by Carol Ko
, Staff Writer | February 07, 2013
So who would be an ideal candidate for this new treatment? "Women who would benefit most would be women with larger tumors, or who have tumors in multiple lymph nodes — especially if this is a left-sided breast cancer," said Hartsell, who explains that it's particularly difficult to treat more widespread areas on the left side thoroughly while missing the heart.
Researchers attending the conference on Friday will discuss issues around treatment techniques, patient selection and the challenges of measuring the treatment's long-term efficacy in relation to radiation therapy. "The problem is, we're trying to prevent something that's going to happen 15, 20 years down the line," said Hartsell. "We can't run a test immediately afterward that says, yes, we're effective in preventing that problem." He also notes that a series of clinical trials in proton centers assessing long-term outcomes are currently underway.
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Though many experts agree that the technology holds promise, it comes with a hefty price tag: proton therapy treatment costs around $50,000, or twice as much as standard radiation. Building a proton center also requires a very large capital investment up front -- roughly $100 to $200 million. To add fuel to the fire, Medicare is offering generous reimbursements for the procedure, paying around $50,000 for patients undergoing prostate cancer treatment.
Skeptics criticize what they see as a hasty medical arms race to adopt a new technology whose benefits have yet to be established in long-term studies. Mayo Clinic, for example, plans to build two proton centers in Minnesota and Arizona to compete with other hospitals such as the University of Pennsylvania and Loma Linda.
However, Hartsell points out that just looking at the price tag is misleading. "Proton centers treat a lot more patients per center than an X-ray center," he said. "You're talking about putting in a Wal-Mart versus a 7-Eleven. The Wal-Mart serves a lot more customers, so there's a lot more cost that goes into the building of it." He also points out that the initial cost savings of using standard radiation therapy may be lost quickly if those patients are later at increased risk for radiation-related heart attacks or lung tissue damage.
"For women with high-risk breast cancer, it makes a lot of sense to evaluate the use of protons to make a big difference in those women's lives 15, 20 years down the line," said Hartsell.
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