Proton therapy
The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. (March 2018) |
Proton therapy | |
---|---|
Other names | Proton beam therapy |
ICD-10-PCS | Z92.3 |
In medicine, proton therapy, or proton radiotherapy, is a type of particle therapy that uses a beam of protons to irradiate diseased tissue, most often to treat cancer. The chief advantage of proton therapy over other types of external beam radiotherapy is that the dose of protons is deposited over a narrow range of depth; hence in minimal entry, exit, or scattered radiation dose to healthy nearby tissues.
When evaluating whether to treat a tumor with photon or proton therapy, physicians may choose proton therapy if it is important to deliver a higher radiation dose to targeted tissues while significantly decreasing radiation to nearby organs at risk.[1] The American Society for Radiation Oncology Model Policy for Proton Beam therapy says proton therapy is considered reasonable if sparing the surrounding normal tissue "cannot be adequately achieved with photon-based radiotherapy" and can benefit the patient.[2] Like photon radiation therapy, proton therapy is often used in conjunction with surgery and/or chemotherapy to most effectively treat cancer.
Description
Proton therapy is a type of external beam radiotherapy that uses
Proton therapy lets physicians deliver a highly conformal beam, i.e. delivering radiation that conforms to the shape and depth of the tumor and sparing much of the surrounding, normal tissue.
Protons can focus energy delivery to fit the tumor shape, delivering only low-dose radiation to surrounding tissue. As a result, the patient has fewer side effects. All protons of a given energy have a certain penetration range; very few protons penetrate beyond that distance.[9] Also, the dose delivered to tissue is maximized only over the last few millimeters of the particle's range; this maximum is called the spread out Bragg peak, often called the SOBP (see visual).[10]
To treat tumors at greater depth, one needs a beam with higher energy, typically given in MeV (mega
In most treatments, protons of different energies with Bragg peaks at different depths are applied to treat the entire tumor. These Bragg peaks are shown as thin blue lines in the figure in this section. It is important to understand that, while tissues behind (or deeper than) the tumor get almost no radiation, the tissues in front of (shallower than) the tumor get radiation dosage based on the SOBP.
Equipment
Most installed proton therapy systems use isochronous
FLASH therapy
FLASH radiotherapy is a technique under development for photon and proton treatments, using very high dose rates (necessitating large beam currents). If applied clinically, it could shorten treatment time to just one to three 1-second sessions, and further reducing side effects.[16][17][18][19]
History
The first suggestion that energetic protons could be an effective treatment was made by
The world's first hospital-based proton therapy center was a low energy cyclotron centre for eye tumors at Clatterbridge Centre for Oncology in the UK, opened in 1989,[24] followed in 1990 at the Loma Linda University Medical Center (LLUMC) in Loma Linda, California. Later, the Northeast Proton Therapy Center at Massachusetts General Hospital was brought online, and the HCL treatment program was transferred to it in 2001 and 2002. At the beginning of 2023, there were 41 proton therapy centers in the United States,[25] and a total of 89 worldwide.[26] As of 2020, six manufacturers make proton therapy systems: Hitachi, Ion Beam Applications, Mevion Medical Systems, ProNova Solutions, ProTom International and Varian Medical Systems.
Types
The newest form of proton therapy, pencil beam scanning, gives therapy by sweeping a proton beam laterally over the target so that it gives the required dose while closely conforming to shape of the targeted tumor. Before the use of pencil beam scanning, oncologists used a scattering method to direct a wide beam toward the tumor. [27]
Passive scattering beam delivery
The first commercially available proton delivery systems used a scattering process, or passive scattering, to deliver the therapy. With scattering proton therapy the proton beam is spread out by scattering devices, and the beam is then shaped by putting items such as collimators and compensators in the path of the protons. The collimators were custom made for the patient with milling machines.[28] Passive scattering gives homogeneous dose along the target volume. Therefore, passive scattering gives more limited control over dose distributions proximal to target. Over time many scattering therapy systems have been upgraded to deliver pencil beam scanning. Because scattering therapy was the first type of proton therapy available, most clinical data available on proton therapy—especially long-term data as of 2020—were acquired via scattering technology.
Pencil beam scanning beam delivery
A newer and more flexible delivery method is pencil beam scanning, using a beam that sweeps laterally over the target so that it delivers the needed dose while closely conforming to the tumor's shape. This conformal delivery is achieved by shaping the dose through magnetic scanning of thin beamlets of protons without needing apertures and compensators. Multiple beams are delivered from different directions, and magnets in the treatment nozzle steer the proton beam to conform to the target volume layer as the dose is painted layer by layer. This type of scanning delivery provides greater flexibility and control, letting the proton dose conform more precisely to the shape of the tumor.[28]
Delivery of protons via pencil beam scanning, in use since 1996 at the
Application
It was estimated that by the end of 2019, a total of ~200,000 patients had been treated with proton therapy. Physicians use protons to treat conditions in two broad categories:
- Disease sites that respond well to higher doses of radiation, i.e., dose escalation. Dose escalation has sometimes shown a higher probability of "cure" (i.e. local control) than conventional radiotherapy.[31] These include, among others, uveal melanoma (ocular tumor), skull base and paraspinal tumor (chondrosarcoma and chordoma), and unresectable sarcoma. In all these cases proton therapy gives significant improvement in the probability of local control, over conventional radiotherapy.[32][33][34] For eye tumors, proton therapy also has high rates of maintaining the natural eye.[35]
- Treatment where proton therapy's increased precision reduces unwanted side effects by lessening the dose to normal tissue. In these cases, the tumor dose is the same as in conventional therapy, so there is no expectation of increased probability of curing the disease. Instead, emphasis is on reducing the dose to normal tissue, thus reducing unwanted effects.[31]
Two prominent examples are pediatric
Pediatric
Irreversible long-term side effects of conventional radiation therapy for pediatric cancers are well documented and include growth disorders, neurocognitive toxicity, ototoxicity with subsequent effects on learning and language development, and renal, endocrine and gonadal dysfunctions. Radiation-induced secondary malignancy is another very serious adverse effect that has been reported. As there is minimal exit dose when using proton radiation therapy, dose to surrounding normal tissues can be significantly limited, reducing the acute toxicity which positively impacts the risk for these long-term side effects. Cancers requiring craniospinal irradiation, for example, benefit from the absence of exit dose with proton therapy: dose to the heart, mediastinum, bowel, bladder and other tissues anterior to the vertebrae is eliminated, hence a reduction of acute thoracic, gastrointestinal and bladder side effects.[36][37][38]
Eye tumor
Proton therapy for eye tumors is a special case since this treatment requires only relatively low energy protons (~70 MeV). Owing to this low energy, some particle therapy centers only treat eye tumors.[22] Proton, or more generally, hadron therapy of tissue close to the eye affords sophisticated methods to assess the alignment of the eye that can vary significantly from other patient position verification approaches in image guided particle therapy.[39] Position verification and correction must ensure that the radiation spares sensitive tissue like the optic nerve to preserve the patient's vision.
For ocular tumors, selecting the type of radiotherapy depends on tumor location and extent, tumor radioresistance (calculating the dose needed to eliminate the tumor), and the therapy's potential toxic side effects on nearby critical structures.[40] For example, proton therapy is an option for retinoblastoma [41] and intraocular melanoma.[42] The advantage of a proton beam is that it has the potential to effectively treat the tumor while sparing sensitive structures of the eye.[43] Given its effectiveness, proton therapy has been described as the "gold standard" treatment for ocular melanoma.[44][45] The implementation of momentum cooling technique in proton therapy for eye treatment can significantly enhance its effectiveness.[46] This technique aids in reducing the radiation dose administered to healthy organs while ensuring that the treatment is completed within a few seconds. Consequently, patients experience improved comfort during the procedure.
Base of skull cancer
When receiving radiation for skull base tumors, side effects of the radiation can include pituitary hormone dysfunction and visual field deficit—after radiation for pituitary tumors—as well as cranial neuropathy (nerve damage), radiation-induced osteosarcoma (bone cancer), and osteoradionecrosis, which occurs when radiation causes part of the bone in the jaw or skull base to die.[47] Proton therapy has been very effective for people with base of skull tumors.[48] Unlike conventional photon radiation, protons do not penetrate beyond the tumor. Proton therapy lowers the risk of treatment-related side effects from when healthy tissue gets radiation. Clinical studies have found proton therapy to be effective for skull base tumors.[49][50][51]
Head and neck tumor
Proton particles do not deposit exit dose, so proton therapy can spare normal tissues far from the tumor. This is particularly useful for head and neck tumors because of the anatomic constraints found in nearly all cancers in this region. The dosimetric advantage unique to proton therapy translates into toxicity reduction. For recurrent head and neck cancer requiring reirradiation, proton therapy is able to maximize a focused dose of radiation to the tumor while minimizing dose to surrounding tissues, hence a minimal acute toxicity profile, even in patients who got multiple prior courses of radiotherapy.[52]
Left-side breast cancer
When breast cancer — especially in the left breast — is treated with conventional radiation, the lung and heart, which are near the left breast, are particularly susceptible to photon radiation damage. Such damage can eventually cause lung problems (e.g. lung cancer) or various heart problems. Depending on location of the tumor, damage can also occur to the esophagus, or to the chest wall (which can potentially lead to leukemia).[53] One recent study showed that proton therapy has low toxicity to nearby healthy tissues and similar rates of disease control compared with conventional radiation.[54] Other researchers found that proton pencil beam scanning techniques can reduce both the mean heart dose and the internal mammary node dose to essentially zero.[55]
Small studies have found that, compared to conventional photon radiation, proton therapy delivers minimal toxic dose to healthy tissues[56] and specifically decreased dose to the heart and lung.[57] Large-scale trials are underway to examine other potential benefits of proton therapy to treat breast cancer.[58]
Lymphoma
Though chemotherapy is the main treatment for lymphoma, consolidative radiation is often used in Hodgkin lymphoma and aggressive non-Hodgkin lymphoma, while definitive treatment with radiation alone is used in a small fraction of lymphoma patients. Unfortunately, treatment-related toxicities caused by chemotherapy agents and radiation exposure to healthy tissues are major concerns for lymphoma survivors. Advanced radiation therapy technologies such as proton therapy may offer significant and clinically relevant advantages such as sparing important organs at risk and decreasing the risk for late normal tissue damage while still achieving the primary goal of disease control. This is especially important for lymphoma patients who are being treated with curative intent and have long life expectancy following therapy.[59]
Prostate cancer
In
The number of cases of prostate cancer diagnosed each year far exceeds those of the other diseases referred to above, and this has led some, but not all, facilities to devote most of their treatment slots to prostate treatments. For example, two hospital facilities devote ~65%[65] and 50%[66] of their proton treatment capacity to prostate cancer, while a third devotes only 7.1%.[67]
Worldwide numbers are hard to compile, but one example says that in 2003 ~26% of proton therapy treatments worldwide were for prostate cancer.[68]
Gastrointestinal malignancy
A growing amount of data shows that proton therapy has great potential to increase therapeutic tolerance for patients with GI malignancy. The possibility of decreasing radiation dose to organs at risk may also help facilitate chemotherapy dose escalation or allow new chemotherapy combinations. Proton therapy will play a decisive role for ongoing intensified combined modality treatments for GI cancers. The following review presents the benefits of proton therapy in treating hepatocellular carcinoma, pancreatic cancer and esophageal cancer.[69]
Hepatocellular carcinoma
Post-treatment liver decompensation, and subsequent liver failure, is a risk with radiotherapy for hepatocellular carcinoma, the most common type of primary liver cancer. Research shows that proton therapy gives favorable results related to local tumor control, progression-free survival, and overall survival.[70][71][72][73] Other studies, which examine proton therapy compared with conventional photon therapy, show that proton therapy gives improved survival and/or fewer side effects; hence proton therapy could significantly improve clinical outcomes for some patients with liver cancer.[74][75]
Reirradiation for recurrent cancer
For patients who get local or regional recurrences after their initial radiation therapy, physicians are limited in their treatment options due to their reluctance to give additional photon radiation therapy to tissues that have already been irradiated. Re-irradiation is a potentially curative treatment option for patients with locally recurrent head and neck cancer. In particular, pencil beam scanning may be ideally suited for reirradiation.[76] Research shows the feasibility of using proton therapy with acceptable side effects, even in patients who have had multiple prior courses of photon radiation.[77][78][79]
Comparison with other treatments
A large study on comparative effectiveness of proton therapy was published by teams of the
The issue of when, whether, and how best to apply this technology is still under discussion by physicians and researchers. One recently introduced method, 'model-based selection', uses comparative treatment plans for IMRT and IMPT in combination with normal tissue complication probability (NTCP) models to identify patients who may benefit most from proton therapy.[84][85]
Clinical trials are underway to examine the comparative efficacy of proton therapy (vs photon radiation) for the following:
- Pediatric cancers—by St. Jude Children's Research Hospital,[86] Samsung Medical Center [87]
- Base of skull cancer—by Heidelberg University [88]
- Head and neck cancer—by MD Anderson,[89] Memorial Sloan Kettering and other centers[90]
- Brain and spinal cord cancer—by Massachusetts General Hospital,[91] Uppsala University and other centers,[92] NRG Oncology[93][94]
- Hepatocellular carcinoma (liver)—by NRG Oncology,[95] Chang Gung Memorial Hospital,[96] Loma Linda University [97]
- Lung cancer—by Radiation Therapy Oncology Group (RTOG),[98] Proton Collaborative Group (PCG),[99] Mayo Clinic[100]
- Esophageal cancer—by NRG Oncology,[101] Abramson Cancer Center, University of Pennsylvania[102]
- Breast cancer—by University of Pennsylvania,[103] Proton Collaborative Group (PCG)[104]
- Pancreatic cancer—by University of Maryland,[105] Proton Collaborative Group (PCG)[106]
X-ray radiotherapy
The figure at the right of the page shows how beams of X-rays (
Megavoltage X-ray therapy has less "skin sparing potential" than proton therapy: X-ray radiation at the skin, and at very small depths, is lower than for proton therapy. One study estimates that passively scattered proton fields have a slightly higher entrance dose at the skin (~75%) compared to therapeutic megavoltage (MeV) photon beams (~60%).[3] X-ray radiation dose falls off gradually, needlessly harming tissue deeper in the body and damaging the skin and surface tissue opposite the beam entrance. The differences between the two methods depends on:
- Width of the SOBP
- Depth of the tumor
- Number of beams that treat the tumor
The X-ray advantage of less harm to skin at the entrance is partially counteracted by harm to skin at exit point.
Since X-ray treatments are usually done with multiple exposures from opposite sides, each section of skin is exposed to both entering and exiting X-rays. In proton therapy, skin exposure at the entrance point is higher, but tissues on the opposite side of the body to the tumor get no radiation. Thus, X-ray therapy causes slightly less damage to skin and surface tissues, and proton therapy causes less damage to deeper tissues in front of and beyond the target.[5]
An important consideration in comparing these treatments is whether the equipment delivers protons via the scattering method (historically, the most common) or a spot scanning method. Spot scanning can adjust the width of the SOBP on a spot-by-spot basis, which reduces the volume of normal (healthy) tissue inside the high dose region. Also, spot scanning allows for intensity modulated proton therapy (IMPT), which determines individual spot intensities using an optimization algorithm that lets the user balance the competing goals of irradiating tumors while sparing normal tissue. Spot scanning availability depends on the machine and the institution. Spot scanning is more commonly known as pencil-beam scanning and is available on IBA, Hitachi, Mevion (known as HYPERSCAN[107] which became US FDA approved in 2017) and Varian.
Surgery
Physicians base the decision to use surgery or proton therapy (or any radiation therapy) on tumor type, stage, and location. Sometimes surgery is superior (such as cutaneous melanoma), sometimes radiation is superior (such as skull base chondrosarcoma), and sometimes are comparable (for example, prostate cancer). Sometimes, they are used together (e.g., rectal cancer or early stage breast cancer).
The benefit of external beam proton radiation is in the
Side effects and risks
Proton therapy is a type of external beam radiotherapy, and shares risks and
Costs
Historically, proton therapy has been expensive. An analysis published in 2003 found that the cost of proton therapy is ~2.4 times that of X-ray therapies.[110] Newer, less expensive, and dozens more proton treatment centers are driving costs down and they offer more accurate three-dimensional targeting. Higher proton dosage over fewer treatments sessions (1/3 fewer or less) is also driving costs down.[111][112] Thus the cost is expected to reduce as better proton technology becomes more widely available. An analysis published in 2005 determined that the cost of proton therapy is not unrealistic and should not be the reason for denying patients access to the technology.[113] In some clinical situations, proton beam therapy is clearly superior to the alternatives.[114][115]
A study in 2007 expressed concerns about the effectiveness of proton therapy for prostate cancer,
As of 2018, the cost of a single-room particle therapy system is US$40 million, with multi-room systems costing up to US$200 million.[121][122]
Treatment centers
As of August 2020, there are over 89 particle therapy facilities worldwide,[123] with at least 41 others under construction.[124] As of August 2020, there are 34 operational proton therapy centers in the United States. As of the end of 2015 more than 154,203 patients had been treated worldwide.[125]
One hindrance to universal use of the proton in cancer treatment is the size and cost of the cyclotron or
United States
Proton treatment centers in the United States as of 2024[update] (in chronological order of first treatment date) include:[24][127]
Institution | Location | Year of first treatment | Comments |
---|---|---|---|
Loma Linda University Medical Center[128] | Loma Linda, CA | 1990 | First hospital-based facility in USA; uses Spread Out Bragg's Peak (SOBP) |
Crocker Nuclear Laboratory[129] | Davis, CA | 1994 | Ocular treatments only (low energy accelerator); at University of California, Davis |
Francis H. Burr Proton Center | Boston, MA | 2001 | At Massachusetts General Hospital and formerly known as NPTC; continuation of Harvard Cyclotron Laboratory/MGH treatment program that began in 1961; Manufactured by Ion Beam Applications[130] |
University of Florida Health Proton Therapy Institute-Jacksonville[131] | Jacksonville, FL | 2006 | The UF Health Proton Therapy Institute is a part of a non-profit academic medical research facility affiliated with the University of Florida College of Medicine-Jacksonville. It is the first treatment center in the Southeast U.S. to offer proton therapy. Manufactured by Ion Beam Applications[130] |
University of Texas MD Anderson Cancer Center[132] | Houston, TX | ||
Oklahoma Proton Center[133] | Oklahoma City, OK | 2009 | 4 treatment rooms, Proteus PLUS system manufactured by Ion Beam Applications[130] |
Northwestern Medicine Chicago Proton Center | Warrenville, IL | 2010 | 4 treatment rooms, Proteus PLUS system manufactured by Ion Beam Applications[130] |
Roberts Proton Therapy Center[134] | Philadelphia, PA | The largest proton therapy center in the world, the Roberts Proton Therapy Center, which is a part of Penn's Abramson Cancer Center, University of Pennsylvania Health System; 5 treatment rooms, Proteus PLUS system manufactured by Ion Beam Applications[130] | |
Hampton University Proton Therapy Institute | Hampton, VA | 5 treatment rooms, Proteus PLUS system manufactured by Ion Beam Applications[130] | |
ProCure Proton Therapy Center[135] | Somerset, NJ | 2012 | 4 treatment rooms, Proteus PLUS system manufactured by Ion Beam Applications[130] |
SCCA Proton Therapy Center | Seattle, WA | 2013 | At Fred Hutchinson Cancer Research Center; 4 treatment rooms, Proteus PLUS system manufactured by Ion Beam Applications[130]
|
Siteman Cancer Center[111]
|
St. Louis, MO | First of the new single suite, ultra-compact, superconducting synchrocyclotron,[136] lower cost facilities to treat a patient using the Mevion Medical System's S250.[137] | |
Provision Proton Therapy Center[138] | Knoxville, TN | 2014 | 3 treatment rooms, Proteus PLUS system manufactured by Ion Beam Applications[130] |
California Protons Cancer Therapy Center[139] | San Diego, CA | 5 treatment rooms, manufactured by Varian Medical Systems[140] | |
Ackerman Cancer Center | Jacksonville, FL | 2015 | Ackerman Cancer Center is the world's first private, physician-owned practice to provide proton therapy, in addition to conventional radiation therapy and on-site diagnostic services. |
The Laurie Proton Therapy Center
|
New Brunswick, NJ | The Laurie Proton Therapy Center, part of Robert Wood Johnson University Hospital, is home to the world's third MEVION S250 Proton Therapy System. | |
Texas Center for Proton Therapy | Dallas Fort Worth, TX | A collaboration by "Texas Oncology and The US Oncology Network, supported by McKesson Specialty Health, and Baylor Health Enterprises"; three pencil beam rooms and cone beam CT imaging.[141] 3 treatment rooms, Proteus PLUS system manufactured by Ion Beam Applications[130] | |
Mayo Clinic Jacobson Building | Rochester, MN | 4 treatment rooms.[142] Manufactured by Hitachi.[143] | |
St. Jude Red Frog Events Proton Therapy Center | Memphis, TN | 3 treatment rooms | |
Mayo Clinic Cancer Center | Phoenix, AZ | 2016 | 4 treatment rooms.[144] Manufactured by Hitachi.[145] |
The Marjorie and Leonard Williams Center for Proton Therapy | Orlando, FL | http://www.ufhealthcancerorlando.com/centers/proton-therapy-center | |
Cancer and Blood Diseases Institute | Liberty Township, OH | Collaboration of University of Cincinnati Cancer Institute and Cincinnati Children's Hospital Medical Center,[146][147] manufactured by Varian Medical Systems | |
Maryland Proton Treatment Center | Baltimore, MD | 5 treatment rooms, affiliated with the University of Maryland Greenebaum Comprehensive Cancer Center, manufactured by Varian Medical Systems. | |
Proton Therapy Center at University Hospitals Seidman Cancer Center
|
Cleveland, OH | Only proton therapy center in Northern Ohio. One treatment room with the Mevion S250 Proton Therapy System. Part of the NCI-designated Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center is one of the nation's leading freestanding cancer hospitals.
| |
Miami Cancer Institute | Miami, FL | 2017 | 3 treatment rooms, all using pencil-beam scanning[148] Manufactured by Ion Beam Applications[130] |
Beaumont Proton Therapy Center | Royal Oak, MI | Single treatment room, Proteus ONE system manufactured by Ion Beam Applications[130] | |
Emory Proton Therapy Center Archived 2018-03-07 at the Wayback Machine | Atlanta, GA | 2018 | Five treatment rooms, ProBeam Superconducting Cyclotron[149] manufactured by Varian Medical Systems |
Provision CARES Proton Therapy Center | Nashville, TN | Three treatment rooms, Two Gantries and One Fixed Beam, All Pencil Beam Scanning, manufactured by ProNova Solutions, LLC | |
McLaren Proton Therapy Center | Flint, MI | The McLaren Proton Therapy System uses the industry's highest energy 330 MeV proton synchrotron to accelerate and deliver proton beam to two treatment rooms, with an opportunity to extend into a planned third room. Both operating treatment rooms are equipped with proton pencil beam scanning, cone beam computed tomography for image guidance, patient positioning system with 6-degrees of freedom that coupled with 180-degree partial gantry allows for complete flexibility of treatment angles. | |
New York Proton Center | New York, NY | 2019 | A partnership between Memorial Sloan Kettering, Montefiore Health, and Mount Sinai Health System. 4 treatment rooms, manufactured by Varian Medical Systems
|
Johns Hopkins Proton Therapy Center | Washington, DC | 3 treatment rooms and 1 research gantry. Manufactured by Hitachi. | |
South Florida Proton Therapy Institute | Delray Beach, FL | One treatment room, manufactured by Varian Medical Systems | |
UAB Proton Therapy Center | Birmingham, AL | 2020 | One treatment room, manufactured by Varian Medical Systems |
Dwoskin PTC - University of Miami | Miami, FL | One treatment room, manufactured by Varian Medical Systems | |
The Inova Mather Proton Therapy Center | Fairfax, VA | Two treatment rooms, manufactured by Ion Beam Applications | |
The University of Kansas Cancer Center | Kansas City, KS | 2022 | Announced Feb 2019[150] |
Penn Medicine Lancaster General Health Ann B. Barshinger Cancer Institute | Lancaster, PA | One treatment room, manufactured by Varian Medical Systems | |
Penn Medicine Virtua Health | Voorhees, NJ | One treatment room, manufactured by Varian Medical Systems | |
Ohio State, Nationwide Children's Hospital | Columbus, OH | 2023 | Three treatment rooms, manufactured by Varian Medical Systems |
Kansas City Proton Institute | Overland Park, KS | 2023 | One treatment room, multidisciplinary practice providing proton therapy, conventional radiation therapy and diagnostic services. |
OSF Healthcare
|
Peoria, IL | 2024 | One treatment room, manufactured by Varian Medical Systems |
Froedtert Hospital | Wauwatosa, WI | 2024 (Estimated) | Announced May 2022[151] |
Mayo Clinic Florida | Jacksonville, FL | 2025 (Estimated) | Announced June 2019[152] |
The Indiana University Health Proton Therapy Center in Bloomington, Indiana opened in 2004 and ceased operations in 2014.
Outside the US
Institution | Maximum energy (MeV) | Year of first treatment | Location |
---|---|---|---|
Paul Scherrer Institute | 250 | 1984 | Villigen, Switzerland |
Clatterbridge Cancer Centre NHS Foundation Trust, low-energy for ocular[153] | 62 | 1989 | Liverpool, United Kingdom |
Centre de protonthérapie de l'Institut Curie | 235 | 1991 | Orsay, France |
Centre Antoine Lacassagne | 63 | 1991 | Nice, France |
Research Center for Charged Particle Therapy | 350–400 | 1994 | Chiba , Japan
|
TRIUMF[154] | 74 | 1995 | Vancouver, Canada |
Helmholtz-Zentrum Berlin | 72 | 1998 | Berlin, Germany |
Proton Medical Research Center University of Tsukuba | 250 | 2001 | Tsukuba, Japan |
Centro di adroterapia oculare | 60 | 2002 | Catania, Italy |
Wanjie Proton Therapy Center | 230 | 2004 | Zibo, China |
Proton Therapy Center, Korea National Cancer Center | 230 | 2007 | Seoul, Korea |
Heidelberg Ion-Beam Therapy Center (HIT) | 230 | 2009 | Heidelberg, Germany |
Medipolis Proton Therapy and Research Center | 235 | 2011 | Kagoshima, Japan |
Instytut Fizyki Jądrowej | 230 | 2011 | Kraków, Poland |
Centro Nazionale di Adroterapia Oncologica | 250 | 2011 | Pavia, Italy |
Protonové centrum v Praze (PTC, Prague) | 230 | 2012 | Prague, Czech Republic |
Westdeutsches Protonentherapiezentrum Essen | 230 | 2013 | Essen, Germany |
PTC Uniklinikum Dresden | 230 | 2014 | Dresden, Germany |
Centro di Protonterapia, APSS Trento[155] | 230 | 2014 | Trento, Italy |
Shanghai Proton and Heavy Ion Center | 230 | 2014 | Shanghai, China |
Centrum Cyklotronowe Bronowice | 230 | 2015 | Kraków, Poland |
Samsung Medical Center Proton Therapy Center | 230 | 2015 | Seoul, Korea |
Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital | 230 | 2015 | Taipei, Taiwan |
Yung-Ching Proton Center, Kaohsiung Chang Gung Memorial Hospital[156] | 230 | 2018 | Kaohsiung, Taiwan |
Skandionkliniken[157] | 230 | 2015 | Uppsala, Sweden |
A. Tsyb Medical Radiological Research Centre | 250 | 2016 | Obninsk, Russia |
MedAustron | 250 | 2016 | Wiener Neustadt, Austria [1] |
Clinical Proton Therapy Center Dr. Berezin Medical Institute[158] | 250 | 2017 | Saint-Petersburg , Russia
|
Holland Proton Therapy Center[159] | 250 | 2018 | Delft, Netherlands |
UMC Groningen Protonen Therapie Centrum[160] | 230 | 2018 | Groningen, Netherlands |
The Christie[161] | 250 | 2018 | Manchester, United Kingdom |
Danish Centre for Particle Therapy[162] | 250 | 2019 | Aarhus, Denmark |
Apollo Proton Cancer Centre[163] | 230 | 2019 | Chennai, India |
MAASTRO Clinic Proton Therapy[164] | 230 | 2019 | Maastricht, Netherlands |
Clínica Universidad de Navarra | 230 | 2019 | Madrid, Spain |
Centro de Protonterapia de Quirónsalud[165] | 230 | 2019 | Madrid, Spain |
King Chulalongkorn Memorial Hospital [166] | 250 | 2021 | Bangkok, Thailand |
University College London Hospitals[167] | 250 | 2021 | London, United Kingdom |
Hefei Ion Medical Center[168] | 250 | 2022 | Hefei, China |
Proton Clinical Research Center of the Shandong Cancer Hospital | 250 | 2022 | Jinan, China |
Singapore Institute of Advanced Medicine Holdings - Proton Therapy SG[169] | 250 | 2023 | Singapore |
Mount Elizabeth Proton Therapy Centre[170] | 230 | 2023 | Singapore |
National Cancer Centre Singapore - Goh Cheng Liang Proton Therapy Centre[171]
|
2023 | Singapore | |
Central Japan International Medical Center [172] | 230 | 2024 | Minokamo , Japan
|
330 | 2023–2025 | Adelaide, Australia |
Australia
In July 2020, construction began for "SAHMRI 2", the second building for the
India
Apollo Proton Cancer Centre (APCC) in Chennai, Tamil Nadu, a unit under
Israel
In January 2020, it was announced that a proton therapy center would be built in Ichilov Hospital, at the Tel Aviv Sourasky Medical Center. The project's construction was fully funded by donations. It will have two treatment rooms.[178] According to a newspaper report in 2023, it should be ready in three to four years. The report also mentions that "Proton therapy for cancer treatment has arrived in Israel and the Middle East with a clinical trial underway that sees Hadassah Medical Center partnering with P-Cure, an Israeli company that has developed a unique system designed to fit into existing hospital settings".[179]
Spain
In October 2021, the Amancio Ortega Foundation arranged with the Spanish government and several autonomous communities to donate 280 million euros to install ten proton accelerators in the public health system.[180]
United Kingdom
In 2013 the British government announced that £250 million had been budgeted to establish two centers for advanced radiotherapy:
See also
- Particle therapy
- Charged particle therapy
- Hadron
- Microbeam
- Fast neutron therapy
- Boron neutron capture therapy
- Linear energy transfer
- Electromagnetic radiation and health
- Dosimetry
- Ionizing radiation
- List of oncology-related terms
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Further reading
- Greco C.; Wolden S. (Apr 2007). "Current status of radiotherapy with proton and light ion beams". Cancer. 109 (7): 1227–1238. S2CID 36256866.
- Koehler, A.M. (1971). "Use of Protons for Radiotherapy". Proceedings Of The Symposium On Pion And Proton Radiography, Fermi National Accelerator Laboratory, Batavia, IL. pp. 63–68.
- Koehler, A. M.; Preston, W. M. (1972). "Protons in Radiation Therapy". Radiology. 104 (1). Radiological Society of North America (RSNA): 191–195. PMID 4624458.
- Kjelberg, R.N. (1977). "Bragg Peak Proton Radiosurgery for Arteriovenous Malformation of the Brain". First International Seminar on the use of Proton Beams in Radiation Therapy, Moscow.
- Austin-Seymour, Mary; Munzenrider, John; et al. (1990). "Fractionated Proton Radiation Therapy of Cranial and Intracranial Tumors". American Journal of Clinical Oncology. 13 (4). Ovid Technologies (Wolters Kluwer Health): 327–330. S2CID 26465153.
- Hartford, Zietman, et al. (1999). "Proton Radiotherapy". In A. D'Amico, G.E. Hanks (eds.). Radiotherapeutic Management of Carcinoma of the Prostate. London, UK: Arnold Publishers. pp. 61–72.
External links
- The Intrepid Proton-Man, educational comic books by Steve Englehart and Michael Jaszewski for pediatric patients
- 2019 BBC Horizon documentary
- 2019 Jove video by the University of Maryland School of Medicine explaining the treatment process: Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
- 2019 The NHS Proton Beam Therapy Programme
- Proton Therapy Collaborative Group PTCOG
- Alliance for Proton Therapy Archived 2019-07-15 at the Wayback Machine
- CARES Cancer Network
- National Association for Proton Therapy
- American Society for Radiation Oncology Model Policy – Proton Beam Therapy
- Proton therapy – MedlinePlus Medical Encyclopedia
- Proton Therapy
- What is Proton Therapy