Is Proton Beam Therapy Worth It?

Comparing degrees of localization of proton beam therapy with other treatment  modalities, in terms of dose v,  tissue depth. 'SOBP' denotes 'spread out Bragg peak' - or the collation of several such peaks via different beams, for different depths. Red line denotes depth dose plot of x-ray beam..


The Wall Street Journal article 'Making A Case for Proton-Beam Therapy', to treat cancer - actually posed an interesting conundrum. On the one hand "six new proton beam centers are set to start delivering state of the art radiation to cancer patients around the country by y ear's end" - with no fewer than ten additional centers expected by 2018 bringing the total to 30.

On the other hand, these centers are "entering an uncertain market" since the therapy still "lacks evidence that it is better than traditional radiation despite costing significantly more".   Indeed, as the WSJ piece notes, Aetna and United Health Group, Inc. have stopped covering it for prostate cancer, "once seen as a main source of patients".

I also (briefly) considered getting proton beam therapy when my prostate cancer was diagnosed back in July, 2012.  However, my wife (a former radiotherapy software specialist) convinced me that high dose rate brachytherapy - which her company specialized in - was the better option.  Plus,  she knew the best center in the nation to get it: the Helen Diller Cancer Center at University of California - San Francisco and had worked with the world-famous oncologists there .  She was  also  skeptical proton beam centers existed that could give 100 percent assurance and confidence that through all the 30 or so days of treatment one would not see a "geographical miss". That is, the proton beam hitting a critical region like the bladder or lower bowel instead of the cancer, putting an  unwanted micro-hole in either..

For those not aware,  proton beam treatment is a form of external beam therapy in which positively charged particles (protons) are accelerated to 60 percent of the speed of light, or 180,000 kilometers per second. They are constrained to form a powerful beam that can be programmed to deposit most of its energy directly into a target tumor - say in the prostate gland - minimizing radiation exposure to surrounding healthy tissues (say bladder and lower bowel in the case of prostate tumors)

While the therapy - according to existing evidence - isn't necessarily "better" than traditional radiation treatments, the proponents (which include now the top ten cancer treatment centers)  insist it can reduce many harmful side effects, especially for localized cancers.  As the WSJ noted:

"The benefits are undisputed for rare pediatric brain cancers, adult eye tumors and cancers at the base of the skull."

But for prostate cancer the jury is still out, and certainly the benefits of the radiation treatment I received have to be considered at least as good and much more cost effective. (I was in the treatment center for one day, and received one high dose of 1930 cGy via Iridium 192 needles introduced in situ, see e.g.

http://brane-space.blogspot.com/2012/09/thge-longest-dayand-then-some.html

While the advocates for  proton beam therapy brag of its accuracy - assuming it's done in the right hands- my own therapy relied on a specialized inverse planning, or "IPSA" software, see e.g.

http://radonc.ucsf.edu/research_group/jpouliot/pages/ipsa/ipsa_hdr.htm

For which testing of the algorithm at multiple sites disclosed  automatic protection for critical organs  achieved by generating contour solutions that cleared a 3D "tunnel" around the urethra and rectum (for example)  to spare them from the maximum delivered dose.
 
The worst side effects for me were in the immediate three or four month aftermath and included frequent urge to urinate and some burning upon urination. Also burning accompanying sexual activity. (Only a bit later I learned I could control the burning effects by taking one cranberry sofgel a day)

Medicare covered almost 95% of the total treatment costs, which - if I'd  had Paul Ryan's stingy "premium support" (voucher)  plan - would have likely bankrupted us - given it would only cover $10k or so a year.

It should also be known, as the WSJ notes, that Medicare also covers proton beam therapy  "at about $1,100 per treatment session" . Nonetheless,

"several major insurers stopped after a 2012 study found it has no long term added benefit. "

Originally, as the WSJ notes,  men with prostate cancer had made up 70 percent of patients at some proton centers, and that is now 50 percent.  

Meanwhile, the manufacturers themselves are designing more compact machines as opposed to the Hitachi machine - nearly the length of two thirds of a football field. But smaller is no guarantee of success and as the Journal piece pointed out, ProTom International Inc.  - maker of compact systems- already had to file for bankruptcy protection.

My advice to anyone considering this option is to look into it carefully, also consider that a simpler, less complex system might actually be better for your cancer treatment needs!

A Niece Begins Her Cancer Journey....

The voice on the answering machine yesterday evening was anxious, as my niece Vanessa, 45, asked my wife to phone her when she returned from her assorted errands. Janice - a former radiotherapist- then learned that Vanessa had just been diagnosed with early stage breast cancer.  She disclosed that she's to go in for further tests next week to learn the extent and whether it has entered the lymphatic system. The specialists will then discuss the possible treatment options.

In any case, her medical specialists and the oncologist appear to recommend surgery then a follow-up course of external beam radiation (most likely electron beam because of the narrower focus) to last 5 weeks. As my wife related to her, this would be the normal procedure, in lieu of say, chemotherapy.  She also discussed all the other options that Vanessa's specialist would likely bring up at the next meeting.

And so begins a niece's cancer journey, just as I had my own last year, ending in high dose brachytherapy for prostate cancer. As Vanessa put it, the diagnosis came as a shock: "One minute you're this healthy person and there are those other sick or cancer people out there. The next minute you're one of them!"

Yes! That's how it is! Humans have a built-in exceptionalist instinct or brain dynamic that registers an individual as a healthy specimen or exception to the rule ....say of cancers, heart attacks, or whatever....until that person also gets it. Cancer is no different, and I was no different when I first received my prostate cancer diagnosis after a biopsy in July, e.g. http://www.brane-space.blogspot.com/2012/07/verdict-is-prostate-cancerso-now-what.html

Until then, I had been a bit worried after seeing my PSA double in a year, but I still dismissed it as an aberration, either as a faulty lab test or because of having a different condition known as benign prostate hypertrophy. I was wrong. Thus I was led to the intimidating trial of deciding on a treatment option- basically between surgery and high dose radiation. I opted for the latter because of all the stuff, complications associated with the former that I preferred not to risk.

With my niece Vanessa, the options are much reduced because obviously the breast is a different organ from the prostate gland, far less localized. Thus, treatments usually occur in duos: surgery and chemo, or surgery and radiation. Also, neither one of the added treatments (to surgery) is a 'walk in the park'. With chemo, you're puking your guts out almost all the time, and the only thing that can relieve it and allow you to eat is marijuana. Fortunately, our state has legal medical marijuana dispensaries. Some anti-MJ halfwits on their blogs have castigated states like Colorado saying (in their dumbness) "the smoke is as bad or worse than cigarettes" - failing to note the MJ dispensaries have options besides smoking, including brownies, cookies, cakes etc. Thus, smoking need not enter into it at all, but what do these jagoffs know?

With radiation, which appears to be Vanessa's choice (for now) the delivery is over weeks, not one day as I had. In that time your skin will get red and raw from the interaction of the electrons or other particles. Yes, the bad nasty cancer cells are 'cooked' but so also are many healthy cells. No one has yet figured out a way to zero in on the bad guys and spare the healthy cells.

Low dose brachytherapy may also be an option for her, after surgery. A small cavity will then be left after tissue removal, into which a balloon catheter is place adjacent to the remaining breast tissue. The radiation low dose sources are then inserted into the balloon catheter - through various holes, by an afterloading machine, e.g. such as shown in the photo in this blog: http://brane-space.blogspot.com/2012/09/thge-longest-dayand-then-some.html  In this treatment, 2-3 applications would be performed over a period of 3 weeks.  The direct proximity of source to tissue may well lessen the negative effects.


As for her mood, she is optimistic and her Eckanckar spiritual system (which she shares with her mother)  also provides her with support, along with an extended family who love each other, as opposed to fighting and condemning. For more on the Eckanckar system see: http://www.brane-space.blogspot.com/2010/05/conversation-with-eckanckar-adept.html

SO, no matter what lay ahead, she is ready to face it, fully prepared.

Best wishes go out to her and that her journey ends on a happy note and with minimal physical distress or stress.