid of patients, despite Sikora urging the NHS to use them as centres of excellence, not just for Proton Beam Therapy.
Right from 2015. Cancer Research UK had poured cold water on the excitement with their estimates that only 1 in 100 people requiring radiotherapy would benefit from proton therapy, adding that there was no long-term research* that proton beam had benefits and that people who travelled abroad to use it were only chosen because the outcome was more likely to be successful.
* By coincidence, two hugely expensive Cyberknife machines proving stereotactic radiation had been purchased for the UK. There was no long-term research on Cyberknife either. Yet it was in use from day 1. The fact was that proton therapy was first invented and used by MD Anderson in 2006, well before the CyberKnife which politics backed!
The cost of Proton Beam Therapy
This could have something to do with it. A course of radiotherapy according to an NHS 2013 study, was a little over £18,000. PBT was estimated at over £32,000 to do the job. When we asked Sikora about the cost of proton therapy for prostate cancer in 2021, he said it would be around £30,000. In America in 2018, a course of treatment for prostate cancer might set you back $50,000 at least.. But more use, brings down prices.
You can see Chris Woollams Interview Professor Karol Sikora HERE.
Go To: Professor Mike Brada talks about Proton Beam Therapy and brain cancer
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References
1. Is Proton Therapy Safer than Traditional Radiation? February 11, 2020, by NCI Staff
2. Comparative Effectiveness of Proton vs Photon Therapy as Part of Concurrent Chemoradiotherapy for Locally Advanced Cancer; Brian C Baumann et al; JAMA Oncol, 2020 Feb 1;6(2):237-246.