Proton Therapy Congress 2016
What is the future of proton therapy in the UK and worldwide?
Dr John Pettingell - Proton Partners International, Cardiff, UK
Obviously it’s the Proton Congress in London, so I’m very interested to be here to meet other scientists and medical people and partners in proton beam therapy; to catch up and learn about some of the projects that are ongoing internationally and in the country, but particularly to meet people and other colleagues.
Proton therapy is a relatively new field in the UK. What do you think is going to define it?
It’s definitely a new practical thing for the UK but proton beam therapies, the first treatments were in 1946, so it’s been around for as long as LINAC based radiotherapy, but the equipment’s a lot bigger, more expensive and so whereas there’s something like 15,000 LINACs worldwide there’s only about 40 centres currently delivering protons. But in the early days they were all based in physics laboratories that also treated but in the last few years there’s been a big increase in centres going into hospitals around the world which has been very positive. There’s also been improvements in technology with pencil beam scanning which is the new way of delivering protons, and also imaging on the machine so actual cone beam CT allows you to image the patient when you’re treating, which is something done in the radiotherapy world that is now being adopted in proton beam therapy.
Another aspect is the manufacturers develop single room solutions now, which could be a real game changer because up until now you’ve had to buy large centres with two or three treatment rooms, probably something like $150 million and that’s a large amount of capital to put down just for a centre. Whereas now a single room centre could be more like $30 million, still quite a lot of money, but much more doable. So for us at Proton Partners that’s really what we’re looking to do, which is rather than just having one big centre located somewhere in the country we are going to have multiple centres spread around the country to try and get more accessibility for people in the UK for proton beam therapy. We are currently building in Newport, Northumberland and developing London, and then there’ll be some more centres coming shortly.
When will the Newport clinic be open?
We are kind of opening in stages actually, so as well as the proton beam machine we’ve got a LINAC as well, partly as a back up to the proton beam machine, but also to deliver radiotherapy on the LINAC. Some patients could benefit from both actually, so some patients might have some treatment on the LINAC and some on the proton machine. We’ll have chemotherapy as well, and again some patients will have a mixture of chemotherapy and proton therapy. The LINAC in fact is coming in about a week’s time and we’ll be starting that service at the end of this year and the proton beam hardware is coming to site at the end of November this year and we want to start the clinical service at the end of next year, end of 2017. I think it will be a really nice clinic. We’ve also got PET-CT in Newport which is an important equipment for diagnosis, but also has some interesting applications for proton beam therapy because after someone is treated with proton beam therapy if you put them in a PET scanner you can actually see where the treatment was because the protons cause reactions where positrons are emitted which are picked up by the PET scanner. That’s one aspect really, again with proton beam, historically, they’ve been separate centres to conventional radiotherapy, so one thing that’s quite interesting is this opportunity of delivering treatments in combination. Conventional radiotherapy has improved significantly in the past few years as well with rotational IMRT and so there are some body sites that could really benefit from rotational IMRT and then with a proton boost, potentially. Considering at the moment the cost of proton beam therapy is higher that gives you an opportunity of making it available to more people.
Where do you see proton therapy heading in the near future?
There are some treatment sites where it’s already well recognised internationally that proton beam is the treatment of choice, particularly with children, young adults and some adult base of brain. But I think in Europe, certainly, there’s a feeling and there’s some evidence that probably at least 10% of patients currently treated with radiotherapy would benefit from proton beam therapy. There’s a few people speaking at the congress, and we heard earlier on that in Holland that they’re developing four centres actually and they are looking at basically double-planning patients so a lot of radiotherapy patients will have a plan on the LINAC and a plan on the proton beam. Then they’ll use the planning system to decide who should get proton beam therapy based on how the planning system calculates what might be the damage to normal healthy tissues, and that’s across the board in terms of treatments, so not just limiting it to a certain number of treatments. In fact I’ve heard Tony Lomax, who’s speaking now, say that across every body site, depending on a patient’s individual anatomy, there will be some patients who would benefit from protons, and it’s about making that available. Our intention at Proton Partners will be to double-plan patients so that we can decide, based on the patient’s particular situation and particular anatomy, if they would benefit from protons or would get an equally good treatment on the LINAC.
Any final thoughts?
One other aspect I guess about protons, in terms of the uptake, there’s a big increase at the moment in the number of centres that are starting, and that will probably have, almost certainly have, an effect on making the treatment cheaper. Also people are looking at the number of fractions, the number of treatment sessions that patients get, so potentially reducing the number of treatment sessions on the proton machine because it can be very highly targeted, especially now with imaging, so you could potentially then reduce the number of treatment sessions people have and that will reduce the cost significantly.
