University Hospitals' new proton beam treatment room looks like a typical patient room—simple, clean and modest in size.
But hidden behind a wall is a 20-ton cyclotron supported by two gantry arms that rotate the machine 180 degrees around the patient—one floor below and above that unassuming treatment room.
That machine, weighing about the same as 105 VW beetles and stretching more than two stories high, is the “compact” version of the technology, which can take up an entire city block in other models.
UH is the first health system in Ohio to offer proton therapy, a form of radiation treatment with unique properties that target a tumor while reducing the effects on surrounding healthy tissue. UH expects to see its first proton therapy patients in late July.
“It's the go-to radiation therapy for pediatrics, and then in adults, brain and spine are the most defined, but other tumors that are in difficult places where you don't want to harm surrounding tissue also has (possible applications),” said Dr. Daniel Simon, president of UH Case Medical Center.
With regular radiation treatment, a fair amount of the radiation invariably impacts healthy tissue. About 70% of the radiation dose goes to the tumor. With proton technology, 90% or more of the beams go right to the tumor with relatively little leakage to surrounding healthy tissue, said Dr. Nathan Levitan, president of the UH Seidman Cancer Center.
This precision is especially important for children and adolescent and young adult patients with cancer or other tumors that need radiation, said Dr. Mitch Machtay, chair of radiation oncology at UH Seidman Cancer Center. Younger patients are more prone to long-term complications from radiation, he said, noting that for those who have many decades of life ahead of them, the concern is that radiation itself can cause cancer.
The dose-per-dose effectiveness of proton radiation is basically the same as other forms of radiation, Machtay said. Because there's less radiation to surrounding tissue, there may be possibilities for a higher dose of radiation, or settings to combine treatments that wouldn't have been possible with other types of radiation because of the risks involved.
“It opens a whole new door for research trials and studies combining new agents with radiation,” Machtay said.
While there's no question about the benefits of proton therapy in pediatric tumors and in many spine and brain tumors, research is ongoing for its application to other cancers, such as prostate, breast, lung and liver cancers, as well as head and neck tumors, Levitan said. And UH has the opportunity to further study whether the technique is superior to traditional radiation.
The Proton Therapy Center has been many years in the making. UH announced the new center in 2011, when it was clear that proton technology would be the next frontier in radiation therapy, Levitan said.
“It was really clear to us in order to bring the most up-to-date care, the best care to our patients, that we had to provide this technology,” Levitan said.
Today, there are only 20 proton therapy centers in the United States, many of which are the first generation of proton beam systems that require massive equipment taking up the space of a football field and that can cost upwards of $200 to $300 million.
UH signed an agreement in 2011 with Mevion Medical Systems to purchase the MEVION S250 Proton Therapy System, which delivers the same treatment in a smaller machine and at a greatly reduced price. UH spent about $30 million on the equipment and facility expansion off the old emergency department space to house the “compact” system. UH is the sixth of Mevion's compact systems in the country.
“We wanted to incorporate it here, not have it 10 miles away in the suburb, where they have a cornfield they can build it, but to have it actually integrated in the medical center and have it close to Rainbow Babies and Children's Hospital,” said Dr. David Mansur, vice chair of the Proton Therapy Center.
Because of the massive size of many of the therapy centers, patients often have to be transported to a different facility for treatment, even in places that do provide proton therapy, said Dr. John Letterio, director of the Angie Fowler Adolescent & Young Adult Cancer Institute at UH Rainbow.
For Northeast Ohio patients, the nearest proton therapy centers were in Chicago or Philadelphia. Now, it's an elevator ride.
“Our music therapists, our art therapists, our child-life specialists are coming with them, so there are familiar faces,” Letterio said. “It's a comfort for the families, and certainly a great convenience for our patients. And certainly for the physicians here it means that we don't have to let go of our patients. They can stay here for all of their care.”
By the end of the year, Levitan estimates the Proton Therapy Center will see 20 patients a day. Since UH still is more than a month out from treating its first patients, no one is yet on the schedule — in large part because people can't wait weeks to start their treatment. But Levitan said he has no question about the level of interest.
With proton therapy being a relatively new and uncommon treatment, insurance companies still are working out details of coverage. Negotiations at UH are underway to work with insurance carriers on reimbursement plans, Simon said.
Proton therapy is roughly double the cost of traditional radiation, and may not be the best choice for all patients.
Simon said it's important that people understand that conventional therapies may be their best option, which is why the role of Seidman Cancer Center's tumor boards—a multi-disciplinary team to help patients develop a holistic approach to treatment—is so important.
“We need to educate people to understand when this type of very specialized technology is available and is necessary and when it isn't,” Levitan said. But for those who can benefit from it, the technology is incredibly exciting, he said.
For children who have decades and decades to live after treatment, and for many patients with brain and spine tumors, the ability to protect healthy tissue is critical.
“I believe—and many of my colleagues believe—this is going to result in a better quality of life for cancer survivors,” Machtay said.
"Proton therapy opens 'new door' for UH" originally appeared in Crain's Cleveland Business.
