In April of 2013, 31 year-old Brad Eastman had a cancerous tumor surgically removed, and everything seemed fine for over a year. Then, a routine scan revealed a re-growth. After careful consideration of his options, Eastman and his physicians determined that he was a candidate for proton therapy.

Today, having undergone a full recovery, he describes himself as a “lucky and blessed man,” and credits his life to the treatment he received at the S. Lee Kling Proton Therapy Center at Barnes-Jewish Hospital in St. Louis, Missouri.

The ease of his 30 visits, each comprised of three unanesthetized twenty-minute sessions under the beam, left a lasting impression on Eastman. “I was amazed at how quick it happened, how effective it was, and how painless it was,” he told Healthcare Business News. “You feel nothing, you smell nothing.”

Eastman says it’s “totally different” from all the other medical imaging procedures he is familiar with, “You don’t change into a gown, they don’t check you for metal, you can leave your cell phone and your wallet in your pocket.” He elected to take his shoes off for the treatment because it would be more comfortable. Afterwards, he would lace them back up, drive himself home, and eat dinner with his family.

Demystifying protons
Although not a “new” concept, proton therapy is very much in its formative years. Medical professionals are familiar with outcomes like Eastman’s, but responsible medicine— and health reform — requires the hard numbers to illustrate what cases yield the greatest benefits and, in turn, justify the treatment. The growth of that data pool is hindered by the staggering costs typically associated with proton facilities.

At S. Lee Kling, they use a system specially designed to resolve those cost problems.

The MEVION S250, from Mevion Medical Systems, is among a new breed of “compact” proton systems that lends itself to installation in clinical facilities, not just research and academic institutions. Since December of 2013, that system has been shedding light on — and adding evidence to — meaningful proton utilization.

S. Lee Kling has already treated over 100 patients with over 6,700 proton treatment fields. On some days, more than 20 patients would take a turn being treated in the system. Of those patients, roughly 25 percent were children, and of the adults, 30 percent were being treated for brain tumors, like Eastman.

HCBN spoke to Dr. Jeffrey Bradley, director of S. Lee Kling, about what he and his colleagues have learned since opening the doors for proton therapy treatment.

Getting started, he says they were unsure what their patient population was going to look like and what disease sites they would be treating most frequently. As those patterns have emerged, other concerns have been happily put to rest.

“We were wondering: Is the machine going to operate at full capacity? And do we have a patient load and referring physicians to keep it in use?” says Bradley, “The answer to both was ‘yes.’”

Experience has also informed the way they utilize radiation therapy using X-rays and protons. “I recently treated a patient with a mediastinal tumor directly behind the sternum, and I decided to mix X-ray and protons so that I could reduce the skin surface dose and reduce the chance that the patient would have skin burns,” says Bradley. Bradley says that technique can be credited to his accumulating hands-on experience, and also applies to head and neck patients. “Their tumors are right beneath the skin surface and so sometimes we’re using mixed beam combinations to reduce the skin surface dose a bit,” he says.

Protons in an X-ray world
The benefits, and unobtrusive nature, of proton therapy may be remarkable news to many candidates for treatment, but for physicians like Bradley they’re fairly well understood. For them, the mysteries around proton therapy may primarily be of a logistical nature.

“I know a lot more about the ins-and-outs of dealing with each individual insurance company with respect to proton therapy than I did before,” says Bradley. In some cases, he and his colleagues draft two different patient plans, one utilizing X-rays and another utilizing protons, to illustrate the benefits to payors. “It doesn’t always work, but it is a means that we use to show that the patient would benefit from protons.”

Within Bradley’s radiology network they perform radiation therapy on 14 linear accelerators, and the importance of those systems is not undermined by the addition of the MEVION S250. “We have a Gamma Knife unit for brain cases, we have linear accelerator for lung and liver stereotactic radiosurgery — and that hasn’t changed,” says Bradley.

He says having only one proton room, (traditional proton centers have multiple) makes his facility extra selective when determining which patients will be treated with it. “We’re getting children referred from all over the region who would have been treated closer to home with X-ray therapy,” says Bradley, who emphasizes the importance of utilizing the system where it can provide the greatest clinical benefits.

Pediatric patients with head and neck tumors are widely regarded as top candidates for proton therapy. For Eastman, getting to know the children being treated at S. Lee Kling was one of the most powerful and emotionally moving aspects of his experience. “When you have radiation appointments, you set it up for all visits at the same time every day, so it’s always the same people before and after you,” says Eastman. “Seeing those same children every day was hard. Their parents were worried and they were scared.”

A brighter future
Looking back, Eastman says there are two key takeaways. “One, I’m so blessed that this technology is right where I live. And two, I have been under the treatment of the best care team in the world, who knew just how to treat me and gave me the opportunity to be with my family, do what I love, and just live.”

At Eastman’s request, he extends his thanks in particular to Paula, Nikki, Matt, Shari, Chris, Dot, Mary Kay, Kimberly and Dr. Clifford Robinson. All of whom were vital members of his care team, in positions ranging from technicians to nurses to administrators at S. Lee Kling.

Eastman advises anyone considering proton therapy to be advocates for their own health and participate actively in determining what course of treatment will be right for them. “You have to ask the right questions,” he says, “There’s no reason in this day and age to be an ignorant patient.”

“It’s just a very positive thing that’s happening,” says Bradley, who looks forward to the next year of treating patients and advancing new techniques to save lives. He says an in-room CT scanner is on the horizon for S. Lee Kling, which will improve tumor localization for the patients still to come.