Proton Therapy

The technology of radiation therapy is developing rapidly. Despite the availability of diverse irradiation modes, further improvement of this method is limited by its properties. One of the latest technologies widely introduced into clinical practice is advanced proton beam therapy techniques. Comparative outcomes of proton therapy vs. traditional radiation therapy demonstrate its efficacy and better tolerability. Insurance and costs of proton therapy are determined on an individual basis.

Content

1. When radiation therapy is used
2. Proton therapy overview
3. Indications for proton therapy
4. How the proton therapy procedure is carried out?
5. Advantages of the proton therapy method
6. Where can I undergo proton therapy?
7. The cost for proton therapy treatment
8. How can I undergo treatment with proton therapy?

When radiation therapy is used

The Associations of Oncologists around the world conduct various clinical trials designed to answer the question: "Which method should be preferred in the treatment of different tumors?". In general, all these trials pursue one goal, i.e. to increase life expectancy and quality of life in patients with cancer.

It is known that the main methods of treatment for various malignant tumors are surgery, chemotherapy, radiation therapy, and their combination. Surgery and radiation therapy are considered methods of local action on the tumor, while drug therapy (chemotherapy, targeted therapy, hormone therapy, immunotherapy) is considered the systemic one.

Radiation therapy is planned taking into account the following factors:

• The location of a malignant tumor and its spreading to surrounding tissues and distant organs
• The degree of malignancy of the tumor, and other prognostic and predictive factors
• The type of prior treatment and its effectiveness
• The general health condition of the patient (age, presence and severity of concomitant pathologies, and life expectancy)

The effects of radiation therapy are based on the irradiation of a target area with proton beams that can damage the DNA of the cancer cells. Radiation therapy can damage the functions and vital activity of cancer cells, which will eventually stop their development, growth, and division. Thus, the result of the malignant tumor being treated is the decrease in its size or its full disappearance. Unfortunately, healthy cells located near to the tumor can also be located in the irradiation zone, which subsequently determines the degree of their damage and the development of side effects. After the treatment completion or in the intervals between the irradiation sessions, healthy cells are able to recover from radiation side effects, while the tumor cells cannot.

Proton therapy overview

The phenomenon that distinguishes proton therapy from other radiation therapy types is its ability to deliver the maximum amount of energy over the short path of the beam. When entering the body, the proton beam transfers little energy and does not affect tissues on its way. Protons release their energy in the target area (the tumor), and ultimately, after that, the ionizing energy drops to zero.

Therefore, proton therapy makes it possible to treat even tumors located inside the organs, completely protecting them from radiation. An accurate dose calculation allows doctors to determine the peak point after which the energy of the proton beam has a near-zero value. In the case of proton therapy, healthy tissues receive a small dose of radiation, thus the possibility of the side effects development is almost eliminated.

The accuracy of modern proton beam therapy has made it possible to overcome important problems of radiation treatment such as the risk of cancer recurrence in the healthy cells surrounding the tumor that received radiation.

This is especially important when using proton therapy for pediatric cancer patients. Exposure of healthy tissues of a child's body even to small doses of photon radiation often leads to impaired growth of bone and muscle tissue and causes side effects that influence cognitive abilities, which are noticed during the irradiation of the brain. Therefore, proton therapy is preferred instead of photon therapy in 100% of cases of cancer in children.

Proton therapy itself is a high-precision radiation therapy tool that effectively and safely achieves the assigned goals. But the modern clinical practice has proven that the key to the effectiveness of cancer treatment is an integrated approach, including the use of various methods. The combination of expert diagnostics, minimally invasive surgery, radiation therapy treatment (particularly proton beam therapy), drug treatment (chemotherapy, targeted treatment, immunotherapy) are available to patients in modern proton therapy centers.

Indications for proton therapy

The patient should be informed about the various treatments, including alternative methods. For example, patients with early stage lung cancer with severe concomitant diseases and absolute contraindications to surgical treatment can consider other methods of cancer treatment, such as radiation therapy – the so-called cancer treatment without surgery.

In the presence of certain indications, radiation therapy can be recommended for patients with pancreatic cancer, breast cancer, and prostate cancer. Stereotactic radiation therapy, for example, is actively and successfully used instead of surgery in brain tumors, thereby significantly reducing the risk of postoperative complications and side effects development, accelerating the rehabilitation after cancer is treated. At the proton therapy centers, the decision to conduct radiation therapy, either as an independent treatment option or as part of a comprehensive treatment, is made by the team of specialists.

Proton therapy eligibility criteria basically include any type of malignant tumor that is sensitive to radiation treatment. This method can be chosen as an alternative to irradiation with X-rays or linear accelerators to destroy neoplasms that cannot be irradiated on devices of a different type due to the high risk of side effects.

Proton therapy helps to treat tumors without surgery, it is the ideal option for inoperable neoplasms. According to medical information resources, in some oncopathologies, proton therapy increases the survival rate and decreases the appearance of side effects by 1,5-2 times compared to the use of conventional radiation therapy.

The range of treatable cancers includes:

• Prostate cancer.

Procedures of prostate cancer treatment with proton therapy usually take from 15 to 20 minutes a day and are carried out five days a week for approximately two months. Most patients with prostate cancer tolerate treatment exceptionally well and are able to continue working and exercising, and remain sexually active during and after the treatment.

After the prostate cancer is treated, the rehabilitation period is minimal. The risk of impotence after proton therapy for prostate cancer treatment is minimal, especially in patients who had a good sexual function before starting therapy.

• Liver cancer.

Proton therapy can have a positive impact on the treatment of the disease. Doctors at proton therapy centers use the most modern technologies in medicine that allows high doses of radiation to be delivered directly to the tumor without damaging healthy liver tissue. Even though proton therapy does not allow liver cancer to be treated completely, it can inhibit the growth of cancer cells, shrink the tumor, and relieve pain.

• Pancreatic cancer.

The high malignancy potential of the pancreatic cancer leads to a greater likelihood of progression and recurrence of the disease after complex treatment. This makes it necessary to resume drug therapy or perform repeated surgeries. Therefore, even at early stages, a course of preoperative systemic proton therapy is recommended, which, in combination with radical surgical intervention and adjuvant treatment allows obtaining the desired effects of pancreatic cancer treatment.

• Lung cancer.

Most patients with lung cancer tolerate proton therapy exceptionally well and continue to work and exercise during and after treatment ends. Treatment usually takes from 15 to 30 minutes each day and is performed five times a week. The course lasts from 4 to 7 weeks. Hospitalization is not required.

• Breast cancer.

The information from clinical studies suggests that patients with locally advanced breast cancer who received proton therapy of regional lymph nodes experienced milder side effects, but the disease control was similar to patients who received the conventional (photon) radiation therapy.

In addition, proton therapy is used in non-cancerous brain tumors, and sarcomas of the spine and pelvic region.

How the proton therapy procedure is carried out?

There are already leaders in proton therapy technologies. In the past, proton therapy centers used a fixed proton beam device, and the patient was irradiated with a constant proton beam.

Modern proton therapy centers, however, are equipped with installations that allow modulating the energy of proton beams, controlling their trajectory, and adjusting the depth of the maximum dose of radiation released.

By controlling the energy of the protons, the doctor sets the depth at which the peak of each of the beams will be located. Therefore, modern proton therapy devices make it possible to use the technique when the tumor is literally shaded layer by layer with a high dose of radiation. At the same time, the highest accuracy of the approach is maintained: the patient lies still, and the device is rotating around him, directing the radiation along almost any trajectory. This is what treatment looks like at the modern proton therapy centers.

Advantages of the proton therapy method

Modern radiation therapy has undergone revolutionary changes in recent decades and has become effective in the treatment of many types of cancer. Currently, more than 60% of patients with malignant tumors require radiation treatment. Many precise types of radiation therapy have been elaborated, such as the Gamma Knife, CyberKnife, and other radiation therapy options.

However, there is one drawback when using these and other conventional methods. The radiation consists of a beam of photons and electrons, which damage not only the tumor but also healthy tissues located near the tumor and along the trajectory of the radiation beam. As a result, it causes healthy tissue damage and various side effects. To avoid side effects, it is necessary to limit the power of radiation applied to the tumor.

The photon beams used in conservative radiation therapy are emitted by a linear accelerator. They penetrate the body, transferring their high energy to the tissues located in their path. By controlling the trajectory of the beams delivery, doctors form high-dose zones, destructive for tumors, coinciding in shape with the neoplasm. Healthy tissues in their trajectory (from entering the body to the tumor, and from the tumor backward) receive practically the same dose of radiation as the tumor. Therefore, it is important to be able to deliver portions of radiation from different positions to spread the radiation between healthy tissues, preventing the intersection of the rays outside the tumor volume.

But what if critical organs or other healthy tissues such as the wall of the bladder, heart muscle, brain, or muscles surrounding the prostate that control urination and sexual function, are located near the tumor, and their irradiation is highly undesirable?

Modern methods of photon therapy provide a partial answer to this question, making up the most complex algorithms for calculating trajectories and splitting the number of beams to protect healthy tissues and critical structures. But only proton beam therapy brings the problem of protection of tissues behind the tumor to a new level.

Proton therapy uses proton beams. The peculiarity of proton radiation is that the main energy of the rays is released at a certain point. This point is called Bragg peak (Bragg curve). The radiologist plans the irradiation session so that the energy is released into the tumor and repeats its borders with the highest accuracy. Thus, only the tumor is destroyed, and the surrounding healthy tissues are practically not affected.

Where can I undergo proton therapy?

Health tourism is becoming more and more popular these days, as treatment abroad ensures a much better quality of the overall cancer care and proton therapy specifically.

The best success rates in proton beam therapy are demonstrated by:

1. University Hospital Essen, Germany
2. University Hospital Heidelberg, Germany
3. Proton Therapy Center Prague, the Czech Republic 
4. Proton Therapy Center of Dr. Berezin Medical Institute (MIBS) Saint Petersburg, Russia

You can check out the full list of hospitals on the Booking Health website.

The cost for proton therapy treatment

The prices in hospitals listed on the Booking Health website are relatively low. With Booking Health, you can undergo cancer treatment with proton therapy in the best hospitals in the world at an affordable price.

The cost of treatment varies, as the prices depend on hospitals, the features of the disease, and the complexity of treatment.

Proton therapy in Germany costs approximately 80,500 EUR.

Proton therapy in the Czech Republic costs approximately 53,800 EUR.

Proton therapy in Russia costs approximately 45,000 EUR.

You should take into account that the possible additional treatment or follow-up care costs some amount of money as well. Therefore, the ultimate cost for proton therapy treatment may differ from the initial price.

To receive the information on the cost of treatment, contact us by leaving the request on the Booking Health website.

How can I undergo treatment with proton therapy?

It is not easy to self-organize any treatment abroad. It requires certain knowledge and expertise. Thus, it is safer, easier, and less stressful to shift some responsibility onto a medical tourism agency.

As the largest and most transparent medical tourism agency, Booking Health has up-to-date information on proton therapy in the best hospitals in the world. Booking Health will help you select a proton therapy center, taking into account your wishes for treatment. It is vital to have accurate information on the success rates of different hospitals in proton therapy.

We want to help you and take on all the troubles. You can be free of unnecessary stress, while Booking Health takes care of all organizational issues and offers patient support services during proton therapy. Our goal is to find the best medical facility for you, where you can undergo proton therapy safely.

Medical tourism can be easy! All you need to do is to leave a request on the Booking Health website, and our manager will contact you shortly.

Authors: 

The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Our editorial policy, which details our commitment to accuracy and transparency, is available here. Click this link to review our policies.

Sources:

National Cancer Institute

Particle Therapy Co-Operative Group

International Journal of Radiation Oncology