Proton Beam Therapy

Depth charges for deep brain and spine tumors
By Mark R. McLaughlin, MD, FACS

The physicians at Princeton Brain and Spine Care want to congratulate our colleagues at Princeton Radiation Oncology for the opening of their state of the art, first of its kind in the New York metropolitan area, Proton Beam Radiation Center.  The Procure Center  http://www.procure.com/OurLocations/NewJersey/ExploretheCenter/PhotoTour.aspx

just opened its doors and began treating patients last month.  We have always been impressed with this group’s innovative and patient centered care.  We are proud to partner with them in the care of cancer patients in the New York and New Jersey area.  Some physicians and lay public have incorrectly thought that they can get the same quality radiation treatments at any facility.  In my experience, it’s not a one size fits all and, in fact, outcomes from radiation therapy for cancer are, in my opinion, NOT strictly related to the technology of the radiation devices utilized or the facilities.  This is far from the truth.  In my years as a physician, I have seen that the physician utilizing that equipment is just as important as the equipment used.  In other words: CHOOSE YOUR RADIATION ONCOLOGIST AND YOUR FACILITY WISELY. I like to think of radiation therapy almost like surgery in that the better the physician/physicist/quality assurance team is, the better the treatment and outcome for our patients.  That is why we are so pleased with our collaboration with Princeton Radiation Oncology- these guys are tops in their field and they continuously bring the best equipment and facilities to our community.

In yet another act of continuing innovation and forward thinking, Princeton Radiation Oncology and CentraState Hospital have brought to this region the highest quality modality for the treatment of cancer.  The purpose of this blog is to educate our patients about proton therapy and to illustrate why this form of radiation therapy is better for some types of cancer.

Background

As we all know, many times cancer cannot be treated with surgery or chemotherapy alone.  Often times there are remnants of cells left after surgery that need to be cleaned up with radiation therapy and sometimes there are tumors that are too deep or too tightly wrapped around important anatomical structures to be removed surgically.  So radiation therapy has become a major tool in the treatment of cancer.

Radiation works by delivering ionizing energy to the cancer which damages the rapidly dividing cancer cells by disrupting the DNA within those cells causing cell death.  Radiation therapy has long been proven to effectively control the growth of many types of cancer.  It is also known that, generally, the higher dose that we can deliver to that cancer cell, the more likely we can kill it.  Advances in radiation therapy over the years have included techniques to increase the dose of radiation and refine the precision of delivery of that dose so that surrounding tissues can be spared any collateral damage.

In the past radiation was delivered by an Xray machine being pointed at the involved area.  While this was effective, it sort of was like a high powered laser beam burning everything in its path including the healthy tissue in front of the tumor all the way through to the tumor.  Fortunately in most cancers, the cells were more susceptible to the radiation than the healthy cells. Therefore the damaged healthy cells would recover and the cancer cells would die.  But with more radio-resistant tumors and with tumors that were deep or attached to vital organs, sometimes this way of delivering radiation therapy was not optimal.

In order to improve the accuracy and decrease the collateral damage of the Xray machine, alternate forms of radiation therapy were developed such as Gamma Ray stereotactic radiation therapy.  This technique allowed Neurosurgeons and Radiation Oncologists the ability to shape the radiation beam and bend it around vital structures to deliver higher doses more precisely to the targeted cancer cells.  This was a great advance because the higher the dose of radiation delivered to a cancer cell, the more likely it will be lethal for the bad cells.  Rather than the laser beam killing/damaging everything in its path, this technique was more like a sniper bullet that could be steered or bent around structures from many angles decreasing the dose to the healthy tissue and getting more to the tumor. But the catch is just like a sniper’s rifle bullet that beam would still have to exit the body and would cause damage on its way out.  So again not only was the tumor being hit, normal tissues in front of and behind the tumor were being hit.

Proton Therapy: “The Rolls Royce of Radiation Therapy”

Proton Beam therapy is the next refinement of radiation therapy in that, rather than clearing a killing path to the tumor like an Xray Beam (Laser analogy) or steering the beams (Sniper Bullet)like stereotactic gamma therapy, this technology is more like dropping a depth charge that is precisely calibrated to explode and deliver its lethal energy within the cancer tissue with very little surrounding damage on the pathway in and nothing on the way out. This technology allows us to destroy cancer cells and spare healthy cells just millimeters away.

Using sophisticated physics planning, this device delivers protons, not ionizing or gamma rays, that release their energy at a planned distance.  This distance is calculated based upon the tumor’s depth inside the body.  This allows the neurosurgeon and radiation oncologist to deliver much higher doses of radiation without the collateral damage of entry or exit radiation.

Conclusions

The Procure Center is one of only 11 Proton Beam Centers in the United States and the only one in the New York/Philly Metro area.  We commend Princeton Radiation Oncology and CentraState Medical Center for their foresight and pursuit of the highest quality of cancer care in the New York/Philly area.  We are proud to collaborate with this group of outstanding physicians and know that our patients and our loved ones will receive cutting edge, compassionate care from this group of talented doctors.