From the May 2011 issue of HealthCare Business News magazine


The draw for protons is that, in principle, the way they work should make them far superior to photons. Like other forms of radiation treatment, proton therapy uses ionizing radiation to scramble the DNA of cancer cells, killing them off. But the benefit of protons is the radiation dose is deposited in what’s called the “Bragg Peak,” where the dose falls sharply away from the target area, sparing more of the surrounding healthy tissue. This is critical for children, whose bodies are more radiosensitive and who have more years ahead of them in which to develop radiation-induced cancers. But – and here’s where some of the controversy lies – it should, in theory, at least, also be better for adults with prostate, lung and other solid cancers.

But there’s no scientific consensus on any of this. However, waiting for head-to-head studies from different modalities is not the only obstacle to adoption. The main obstacle is cost.


Big numbers
The final price tag for all construction, furnishings and equipment for the football-field-sized proton therapy centers in the United States has been between roughly $120 million and $300 million.

A good chunk of the cost is the price of the mammoth, multimillion dollar particle accelerators – either cyclotrons or synchrotrons – that fire the protons at nearly two-thirds the speed of light. Further, the beam is often directed by huge, rotating metal devices called gantries. Typically, the accelerator and gantries run about $60 million to $100 million for a center with about four treatment rooms.

ProCure Treatment Centers Inc., a for-profit company which has two centers with four more in the works, has a somewhat cheaper model that uses one gantry and three gantryless rooms with fixed beams. ProCure said it cuts costs through what could be termed a McDonald’s model: the New York City-based company uses prefab construction plans they replicate (down to the office furniture) in every city. Also, the company says using a two fixed-beam system, instead of a gantry, shaves off about half the construction costs. But their most recently opened center, in Illinois, still cost about $140 million.

Another big chunk of the expense comes from the shielding. Cyclotrons need a 12-foot-thick, or one-story-thick, ceiling above them. And walls between treatment rooms are 6- to-8-feet thick. That means a four-room proton therapy center can use up to 15,000 cubic yards of concrete, equivalent to the load carried by 1,800 concrete trucks.

Service – with a price
Another factor for cyclotron and synchrotron costs is service: according to industry experts DOTmed News spoke with, the proton therapy equipment essentially needs daily maintenance. For instance, most U.S.-sold cyclotrons come with 10-year service contracts. At many centers, an engineer is almost always on-site; when the doctors and technologists go home for the night, the night-shift engineer is there to recalibrate the machine.

May 2011 Magazine

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