Ground Rattling Move
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Ground Rattling Move | Proton Therapy Center, MD Anderson-Orlando, Dr. Mark Roh, Daniel Buchholz, Orlando Health, S. Lee Kling Center for Proton Therapy, Barnes-Jewish Hospital, Siteman Cancer Center, Washington University School of Medicine.

Superconducting synchrocyclotron being delivered to Barnes-Jewish Hospital, Siteman Cancer Center at Washington University, St. Louis.
MD Anderson-Orlando prepares for Proton Therapy Center, patterned after similar facility in St. Louis; less than a dozen proton therapy centers exist in the U.S.

 

ORLANDO – In 2013, the site of the new $25 million Proton Therapy Center being built at MD Anderson Cancer Center-Orlando may look like something out of a science fiction movie.

As soon as the sides of the 15,000-square-foot building shell are completed and the appropriate shielding is put into place, Mevion Medical Systems will deliver the massive Mevion S250 superconducting synchrocyclotron to the construction site, and use a crane from the truck to attach it to the gantry. It represents arguably the first time that Mevion has delivered the new proton therapy system through the roof instead of the side of a building and then closing it in.

“It’ll be quite an eventful watch,” said Daniel Buchholz, MD, director of the radiation oncology department at MD Anderson-Orlando, with plans to begin treating patients with proton therapy in early 2014 and anticipates treating more than 30 patients a day, or 300 a year, with the new proton accelerator.

Proton therapy is considered the most precise and advanced form of radiation treatment, primarily radiating the tumor site while leaving intact surrounding healthy tissue and organs. Instead of radiotherapy that is delivered via photons, proton radiotherapy uses positively charged protons consisting of a hydrogen atom stripped of its electron. Protons are harnessed for treatment using the three-story cyclotron. Compared to conventional forms of radiation, side effects are minimal from proton therapy, particularly in pediatric patients.

“Children definitely have the most to benefit from proton therapy because the long-term effects of radiation can be devastating for them,” said Mark Roh, MD, president of MD Anderson-Orlando. “It holds the promise of significantly decreasing long-term effects in pediatric patients.”

Even though the proton accelerator takes up three floors – one underground and two above ground – it will appear similar to a traditional radiation therapy machine to the patient. The inner shell has been described as “pleasing to the eye … patients don’t see the mechanical wiring. The difference is the robotic couch that will be able to swing in multiple directions to get the patient in position for treatment.”

Tumors best treated by proton therapy include those that are localized and haven’t spread to distant areas of the body. If the tumor is near a critical organ, such as the spinal cord or optic nerves, proton therapy may allow for preservation of the function of the organ while delivering effective doses of radiation to the tumor.

The types of cancers best treated by proton therapy include pediatric cancers, brain cancer, prostate cancer, gastrointestinal cancers, thoracic cancers, sarcomas, and also orbital and skull-based tumors. Proton therapy may be used in combination with traditional radiation, chemotherapy and/or as a follow-up to surgery.

The timetable for proton therapy varies with each patient, from a day to seven weeks, depending on the tumor site. The length of treatment time decreases over time, as heavier doses begin to increase. Many insurers and Medicare cover proton therapy, which costs more than conventional radiation but typically less than surgery.

Even though proton therapy was initially proposed in 1954, its use has been very limited worldwide. Loma Linda University Medical Center in California was the site of the first hospital-based treatment center when it opened a proton therapy center in 1990. At press time, only 41 proton therapy centers existed in the world. Only 10 are located in the United States. Of those, two are located in the southeast – Jacksonville and now Orlando. Jacksonville will soon have a second and competing proton therapy system.

Last June, the U.S. Food and Drug Administration (FDA) 510(k) clearance and CE Certification enabled Mevion clients to treat patients with the proton accelerator. Based in Littleton, Mass., Mevion was established in 2004.

“FDA clearance happened very rapidly,” noted Roh. “Everyone who has and anticipates having one of these machines was very excited with how quickly it passed through the FDA process.”

The idea for the Proton Therapy Center at MD Anderson-Orlando began in 2006, when many of the large proton facilities had an exorbitant price tag: hundreds of millions of dollars. By waiting a few years, the size of the machine decreased, along with the cost.

“Dr. Wayne Jenkins started the project, which as with many significant projects experienced significant delays,” said Roh.

Buchholz said he and a staff physicist traveled to St. Louis, Mo., several months ago to see the new proton therapy system recently put into place at the S. Lee Kling Center for Proton Therapy, at Barnes-Jewish Hospital’s Siteman Cancer Center at the Washington University School of Medicine.

“It’s incredible,” he said. “When you see it in person, it’s so much bigger and better than in the pictures. They’re very happy with their progress.”

After installation of the accelerator, Mevion maintains control of the unit until it’s properly functioning, and then turns it over to the customer.

“That’s already happened at Washington University,” said Buchholz. “They’re now getting ready to treat their first patient by the first of the year.”

Buchholz said a primary goal of the center involves starting the treatment while also continuing the research of patients treated with proton therapy.

“It’s important that proton therapy is delivered properly, and it’s important that it’s delivered in a method we’re able to learn from, to continue to advance the field,” he explained. “That’s very much our goal: to treat the vast majority of our patients on protocol where we’re able to track the benefits of this treatment.”


 


Barnes-Jewish Hospital, Daniel Buchholz, Dr. Mark Roh, MD Anderson-Orlando, Orlando Health, Proton Therapy Center, S. Lee Kling Center for Proton Therapy, Siteman Cancer Center, Washington University School of Medicine.



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