A prostate treatment plan, for example, might include two dozen layers and 1,800 to 2,000 spots delivered in about two minutes, controlled by the machinery software in a rapid fire to pre-set coordinates.
Advanced medical imaging provides the visualization to aim protons precisely at tumors. Modalities including 4-D CT, MRI, and PET/CT.
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The massive particle accelerator cyclotrons or synchrotrons needed to perform proton therapy are the reason for the cost-in excess of $150 million-of building a proton therapy center. However, another type of cyclotron can be employed instead, operating at higher magnetic field strengths so that the accelerators are smaller - about 20 tons compared to 200 tons. This more affordable approach by Still River Systems might transform the proton therapy landscape and market.
Still River Systems is working on the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis. Other sites under development include Robert Wood Johnson University Hospital, New Brunswick, N.J. and Oklahoma University.
"Our approach greatly lowers the price of entry and cost of proton therapy," said Lionel Bouchet, Director of Product Management, Still River Systems. "Our model fits very well in what we as a nation need to do, which is reduce expenses and the price of health care."
A "Radiation Vacation"
It's easy to see why cancers of the brain, neck or eye are the treated with proton therapy. Additional applications include lung, lymphoma, breast, and anywhere that conventional radiotherapy is employed.
Prostate cancer treatment is a major application for proton therapy. M.D. Anderson, Loma Linda University, and the University of Florida all treat heavy patient loads of about 60 to 110 patients per day with this condition.
"While radical prostatectomy may be recommended by urologists, patients want to avoid surgery and when they find out about protons, that is what they want," said Leonard Arzt, Executive Director, National Association for Proton Therapy. He noted that two of the nation's proton therapy centers are located in attractive tourist destinations, a point not lost on patients. "Patients say that if you are a golfer go to Loma Linda; if you like the beach, go to Jacksonville. They call it a 'radiation vacation.' They are outpatients, take their spouses and do whatever they want to do."
While patients make the best of their plight, several controversies are brewing related to proton therapy. An overall trend toward comparative effectiveness research may require additional investigations into the relative efficacy and cost.