What is Proton Therapy?
Proton therapy, also called proton beam therapy, is a type of radiation therapy. Instead of using x-rays, this type of treatment uses proton to treat various types of cancer. Similarly to x-ray radiation, proton therapy is one form of external-beam radiation therapy whereby radiation is delivered painlessly and non-invasively through the skin using a machine from outside of the body.
Like x-ray radiation, proton therapy is a type of external-beam radiation therapy. It painlessly delivers radiation through the skin from a machine outside the body. It works by:
- Applying genetic modifications to make them less visible to the immune system
- Using molecules which act to deactivate immune cells
- Making the surrounding environment hostile to immune cells
- Affecting non-cancerous cells in the vicinity to change how immune cells respond
What is the History of Proton Therapy?
Proton therapy is an albeit relatively new form of radiation treatment although the concept was first talked about back in the 1940s by physicist Robert Wilson where he put forward the notion of using this type of beam medically. While it was initially explored in the 1940s, it wasn’t until the 1950s that scientists began to consider the full potential of using protons as a treatment method in humans.
Initially, proton beam therapy was used in the 1950s, first using pituitary irradiation to control metastatic breast cancer. Over the years, more cyclotrons were then developed to establish various proton therapy programmes across the United States and across the world. Through ongoing research and development of the treatment and the technologies needed for successful treatment, proton therapy has developed itself as being a leader in the field of cancer treatment and it’s predicted that by 2030, between 300,000 to 600,000 will have received this type of treatment.
More countries are opening up clinics too due to its success. Back in 2017, the United Kingdom opened up three proton treatment centres in Cardiff, London and Northumberland as a result of successful treatment of brain cancer in a child who underwent the treatment in the Czech Republic.
How Does Proton Therapy Work?
A proton is a positively charged particle. When used at high energy, the protons can kill cancer cells. Using radiation beams, the proton’s energy is directed into the areas of the body where cancer cells require treatment. When the proton hits the target cells, the energy is released.
What Are the Benefits of Proton Therapy?
Proton therapy has a wide range of benefits and has been shown to have a number of additional advantages when compared with traditional radiation treatment. One of the main advantages is that proton therapy can accurately and precisely target cancer cells and minimise damage to nearby, otherwise healthy cells.
Other benefits include:
- Minimises overall toxicity
- Lowers amount of radiation to nearby healthy tissue
- Can be used to treat recurrent cancers
- Can enhance quality of life during and after treatment
- Minimal treatment time
- Proton therapy alone can produce less side effects than traditional cancer treatments
Drawbacks of Proton Therapy
- Not suitable for every type of cancer
- Still a relatively new type of cancer treatment and research is still ongoing into the late effects of this type of therapy
- Can be costly to receive if not available through insurance providers or healthcare systems
- Only a select number of clinics offer this type of treatment
No cancer treatment is without risk and proton beam therapy may not be suitable for every patient. Your care team should discuss with you the advantages and disadvantages of treatments you are considering to ensure you make an informed decision about your plan.
When is Proton Therapy Commonly Used?
Although it is a relatively new treatment modality, proton therapy is increasingly being used to treat a wide range of cancer types due to its accuracy and effectiveness. Whereby the risks presented are too great, proton therapy may be used as an alternative to more traditional radiation treatments. It’s also often used to treat cancer cells in children as it minimises damage to healthy tissue that may be developing and growing.
Doctors may use proton therapy alone or alternatively, they may use it in conjunction with other treatment methods such as x-ray radiation therapy, surgery, chemotherapy, and/or immunotherapy.
Types of cancer that proton therapy is more commonly used to treat include:
- Brain cancer
- Breast Cancer
- Head and Neck Cancers
- Liver Cancer
- Lung Cancer
- Pediatric Cancers
- Prostate Cancer
- Tumours located in the spine
- Tumours located in the base of the skull
Proton therapy may not be suitable for every patient and may not be advised in conjunction with other treatment types. In fact, Cancer Research UK estimate that only one in 100 people may be suitable for this type of treatment. If you are considering proton therapy as a treatment choice, make sure to consult with your physician team about your options to consider the implications.
Alternatively, you may want to consider getting a second opinion whereby you can get more information and think about your options further.
What to Expect When Receiving Proton Therapy?
You will usually receive proton therapy in an outpatient setting. This means you won’t usually need to stay overnight in hospital.
During the treatment planning stages, your doctor will talk to you about the number of sessions you may require. This may vary depending on the type and stage of the cancer. Your doctor may deliver more sessions with less radiation or fewer sessions with higher levels of radiation doses which is otherwise known as stereotactic body radiotherapy.
Preparing for Proton Therapy
Receiving proton therapy requires careful planning to ensure the right dose of proton beam radiation is delivered to the right areas of the body. Prior to treatment, you will be asked to have a MRI or CT scan. This will be done in the same position you will have your treatment. Depending on where your tumor is may require you to wear a device which will stabilise and keep your body in position to minimise movement. This device may have to be worn during the radiation planning scan too.
After you have had your CT or MRI scan, the next stage is to have a radiation planning scan. This scan involves your doctor working out exactly where the radiation should be given. This is an essential step to ensure the proton beams are targeted in the right areas. Your physician will mark the areas of your body where the tumors are while also identify where the healthy tissue is to ensure radiation is avoided in these areas.
It’s perfectly normal during these two stages to feel anxious and out of control, especially as you will be restricted in movement which may also feel slightly uncomfortable. For this reason, it’s important to talk to your doctor if you do feel like this as they can support you throughout the whole process and medication may be able to be administered to help you relax.
What Happens During the Treatment?
On the day of your treatment, you will go into hospital and be placed in a special treatment room and depending on where the cancer is, you will either be laid flat on a couch or in a chair. It’s important that you are in the correct position to ensure the radiation is delivered in the right areas to match with the areas identified in the planning stages. Prior to any treatment sessions, CT scans or x-rays will be taken to ensure you are in the same position for every session.
Once the patient is in the correct position, the radiologist will leave the room in order to administer the radiation beams through the delivery controls which will be outside the room. This part of the treatment can be daunting as you will be on your own in the room however your treatment team will be able to see and hear you using video equipment.
The radiation beams may be delivered through a special machine called a gantry that works by rotating around the body. This may be used to target the tumor from a certain angle for more precise targeting. The gantry features a nozzle where the beams come out of the machine.
No matter what type of equipment is used, the radiation beams will be delivered through a nozzle with the protons travelling through the machine, directing them to the tumour area.
The whole treatment process is usually over relatively quickly in between 15-30 minutes however it may vary due to factors such as where the radiation is being given and how much is being given.
What Happens After the Therapy
As the treatment is performed as an outpatient, you will able to leave hospital and return to normal daily activities thereafter. However, as you may be feeling fatigued, you may want to limit what you do for a few days after the treatment.
Potential Side Effects from Proton Therapy
Compared with traditional radiation therapies, proton therapy has been recognised for having less side effects although some side effects may still present themselves. You will not feel the treatment itself however you may experience some side effects such as fatigue and changes to the skin where the radiation was delivered such as redness, soreness and blistering. Hair loss may also occur in the areas where the proton beams were directed which can be the case if treating head and neck cancers and brain cancers.
Signs the Treatment is Working
Ongoing tests such as MRI and CT scans will usually be performed to see the effect the proton therapy is having on the tumors. More treatment may need to be given depending on how it is working. Your care team should be on hand after the treatment to answer any questions you have about how the treatment is going.
Cost of Proton Therapy Treatment
As proton therapy is a more modern treatment alternative, it may not always be available through your insurance provider or country’s healthcare system. For example, proton beam therapy is only available through the NHS in the United Kingdom in certain cases such as specific types of cancer. For this reason, you may incur costs if you choose to have it done privately or you may choose to travel abroad for treatment. This may lead to other costs such as travel costs. If proton therapy is an option you are considering, it is best to speak to your healthcare team about the costs involved.
Nutrition Advice When Receiving This Form of Treatment
As with all cancer treatments, following a healthy diet is important in helping you recover both before and after treatment. Depending on the type of cancer you have, your care team may suggest a specific nutrition plan to follow that makes recommendations for food you should be consuming and what to avoid. It’s important to talk through any specifics with your care team.
General advice for cancer patients around nutrition may include:
- Limiting alcohol
- Limiting consumption of greasy or fatty food
- Consumption of healthy fats such as olive oil or avocados
- Increase intake of fruit and vegetables
- Ensure you are drinking enough water to hydrate your body.
Alternatives to Proton Therapy
There are a wide range of cancer therapies available, the most effective options for you will take into account a number of key factors in your specific situation. These should be discussed at length with your care team. Ensure you have all the information you need to make the right decision for you.
OncoloMed offer a broad range of novel cancer treatments that you may not have considered through our network of clinics and specialists. Find out about the treatments we can facilitate and how we can help you make the best decision for you.
Expert Opinions and Research on Proton Therapy
Increasing numbers of studies and research has been conducted around proton therapy, looking into the effectiveness of it. As the treatment is relatively in its infancy, research is ongoing in the field of proton therapy aiming to look at the effectiveness and side effects in the long-term and, to ensure patients always have access and information on the latest developments in the field.
Many studies report the effectiveness of the treatment, particularly in paediatric cancer cases with researchers reporting that the treatment does not produce common toxic effects in comparison to traditional radiotherapy.
Other recent studies such as this one by Yuan et al., find that proton therapy offers superior advantages due to the depth-dose characteristics of proton itself, which in turn, can result in a dramatic reduction in normal tissue doses and minimising risk to neighbouring organs.
In the United Kingdom, the first clinical trial that is looking into whether proton beam therapy reduces long-term side effects and improves quality of life in patients treated with radiotherapy for throat cancer is currently being conducted in The Christie NHS Foundation Trust in Manchester.
Explore Your Treatment Options
Proton therapy is a potentially effective option for a number of cancers, however the most effective treatment for you will take into consideration a range of factors based on your individual situation.
See how we can compassionately guide you in your cancer treatment journey by exploring our range of services.
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