Revolutionary Tumor Radiation Treatment
Precisely delivered within 2 millimeters, our intensity-modulated pencil beam scanning technology, offered in all five treatment rooms, releases a high dose of cancer-killing radiation that conforms precisely to the unique shape and size of the tumor. This highly targeted technology attacks the tumor with laser-like precision, while sparing surrounding healthy tissues and organs.
Limitations Of The Studys Design
The study leaders and other experts noted several limitations to the studys design.
For instance, this observational study cant establish a cause-and-effect relationship between proton therapy and fewer side effects. In addition, all of the study participants were treated at a single institution, which can make it difficult to generalize the findings to a larger population.
Those are very significant limitations that shouldnt be understated, Dr. Buchsbaum emphasized.
Although single-institution studies have inherent limitations, Dr. Baumann noted, all patients in this study received high-quality treatment at a large academic medical center, regardless of whether it was proton or traditional radiation therapy, which suggests that the benefit of proton therapy that we saw is meaningful.
Also, because patients were not randomly assigned to treatment groups, there were differences between patients who got proton and traditional radiation, and that may have skewed the results.
For instance, patients who received proton therapy were, on average, older and had more health issues.
The proton therapy group may also have included more patients from privileged backgrounds, Drs. Park and Yu noted. Socioeconomic status and social support can affect treatment outcomes, they wrote.
In addition, fewer people with head and neck cancerwho are more likely to suffer from radiation-associated side effectswere included in the proton therapy group, the editorialists added.
What Is Proton Therapy
Proton therapy, also known as proton beam therapy, is a form of radiation treatment used to destroy tumor cells. Instead of using x-rays like regular radiation treatment, it uses protons to sends beams of high energy that can target tumors more precisely than X-ray radiation.
When treating a patient, doctors and physicists work together to focus the proton beam on the exact size and shape of the tumor. The beam kills the tumor cells layer by layer, sparing surrounding healthy tissue.
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Who Are They Looking For
This study is looking for people who have been diagnosed with adenocarcinoma of the prostate within the last year. Only patients with early stage tumors will be accepted.
Patients with cancer spread beyond the prostate, who already underwent surgery, radiation therapy or chemotherapy cannot take part in this trial. Patients who received hormone therapy will also be excluded. Other conditions, such as autoimmune diseases , HIV infection, inflammatory bowel disease and previous hip replacement surgery also represent exclusion criteria.
Why Choose Memorial Sloan Kettering For Proton Therapy
- MSK radiation oncologists have vast experience in using proton therapy. Over the last five years, our specialists have used proton therapy to treat more than 2,000 MSK patients with a range of cancers. This is far more than anyone else in the New York City region. MSKs radiation oncology group has been at the forefront of developing the treatment guidelines and training specialists at other institutions how to properly use protons.
- Patients at MSK are cared for by a multidisciplinary team of cancer experts which includes radiation oncologists, medical physicists, oncologists, and surgeons that is among the most experienced in the world. This team will ensure that each patient receives the optimal treatment for his or her unique case.
- The MSK radiation oncologists who will practice at NYPC specialize in each type of cancer that can be treated effectively with proton therapy.
- Our experts are currently using pencil beam scanning technology, which is the most advanced form of proton therapy delivery. Pencil beam scanning allows proton therapy to be delivered in the most-focused form, reducing exposure to nearby healthy tissues in some cases more than any other form of radiation. The New York Proton Center offers pencil beam scanning with the smallest diameter and highest precision.
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What Types Of Cancer Can Be Treated With Proton Therapy
Many clinical studies are ongoing to compare proton therapy with other types external beam radiotherapy. For most cancers proton therapy has not been shown to improve tumor control or reduce side effects as compared to other types external beam radiotherapy. Proton therapy is thought to be most beneficial when treating specific types of cancers such as cancer in children, some recurrent previously treated cancers and some brain cancers. Your provider can review with you whether protons would be beneficial in your situation.
What Do We Think
For men with localised prostate cancer, current evidence suggests that proton beam therapy does not produce better outcomes than existing radiotherapy techniques. There is also limited evidence to suggest that it results in fewer side effects than radiotherapy. Because standard radiotherapy works just as well as, or better than proton beam therapy, it isnt used to treat prostate cancer in the UK.
Radiotherapy is a highly effective treatment for localised prostate cancer, enabling 98% of men with localised prostate cancer who receive conventional radiotherapy survive for at least 10 years. Men with this stage of the disease can also choose from a series of other treatment options that include active surveillance, radical prostatectomy and brachytherapy.
Unless further clinical trials are carried out to show that proton beam therapy will benefit men with prostate cancer through increased overall survival or the reduction of side effects, Prostate Cancer UK does not actively encourage men to pay for this treatment or seek it abroad.
If you have any concerns about prostate cancer or the treatment options for localised prostate cancer, you can confidentially contact our Specialist Nurses on 0800 074 8383.
i NHS England : Clinical Commissioning Policy: Proton Beam Therapy for Cancer of the Prostate. July 2016.
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Proton Therapy Advantages And Disadvantages
Proton radiation may represent an incremental improvement over IMRT due to the reduced exposure of surrounding normal body tissues to radiation. Therefore, in the situations outlined above where IMRT would normally be considered, men may prefer to choose proton radiation over IMRT. The purported advantages of proton radiation over IMRT remain theoretical and clinically unproven. No head to head studies comparing the IMRT and proton radiation exist.
Disadvantages associated with proton radiation are related to its high cost and the fact that not all insurance programs cover proton radiation. In addition, there are relatively few centers doing proton radiation, so geographic inconvenience can be a major factor considering that numerous visits are required over a 5 to 9-week period.
Men considering treatment for prostate cancer need to do their homework. Side effects from radiation can be irreversible. The selection of optimal radiation varies with patient circumstances. Many factors need to be considered when radiation is contemplated.
What Is The Recovery And Outlook After Proton Therapy
Most people return to their daily activities immediately following a proton therapy session. Many people see benefits from this procedure within 2-8 weeks. The tumors response to proton therapy depends on the type of cancer you have and its location within your body.
If you are diagnosed with cancer, ask your doctor about proton therapy as a possible treatment option. Your doctor will help you determine whether this treatment is a good option for you.
Last reviewed by a Cleveland Clinic medical professional on 05/26/2021.
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Who Is A Good Candidate
In most cases, you will be a good candidate for proton therapy if you were initially offered radiotherapy as an option. Patients who receive radiotherapy usually have no problems being a candidate for proton treatment. They are usually patients in an early stage or those with localized prostate cancer. It is also useful to keep advanced cancer under control for as long as possible and treat recurrent prostate cancer cases.
However, some patients may not benefit from proton therapy if they have one of these problems :
- In patients with hip replacements, because proton beams often cant reach beyond the prosthesis. In some proton therapy centers, these patients can still get a session when a hip replacement is limited to one side. But bilateral replacement makes it impossible to treat the patient with proton beam therapy.
- In patients with advanced prostate cancer in which treating the pelvic lymph nodes is fundamental. Since proton beam radiation is less likely to reach other tissues than the prostate, it is not applicable when treating surrounding lymph nodes.
- In overweight patients, because the proton beam can only go through a determined depth. This depth depends on the beams energy, and some centers may have a higher energy device that solves the problem.
Proton Therapy Centers In The United States
This website is provided by Robert D. Ferre, author of the books Best Prostate Cancer Treatment: Proton Beam Therapy and Prostate Cancer and Proton Therapy. More information is available through the links on the navigation bar above. Eventually, we will have detailed information for each of the centers.
We now list 39 centers operating in the United States with 17 in planning or construction stages. This list was updated July 15, 2021.
CENTERS IN OPERATION: ALPHABETICAL LIST BY STATE AND CITY PBS = Pencil Beam Scanning . Yes or no. Gantry turns around the patient. Fixed beam stays in one place, or shifts up to 60 degrees of movement . Low energy sites specializing only in ocular tumors are not included.
1. Alabama, Birmingham University of Alabama at Birmingham 400 20th Street South, Birmingham, AL 35233 Tel: 800.822.8816
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What Are The Best Proton Beam Centers In Europe
Proton beam therapy is a quite new treatment option, and is available not in every European medical center.
Among the most popular proton treatment centers in Europe are:
- Rinecker Proton Therapy Center . It is the 1st certified proton beam center in Europe, serves about 2,000 patients annually.
- Proton Therapy Center .
Positioning For Proton Beam Treatment
Positioning the body is very important. It can take several minutes for the team to adjust both you and the instruments to make sure the proton beam will reach the exact spot of the tumor.
While the treatment is happening, you must be very still on the table. The team will work with you to help keep you in place. For example, a custom-fitted mask can help those who are getting treatment for brain tumors. The mask is made of mesh that allows patients to see and breathe.
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Why Choose Us For Prostate Cancer Care
- Prostate cancer specialists: Because our team is subspecialized in prostate cancer, you get the most comprehensive, most personalized care plan available.
- Unparalleled in proton therapy: We’ve treated over 10,000 prostate cancer patients using proton therapy more than any other center in the world.
- Leaders in robotic surgery: Our surgeons perform more minimally-invasive robotic surgeries each year than those at any other teaching hospital in the West.
- State-of-the-art tech: As the largest urology group in the region, we offer you access to the most advanced technology available.
- Clinical trials: You have access to many clinical trials for prostate cancer, which may offer potential new treatments.
External Radiation Therapy At The Knight Cancer Institute
At the OHSU Knight Cancer Institute, our team specializes in all types of external radiation therapy.
- Leading-edge technology and innovative new approaches.
- Tools and techniques to precisely target cancer while sparing healthy tissue.
- Experienced radiation oncologists who work with your full cancer team to give you the best possible care.
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How Is Proton Therapy Delivered
Proton therapy is delivered by a device called a cyclotron, which sends a high-energy beam of protons through the skin toward the tumor. At Memorial Sloan Kettering, the first step is a CT or MRI scan to map the tumor in three dimensions. Then our radiation oncologists, in close collaboration with medical physicists, use computer programs to calculate how to deliver the treatment at the precise dose and location.You will receive proton therapy in a special treatment room, where you will be positioned on a treatment table. An immobilization device will make sure you stay in the exact position on the table.
How Proton Beam Therapy Works
Proton therapy is an advanced form of radiation treatment that uses protons instead of X-rays.
In regular radiation therapy, the beam of energy goes into the body, through the tumor, and out the other side. This exit dose of radiation might affect healthy tissue beyond the tumor. Protons, in contrast, are larger particles than those used in regular radiation. They release more of their energy within the tumor itself. This burst of energy can appear on a graph as what is called the Bragg peak.
After delivering the energy to the tumor, the protons stop: They do not exit the tumor and go into healthy tissue on the other side.
In this way, proton therapy reduces radiation exposure and potential damage to healthy tissue, especially in sensitive areas such as the brain, eyes, spinal cord, heart, major blood vessels and nerves.
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Ideas For Future Studies Of Proton Therapy
Despite the studys limitations, these intriguing findings raise questions that should inform future prospective phase 3 trials, Dr. Buchsbaum said, although there are barriers to large studies of proton therapy.
For instance, it is particularly encouraging that proton therapy appeared to be safer in a group of older and sicker patients who typically experience more side effects, Dr. Baumann noted.
Dr. Buchsbaum agreed that proton therapy may be especially helpful for older and sicker patients, but he noted that ongoing phase 3 trials were not designed to analyze this group of patients.
And because proton therapy may cause fewer side effects, future trials could also explore whether combining proton therapy with chemotherapy might be more tolerable for patients, the authors wrote.
For example, both chemotherapy and traditional radiation for lung cancer can irritate the esophagus, making it painful and difficult for patients to eat. But proton therapy might limit damage to the esophagus, making it easier for a patient to tolerate the combination, Dr. Baumann explained.
Future studies could also explore whether combining proton therapy with higher doses of chemotherapy might increase cures without causing more side effects, he added.
Dr. Buchsbaum agreed, saying that it would be worthwhile to explore this possibility. Just asking the question: Is more effective? might not be giving it a fair opportunity to demonstrate its benefit to society, he said.
Effectiveness And Toxicity: Reviewing The Literature
Although PBT has generated much enthusiasm, its utility can be best confirmed by clinical trials. Unfortunately, there are no randomized trials completed that directly compare 3D-CRT or IMRT with PBT, and thus we must rely mainly on single-arm studies.
Loma Linda University Medical Center was the first center to open a hospital-based proton facility in 1990, and reported the first large single-arm experience. The authors analyzed 1255 patients, 731 of whom received 3D-CRT plus a boost with PBT and 524 of whom received PBT only. Included were patients with low-, intermediate-, and high-risk prostate cancer. Using American Society for Therapeutic Radiology Oncology consensus criteria, the 5- and 8-year biochemical failure free survival was 75% and 73%, respectively. More importantly, there were very low rates of Radiation Therapy Oncology Group grade 3 or higher morbidity: 1% genitourinary and 0.2% GI. To put these numbers in perspective, patients treated with IMRT at our institution had 6% GU and 1% GI grade 3 or higher morbidity.
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Reirradiation For Recurrent Cancer
For patients who develop local or regional recurrences after their initial radiation therapy, physicians are limited in their treatment options due to their reluctance to deliver additional photon radiation therapy to tissues that have already been irradiated. Re-irradiation is a potentially curative treatment option for patients with locally recurrent head and neck cancer. In particular, pencil beam scanning may be ideally suited for reirradiation. Research has shown the feasibility of using proton therapy with acceptable side effects, even in patients who have had multiple prior courses of photon radiation.
Risk Of Erectile Dysfunction
So far experts are unable to agree that one type of radiation consistently outshines all the others. However, depending on the various types of situations that patients face, one form of therapy may have advantages over others. All the options, when delivered by experienced physicians, achieve good cure rates and have relatively few permanent side effectsexcept for the risk of erectile dysfunction .
The risk of permanent EDdefined as ED unresponsive to Viagra or similar drugsis about 50% with all types of radiation. The risk is higher in older men and in men with preexisting sexual impairment. The risk is lower in younger men and when preexisting sexual function is good. Treatment for radiation-induced ED is effective but unnatural and requires either an injection of prostaglandins into the penis or a surgically-placed prosthetic implant.
Bottom line, though ED after radiation is common, it is not considered a determining factor in the selection of one type of radiation over another. This is because the risk of ED is the same with all types of radiation. Comparing radiation options, therefore, depends on other factors such as cure rates and the incidence of bladder or rectal problems.
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Proton Therapy Vs Hormone Therapy
Unlike surgery, hormone therapy is a common treatment option when prostate cancer spreads in other tissues.
In these cases, proton therapy has limited utility because it is designed to treat localized prostate cancer.
Still, even in advanced prostate cancer, proton therapy can slow the progression of the primary tumor.
What Is External Radiation Therapy
External beam radiation attacks cancer with high-powered beams of energy, such as X-rays. It uses a machine called a linear accelerator to send energy beams through the skin and into the body. While you lie on a table, the linear accelerator moves around you, sending radiation to the tumor from different angles.
Schedule: Treatment usually lasts five days a week for several weeks. This allows your team to deliver enough radiation to kill cancer cells while giving your body time to recover.
Type: Your team may consider several types of radiation therapy. They will recommend a treatment plan tailored to your overall health and the type and stage of your cancer.
What is it? 3D CRT uses computer-assisted scans to pinpoint the size, shape and location of your tumor and surrounding organs. This helps your doctor tailor radiation beams to the shape of the tumor. Because the shaped beam is so precise, we can deliver a higher dose of radiation without harming healthy cells.
How is it delivered? Most patients receive 3D CRT five days a week for several weeks. Your radiation oncologist will make a mold or cast of the body part being treated. This serves as a shield and helps you stay still so radiation targets the tumor and avoids healthy tissue. It helps destroy more cancer cells with each treatment and allows you to recover more quickly.
What cancers is it used for?
- Breast cancer
What cancers is it used for?
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