David Beyer, MD
The first proton beam therapy units cost huge amounts of money and were well beyond the means of all but the most well-financed cancer centers. However, this technology is vastly cheaper than before, and David Beyer, MD, medical director for Cancer Centers of Northern Arizona Healthcare, foresees a time when proton treatment will become mainstream.
“Now, you can get it into the tens of millions,” Beyer said. “It’s still a big nut to crack. It’s still a challenge for a private practice to spend $30 million. But it’s not as inconceivable as $150 million.” Beyer predicted prices are going to drop further and independent practices will be able to afford this technology. “It’s going to take some time. It’s going to be a few years before the systems get small enough.”
Physicians are anxious to see more data emerge, but the utility of this precision form of radiation therapy is undeniable, which means that the cancer center that can offer it will have a competitive advantage. In interviews with Oncology Business Management
, oncologists talked about proton beam technology, the ways in which it already has been extended to community level care, and the barriers that remain.
Proton Centers Are Proliferating
When Andrew Lee, MD, guided proton beams toward a patient’s prostate tumor at MD Anderson Proton Therapy Center in May 2006, marking the first time proton therapy was used in Texas, there were fewer than five clinical proton centers in the United States. Ten years later, he oversaw another “first” for proton therapy, this time as the medical director of Texas Center for Proton Therapy. By the time his facility combined pencil beam scanning with isocentric cone beam CT, in April 2016, there were 24 proton therapy centers in the United States and 43 worldwide.
Researchers have pioneered new methods of delivery over the past 10 years. Perhaps the most significant is intensity modulated proton therapy (IMPT), also known as pencil beam therapy, which “paints” proton radiation onto a tumor using individual spots of proton beams, often smaller than a dot made by a pencil. The advent of IMPT in North America in 2008—also delivered for the first time at MD Anderson by Lee—excited clinicians and researchers, who say it increases patients’ quality of life by reducing the side effects caused by excess radiation from traditional radiation therapy. “Anything we can do to eliminate unnecessary radiation is very powerful,” said Steven Frank, MD, medical director of the Proton Therapy Center at MD Anderson.
As excitement about the treatment mounted, more proton therapy centers popped up. Eighteen of the nation’s 24 facilities opened after 2010, and 12 opened in just the past three years, according to the National Association for Proton Therapy.
The research has largely kept pace, said Beyer. A leading publication in the radiation oncology field, the so-called Red Journal—short for the International Journal of Radiation Oncology, Biology and Physics—devoted an edition to proton beam therapy this spring. “The number of proton articles in that journal has gone up because the number of submissions of high-quality proton work has gone up,” Beyer said. “There’s so much, in fact, that they had, in May of this year, an entire edition that was devoted to proton beam—more than 500 pages of just proton articles.”
“And that’s just one journal,” Beyer added.
MD Anderson researchers have authored more than 350 publications on proton beam therapy to date, and the center has only accelerated the pace of its research. “In 10 years, we have advanced and changed an entire industry with new delivery vehicles of proton beam. And we have more to learn,” Frank said. “We don’t know everything about it, and that’s why we have to run these trials.”
As delivery methods grow more sophisticated, proton therapy machines become smaller and cheaper—like IBM computers did, Frank says— although “cheaper” is a relative term when it comes to a multi-million dollar machine. “With the traditional proton facility, you have one cyclotron, and it feeds four treatment rooms. It’s a big, big project, and these big projects are in the hundred-plus million dollar range,” Beyer said. “But there are some people who’ve figured out a way of making this more affordable.”
Companies such as Hitachi, IBA, Mevion, Varian, and ProNova sell those single-room solutions at “a fraction of the cost of a multi-room center of 10 years ago,” Lee said. “When the footprint gets down to probably the $10- to $15-million range, that’s when it’s going to become more universally acceptable and adaptable,” Beyer said.