By Doug Magill
The recent announcement concerning the development of a proton therapy center by University Hospitals is great news for northeast Ohio. The most advanced form of radiation treatment, proton therapy is also the most precise, providing extraordinary effectiveness with few side effects.
The first treatments of difficult head and neck cancers occurred in 1957, using particle accelerators developed for research purposes. Loma Linda University built the first hospital-based system, and has been treating prostate cancer there since 1990. The UH facility will be a smaller unit, and UH reports that only 300 – 400 patients per year will be treated with it. Too bad. The waiting list for proton therapy is growing dramatically.
When I received my therapy at Loma Linda University in late 2003, only one other center was fully operational: the Northeast Proton Therapy Center at Massachusetts General (out of Harvard). MD Anderson was building its facility in Houston, as were the University of Florida and Indiana University. In fact, I had been accepted as one of the first patients to be treated at Indiana University, but I was able to fill a vacated slot at Loma Linda and felt it prudent to be treated as early as possible.
Subsequently, centers have opened at the INTEGRIS Cancer Campus in Oklahoma City, the University of Pennsylvania, Hampton University in Virginia, and the CDH Proton Center in Chicago. New facilities are under construction in Somerset, New Jersey, Flint Michigan, Saint Louis and Seattle. Additional centers are in development in Dayton, Ohio, Knoxville, Tennessee, and by the Mayo Clinic in Rochester, Minnesota and Phoenix, Arizona.
Internationally, there are centers in Canada, China, England, France, Germany, Japan, Italy, Korea, South Africa, Switzerland and Sweden. All of these centers have come on line since my treatment in 2003.
So what has taken the Cleveland Clinic and UH so long? The technology is not new, although it is revolutionary.
It is disheartening to realize that these two powerhouse medical centers are so lagging in terms of effective treatment. The Clinic especially is known for being behind the curve in medical treatment, and not willing to take any investment risks. And, perhaps, the surgery business is so lucrative that diversion of patients to a different treatment modality might affect profitability.
A woman who handled PR for a major hospital told me of an angry confrontation with a urological oncologist who demanded that proton therapy not be discussed at a planned seminar because of the potential effect it would have on his livelihood. Although we don’t like to consider such things, medical establishments are businesses and efficacy and quality of life can sometimes be ranked lower than profitability and cash flow.
The concept of proton therapy was first evaluated after World War II. By splitting hydrogen atoms, protons could be accelerated and shaped to conform to the tumor being targeted. Because protons are heavy particles, the delivery of their energy (called the Bragg Peak) could be precisely determined. Unlike conventional X-Rays where most of the energy is dispersed within the first 10cm, protons could be directed to deep internal targets without damage to any surrounding tissue.
The daily treatment cycle is straightforward. The patient is placed in a pod that has been conformed to his body, laser targets illuminated to insure proper alignment, X-Rays are taken to verify target positioning, and the beam is turned on for 60 seconds. And the patient is done until the next day’s treatment.
The magic is in the physics – and biology. Protons destroy the DNA of the cancer cells, preventing them from replicating, and causing them to effectively die off. Along with your prostate.
Side effects were a big concern for me. When I interviewed men who had been treated via surgery (“We’ll cut it out to make sure the cancer is gone”) I was astonished at the fact that the vast majority had lingering side effects: incontinence (“I only have to wear diapers when I play golf”), impotence (“My doctor says maybe we could try a prosthesis”), scarring requiring multiple corrective surgeries, infections from the surgery, and so on.
I was terrified.
I found that the chances of recurrence were relatively the same for most modalities, and depended more on the severity of the cancer before treatment (Loma Linda treated surgery patients whose cancer had recurred – calling it “salvage”). The biggest differentiator was the quality of life that could be expected post-treatment.
Proton therapy beat all other options in the potential for a relatively normal quality of life, and efficacy of treatment. In my case I was able to play basketball the last week of my treatment (one of the prouder of my athletic achievements was being considered a ringer in the 50-and-over basketball league at the university).
Now there are a plethora of treatment centers throughout the country, with more being planned. It was long past time for one of the Cleveland medical centers to adopt this technology, no matter how timidly. The question now is when will they fully embrace it and live up to the undeserved hype of being the most advanced in the world?
Doug Magill is a proud member of the Brotherhood of the Balloon – a prestigious organization limited to proton treatment survivors of prostate cancer therapy. He is also a consultant, freelance writer and voice-over talent. He can be reached at email@example.com