Proton therapy: a double-edged sword?

 

Proton beam therapy is an advanced form of external radiotherapy that uses high-energy proton beams to treat tumours, rather than photon x-ray beams or electrons. Recent independent medical research suggests that proton beam cancer therapy treatment is far less harmful and traumatic to cancer patients than chemotherapy.

Since 2008, UK patients have been sent to private NHS commissioned clinics in the US, Germany and Switzerland to get proton beam therapy. With the increasing preference for this treatment however, several companies are opening centres across the UK for both private and NHS patients.  

By making proton beam therapy available in the UK, costs are significantly reduced, as is the negative effect that long-distance travelling can have on patients and their families. Some patients still need to travel abroad for treatment, however, until more NHS proton beam therapy centres are fully operational.

While the UK cancer care market has made major strides over the past year, thanks to a complementary mix of private and public facilities, rising demand for precision radiotherapy means that there is still some way to go. Based on treatment rates in other advanced European countries, the UK may need at least more 18 proton beam therapy facilities in the future, to make it the leading country in Europe for cancer treatment.

How does proton beam therapy work?

Proton beam therapy uses beams of protons to shrink tumours. Protons are small particles of an atom and a particle accelerator (cyclotron) is used to speed up the protons to produce the beam. The latest form of proton beam therapy is called intensity-modulated proton therapy (IMPT) with pencil beam scanning, an advanced technique that allows each dose to be precisely targeted.

The proton beam's ability to be specifically targeted during treatment allows for harder to reach tumours to be treated, as well as tumours that are in sensitive locations such as near the spine, in the brain or affecting vital organs. The proton beam can be specifically targeted to a particular treatment site and the beam made to 'stop' before affecting surrounding healthy cells.

The individual sessions for proton beam therapy, referred to as fractions, can take between 15 to 45 minutes. Only a few minutes is dedicated to the delivery of the proton beam therapy. The majority of the time is spent ensuring patients are comfortable on the robotic positioning couch, with cushions and braces where necessary to prevent movement while the treatment takes place.

Side effects are significantly lower when undergoing proton beam therapy treatment. During treatment sessions any side effects are closely monitored by the therapy radiographers and treatment team, who also provide guidance to patients during appointments.

Proton beam therapy is not always a standalone treatment and can be used alongside other cancer treatments such as chemotherapy or immunotherapy. It is also not a panacea for all types of cancer. 

There are more than 90,000 cancer patients in the UK every year who are treated with radical radiotherapy.  However one of the first investors in the UK proton beam therapy market, Rutherford Health plc, believes around 10% of patients currently treated with radical radiotherapy, the figure accepted at European level, could be better treated with proton beam therapy.

UK market operators and growth plans

Rutherford Health (formerly known as Proton Partners International) was the first in the UK to invest in proton beam therapy for cancer patients, through their Rutherford Cancer Centres. 

Their centre in Newport, South Wales, was the first in the UK to offer high-energy proton therapy. Rutherford Health has since opened two more centres offering this therapy, the Rutherford Cancer Centre North East in Northumberland and this month, the Rutherford Cancer Centre Thames Valley in Reading. A fourth site, the Rutherford Cancer Centre North West, is under construction in Liverpool. Their stated aim is to provide the majority of patients with a ‘state-of-the-art cancer centre’ within a ninety-minute journey of their front door, wherever they are in the UK.

The Rutherford Cancer Centre Thames Valley is planned to serve all of London, as well as international patients, and has a permanent consultation facility in London’s Harley Street. This will allow patients to undergo initial consultations in London before receiving treatment at Thames Valley, a short train journey away in Reading. 

Each Rutherford Cancer Centre provides imaging, chemotherapy, radiotherapy, immunotherapy and proton therapy, as well as a suite of diagnostic services.  The centres use the IBA ProteusONE machines for the proton therapy which offers pencil beam scanning, an advanced technique that allows doses of radiation to be delivered precisely to the size and shape of the treatment area, in combination with a robotic patient-positioning couch and the most up-to-date imaging capabilities.

Other companies are looking to set up centres in the UK, including Circle Holdings which has set up a joint company with Advanced Oncotherapy to run a proton beam cancer therapy unit in Harley Street, London.

Two NHS centres also provide high-energy proton beam therapy in the UK. The Christie NHS proton beam therapy centre opened in Autumn 2018, and the first patient was treated by the end of last year. The second NHS centre is being built at University College London Hospitals (UCLH), with treatment due to begin in 2020. When complete the two centres will each treat up to 750 patients every year.

UCLH is also partnering with US centre operator Proton International to extend proton beam therapy access to private patients. 

Another proton beam therapy centre, The Clatterbridge Cancer Centre NHS Foundation Trust in Merseyside, has also been operating in the UK delivering low energy proton therapy specifically for NHS patients with eye tumours.

Proton beam therapy beyond the UK

While the UK cancer care market is improving its offer to international patients for proton beam therapy, there is developing competition worldwide. For example:

  • Abu Dhabi - the first high-energy proton beam therapy centre in the Middle East. Rutherford Health is building a proton beam therapy centre as part of their Gulf International Cancer Centre (GICC), a large existing cancer centre in Abu Dhabi. GICC is open but only currently offering conventional cancer treatments. It is currently unknown when proton therapy will be offered.
  • China – multiple proton centres throughout the country. Proton International has entered into a joint venture with Glorying Health in China. The goal is to expand the access of proton therapy to Chinese citizens. They will work together to treat eligible patients in both Europe and the US, as well as train Chinese physicians and physicists on the best uses for particle therapy. The Boao Evergrande International Hospital, based in the special economic zone for medical tourism on Hainan Island, has also stated it will focus on cancer treatment and prevention and ‘treat more than 2,000 patients with cutting-edge treatment’ at its proton therapy centre.
  • South Koreadeveloping reputation in proton therapy. Korea was among the very first nations outside Japan to fund and utilise proton therapy for prostate cancer, and the technique is now used by Korean practitioners to treat many other types of cancer.
  • Spain  centres opening soon. Private hospitals Quirónsalud and Clínica Universitaria de Navarra (CUN), are due to open proton beam therapy centres in Madrid soon. The first centre is apparently due to open in the last quarter of this year, and the second one in March 2020.
  • Czech Republic - offering proton beam therapy to UK patients. Bupa UK has partnered with the Proton Therapy Centre in Prague to offer its eligible health insurance members access to pencil-scanning technology for the treatment of tumours. 

Proton therapy and international medical travel

For medical tourism, proton therapy centres are double edged. The more a country has, the less the need for cancer sufferers to make their lives worse by regular travel overseas for treatment.

But only a handful of countries currently have this expertise. Setting up a proton therapy centre takes time, and only really works when there is a range of cancer treatments on offer for the patient. It is still likely that cancer sufferers in countries with no proton therapy centres will continue to seek to travel to places that do have them.

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