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Proton cancer therapy is promising, but pricey

Some are concerned patients will be steered to expensive treatment that may not be more effective

Proposed Miami Twp. proton center offers new kind of cancer treatment

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By Tom Beyerlein, Staff Writer 9:34 PM Saturday, November 7, 2009

As he fought the brain cancer that killed him Aug. 25, Sen. Edward Kennedy received proton radiation treatment at Massachusetts General Hospital.

“People asked me when Sen. Kennedy died, ‘What did it (proton therapy) buy him?’” said Leonard Arzt, executive director of the National Association for Proton Therapy in Washington, D.C. “Nobody knows. Did it buy him better quality of life? That’s what we believe. Did it buy him any more time? No.”

Proton therapy is in the midst of a growth spurt — new treatment centers are planned or hoped for in numerous communities, including Miami Twp. — but critics say there hasn’t been sufficient research to prove the effectiveness of the expensive technology against various cancers.

In a bulletin released in September, the National Cancer Institute said “there is concern among members of the medical and research communities that enthusiasm for this promising therapy may be getting ahead of the research.”

Proton therapy is billed as a breakthrough in cancer care, attacking tumors with greater precision and intensity than conventional radiation treatment. It’s also very expensive — the treatment center planned for Miami Twp. has a $150 million price tag, and Medicare pays about twice as much for protons as for traditional X-ray treatments. Proton therapy is covered by most health insurers, according to the association.

There are only six treatment centers in the country, but a seventh is expected to begin treating patients next month and three others are under construction. Numerous others, including the one planned for Interstate 75’s new Austin Boulevard interchange, are on the drawing board.

Proton therapy may be just coming into its own, but the technology is an outgrowth of the World War II Manhattan Project that resulted in the atomic bomb.

The physics behind protons make them attractive cancer fighters. The energy of X-rays steadily diminishes as radiation passes through the body, causing damage to tissue surrounding the targeted tumor. Proton beams, the cancer institute explains, deliver most of their energy to an area called the Bragg Peak, then stop. Doctors are able to guide the proton beams by computer to unleash their power at the depth of the tumor.

Proton beams act “like a depth charge delivered to its calculated destination,” the institute’s bulletin said. “When the target is hit, healthy tissues are largely spared side effects from treatment and there is greater damage to the tumor.”

The world’s first proton treatment center affiliated with a hospital opened in 1990 at Loma Linda (Calif.) University Medical Center. Jon Slater, whose Optivus Proton Therapy Inc. is heading the Miami Twp. plan, helped to engineer the Loma Linda facility, which is headed by his brother, Dr. Jerry Slater.

In an interview, Jerry Slater said protons are being used to treat localized cancers of the brain, head, neck, eyes, prostate and lungs, early breast cancer and pediatric cancers. Because X-rays can interfere with the proper development of bones and other bodily structures, Slater said, protons hold special promise when patients are growing children.

Protons can be used in conjunction with other treatments like surgery and chemotherapy or as a follow-up to standard radiation.

Slater said the average length of outpatient treatment at Loma Linda is five to six weeks, and up to nine weeks for prostate cancer patients. Now in its 19th year, Loma Linda treats 150 to 175 patients per day and 1,100 to 1,200 per year. Patients stay in local hotels or apartments specially built for them nearby.

It took 11 years after Loma Linda opened before the second hospital-based proton center began.

“The reason is, nobody thought we could pull it off,” Slater said. “They thought we were creating the world’s biggest white elephant. There are still more doubters than believers out there. (With) every major development in radiation oncology, the same people said the same thing.”

But experts at the National Cancer Institute said while proton therapy is “very promising,” there have been no randomized controlled trials to prove it works better than standard radiation treatment. Among the concerns is whether the ultra-precise shape of the beam, based on diagnostic imaging, is accurately hitting the real tumor.

Other experts worry that proton center entrepreneurs, needing more patients to make a profit, may end up steering patients with more common cancers to proton treatment, even if less costly standard treatment would work just as well. Some for-profit centers have sold minority ownership stakes to oncologists in what some consider an ethical breach.

Proton centers require giant, costly machinery and buildings with thick concrete shielding. They are, Arzt said, “the size of a football field or two, and two or three stories underground. It’s not a small machine.” There are efforts to design smaller, less costly facilities.

Fewer than one percent of radiation patients use protons, but Arzt and Slater said the numbers will grow with the advent of more centers and the fine-tuning of the technology.

“It’s evolving, and continues to evolve,” Arzt said. “What we’re seeing now is the tip of the iceberg as far as what can be done.”

Staff Writer Kristin McAllister contributed to this report.

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