Pursuing lower costs and greater access to proton therapy

by John R. Fischer, Senior Reporter | October 03, 2022
Rad Oncology Proton Therapy
From the October 2022 issue of HealthCare Business News magazine

The technology is rapidly emerging with gantries and accelerators being designed in smaller sizes. Rotating chair systems with fixed beams may contribute to further cost savings.

These changes in size decrease infrastructure needs and in turn, expenses, says Dr. Steven Frank, executive director of the Particle Therapy Institute at the University of Texas MD Anderson Cancer Center. “We’re seeing the ability for more access to protons by lowering the cost of the development and the building size. It makes it more accessible not just to academic centers but hospitals in the community.”

Frank also says that as the technology becomes more sophisticated, it closes gaps associated with photon-based radiotherapy, optimizing outcomes and workflows. Advancements include faster and conformal beam delivery; motion management; intensity modulated proton therapy; ARC therapy; real-time tumor tracking; adaptive proton therapy with in-room CT on rails; surface imaging with alignment; and shrinking the spot sizes of beams.

Advanced proton planning techniques using LET optimization, which reduces dose to critical organs, and variable radiation biologic effectiveness (RBE) are being further developed to personalize individual proton treatments.

Matthew Palmer, president and COO of Legion Healthcare Partners, a company in Houston, Texas, that helps providers develop and operate proton therapy centers, says more advanced software developments have improved treatment planning for proton therapy. One example is the incorporation of dual-energy CT scans, which mimic proton characteristics better to allow doctors to reduce the treated volume around the tumor.

"The properties of the dual energy CT scan reduce the total volume that needs to be treated during the treatment planning process. This allows the physician to further reduce the radiation to nearby critical structures and healthy tissue, " he said.

Advanced particle therapies of the future
Progress is also being made with more advanced therapies, especially FLASH, which delivers full proton doses in a fraction of a second, reducing associated side effects even further. Cincinnati Children's/UC Health Proton Therapy Center in Ohio completed enrollment for the first clinical trial involving humans in October 2021. It included 10 patients with bone metastases in their arms and legs, and concluded in April 2022, with follow-up studies now underway to examine potential side effects and outcomes of the treatment.

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