Proton therapy for brain tumor (program ID: 603582)
Proton Therapy Center Prague
Jiří KubešSpecialized in: adult and pediatric proton therapy
Department of Adult and Pediatric Proton Therapy
- Initial presentation in the clinic
- clinical history taking
- review of medical records
- physical examination
- laboratory tests:
- complete blood count
- general urine analysis
- biochemical analysis of blood
- TSH-basal, fT3, fT4
- tumor markers
- inflammation indicators
- indicators blood coagulation
- PET-CT (if indicated)
- MRI scan
- proton therapy (full course)
- nursing services
- consultation of related specialists
- treatment via head doctor and all leading experts
- explanation of individual treatment plan
How program is carried out
Proton therapy is the outpatient procedure, you do not need to stay in the hospital all the time.
During the first visit, the physician will conduct a clinical examination, go through the available medical records and CT scans. If necessary, the physician will prescribe you additional examinations in order to clarify the diagnosis and determine the localization of the tumor more accurately.
Preparation for proton therapy begins with manufacturing the special device – the individual immobilizer that will fix the position of your body during a proton therapy session. Immobility is essential for high irradiation accuracy.
After the control computed tomography, during which you will stay in the immobilizer, the healthcare professionals will develop an individual treatment scheme. The treatment scheme determines the number of proton therapy sessions, the radiation dose, the angle of the rays and the depth of their penetration. In accordance with these, technical devices are manufactured that determine the depth and form of irradiation. These are the collimator (determines the shape of the proton beam) and the bolus (determines the depth of the proton beam penetration).
After that, a trial irradiation session is carried out using the individual immobilizer, collimator and bolus. Doctors evaluate the radiation dose received by the tumor and its compliance with the treatment scheme.
Proton therapy. The procedures are carried out once a day, 5 days a week. Usually Saturday and Sunday are your free days when you do not need to visit the hospital.
Before each procedure, specialists check the position of your body using X-ray in two projections. If necessary, the irradiation is synchronized with the respiratory movements. After that, the tumor is exposed to the proton beams for 1-3 minutes. The total duration of the session with all the checking procedures is 15-30 minutes.
The procedure is painless and is performed in open-type devices (this is important for overweight people or people with claustrophobia). Proton therapy does not require bed rest or other restrictions of physical activity.
Monitoring the treatment effectiveness. After completing the treatment, you will be advised to come in for the long-term follow-up. You will visit your doctor regularly for a clinical examination and, if necessary, a CT scan.
- Medical records
- MRI/CT scan (not older than 3 months)
- Biopsy results (if available)
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About the department
The Department of Adult and Pediatric Proton Therapy at the the Proton Therapy Center Prague offers the most advanced and accurate form of radiotherapy currently available to treat various cancers. The department has 5 specialized treatment rooms equipped with state-of-the-art technology, including IBA Proton Technology, Pencil Beam Scanning, Patlog™ from a Swedish firm called ONCOlog etc. The department also has a specially designed room for eye treatment. A feature of the department is that it deals with the treatment of young patients. Each specialist working here sets a goal not only to provide excellent treatment quality, but also to please patients with high standards of patient care. The department is headed by Asst. Prof. Dr. med. Jiří Kubeš.
The department is highly-specialized in proton therapy, which is an invisible and highly controlled beam that works by using pencil point precision to target a tumor. When it releases radiation, the radiation beam slows down, which allows the protons to interact with electrons allowing a release of high-energy. This high-energy is then released into its designated location (the tumour). As the beam is controlled by a physician, it only targets the shape and depth of a tumor to allow healthy tissue to remain undamaged.
Proton therapy is made possible through the cyclotron technology. A cyclotron is a type of particle accelerator in which charged particles accelerate outwards from the centre along a spiral path. The particles are held to a spiral trajectory by a static magnetic field and accelerated by a rapidly varying (radio frequency) electric field. The cyclotrons can be used in particle therapy to treat cancer. The ion beams from cyclotrons can be used, as in protons therapy, to penetrate the body and kill tumours by radiation damage, while minimizing damage to healthy tissue along their path.
Proton therapy is considered a better way to treat cancer because it has fewer side effects, but the technology is expensive. The majority of proton centres throughout the world currently use "scattered beam" nozzles to deliver the protons to cancerous tumors. Although the scattered beams are extremely effective, the department is among the leaders who use even more effective and very precise "pencil-beam" technique.
Proton therapy is based on the use of positively charged elementary particles of hydrogen atom nuclei – namely protons that have a weight much higher than that of electrons. Protons are accelerated in a cyclotron to a speed equal to approximately half the speed of light. This also determines their energy, which reaches up to 230 MeV (mega-electron volts) and enables them to damage tumors up to a depth of approximately 30 cm. The protons are then targeted with a strong magnetic field into a very narrow beam (a "pencil beam") and transferred with a high degree of accuracy via a 3D image to the malignant tumor. Energy is released during deceleration in the tumor tissue with subsequent ionisation and damage to the DNA of the affected cell. If the damage is sufficient, the cell stops dividing (and growing) or dies immediately.
Such physical properties of the proton beam as low entry dose, maximal dose of energy at the required depth and a zero exit dose enable extremely precise modulation of dose distribution inside the patient’s body and represent the main advantage of proton radiotherapy. Due to this feature, it is possible to increase the dose directed at the tumor to a level above that which could be achieved using common, conventional X-ray radiotherapy techniques, and at the same time the doctor can reduce the dose to surrounding tissues that are sensitive to the harmful effects of radiation.
An integral part of each treatment scheme is an individual planning of the proton therapy procedure. To this end, the department has several high-tech systems that allow the doctors to clearly imagine the true size, shape and position of tumors. By combining a radiation oncology information system (MOSAIQ) and the other various high-end 3D and 4D imaging systems, the department's specialists are able to obtain a comprehensive understanding of a tumour and the treatment options available.
Special attention should also be given to the modern patient positioning systems within every treatment room. These systems serve to support and position patients with submillimeter accuracy to allow the proton beam to be delivered with great precision to any point in the patient from any angle.
All treatments and examinations are usually performed on an outpatient basis, but it is worth noting that children usually require hospitalization (hospital stay is provided by the department's partner – University Hospital in Motol).
In some cases, patients may need a combination of proton therapy and chemotherapy. To this end, the department offers specially designed rooms for chemotherapy treatment and competent medical staff.
The patients with metal or ceramic parts in the body may be a contraindication for proton therapy. A pacemaker is a contraindication for proton therapy as well.
The department specializes in proton therapy for the following types of cancer:
- Brain cancer
- Low grade gliomas
- Pilocytic astrocytoma
- Nonpilocytic gliomas (astrocytoma, oligodendroglioma, oligoastrocytoma)
- Pituitary adenomas
- Chordomas and chondrosarcomas
- Low grade gliomas
- Breast cancer (proton therapy can be conducted only after surgery)
- Gastrointestinal cancer
- Oesophageal cancer
- Hepatocellular carcinoma
- Pancreatic cancer
- Head, neck and orofacial tumors
- Tumors of paranasal sinuses (primary or postoperative radiotherapy)
- Tumors of salivary glands (primary or postoperative radiotherapy)
- Nasopharyngeal cancer (primary radiochemotherapy)
- Skull base tumors (chordoma, chondrosarcoma)
- Tonsil tumors (mainly postoperative, HPV16+, youth)
- Non-small-cell lung carcinoma
- Stage I, IIA – T1-2N0M0, inoperable due to comorbidities or due to refusing of operation
- Stage IIB, IIIA – locally advanced tumors (T1-4 N1), non-resectable
- Stage IIIB – T1-4, N2 – locally advanced tumors (T1-4 N1), non-resectable
- Hodgkin’s lymphoma
- Non-Hodgkin’s lymphoma
- Pediatric cancers
- Medulloblastoma (postoperative proton therapy)
- Craniopharyngioma (postoperative radiotherapy, radical surgical resection contraindicated in the case of recurrence)
- Ependymoma (postoperative radiotherapy, radiotherapy of recurrent tumors to the extent according to the stage of disease)
- Germ cell tumors (to the extent according to the relevant protocol (independently or after chemotherapy))
- High-grade gliomas (recurrent tumors after previous radiotherapy, primarily in unfavourable locations in selected patients)
- Soft tissue sarcomas (in unfavourable locations) to the extent according to the relevant protocol
- Ewing’s sarcoma (in unfavourable locations) to the extent according to the relevant protocol
- Any other tumors as specified by a multidisciplinary team (esthesioneuroblastoma, neuroblastoma, nephroblastoma, malignant lymphomas, and others)
- Prostate cancer
- Other oncological diseases in adults and children
With a great deal of clinical experience from several institutions as a radiation oncologist, Dr. med. Jiří Kubeš is a specialist in prostate cancer, as well as head and neck tumours. He joined the Proton Therapy Center Prague in 2012 and became the Medical Director in January 2014. Dr Kubeš is an Assistant Professor at the Charles University and the Institute for Postgraduate Education in Medicine.
Photo of the doctor: (c) Proton Therapy UK