In February 2014, the last two of a total of four licenses for the treatment of cancer using proton therapy honored. Within three years, it should be possible to be able to be against certain types of cancers. Treated in the Netherlands through proton therapy must now be diverted yet for this treatment abroad. Mainly is moved to Germany and Switzerland, countries that have these facilities available.
- The four licensees
- Why proton therapy
- How does proton therapy
- What types of cancer are treated with it
- Benefits proton therapy
- Disadvantages proton therapy
The four licensees
On the basis of the Law on Special Medical Procedures four permits for proton therapy with a treatment capacity of 2,200 patients. These permits are only issued to University Medical Centers (UMC) or institutions that have a partnership with UMC. Many institutions have a combined their expertise in a partnership. In the north of the Netherlands is this:
- UMC Groningen Proton Therapy Center: it expects to start construction of the new center in the summer of 2015. The first Patients will be treated then around 2017 and the expected capacity will be 600 patients per year.
- SouthEast Netherlands, Proton Therapy Center, SUN-PTC: MAASTRO wants to build the new center on the north side of the Academic Hospital Maastricht. MAASTRO is a partnership between:
- Academic Hospital Maastricht in Maastricht
- Orbis Medical Center in Sittard
- Atrium Medical Center in Heerlen
- St. Laurentius Hospital Roermond
- St. John’s Hospital in Weert
- VieCurie in Venlo
- In the Randstad Amsterdam Proton Therapy Center (APTC): This is a partnership between the Academic Medical Center (AMC), Antoni van Leeuwenhoek and VUmc. Go the APTC and Princess Máxima Center for Pediatric Oncology (PMC) in Utrecht intensively. The first patient are expected to be carried out in the ‘Amsterdam Proton Therapy Center (APTC) in 2018. The expected capacity will be 600 patients per year are also here.
- Also in the Randstad Holland Particle Therapy Centre (HollandPTC): This is a collaboration between Leiden University Medical Center (LUMC), Erasmus University Medical Center Rotterdam (Erasmus MC) and TU Delft. HollandPTC It will be located adjacent to the university. HollandPTC expects to start the first treatment in 2016.
Why proton therapy?
In 2013, with approximately 101,500 people in the Netherlands diagnosed with cancer, almost the same number as in 2012 (100,800). The last 25 years the number of new cases of cancer in the Netherlands almost doubled. Between 42,000 and 45,000 people die annually from the effects of cancer. Roughly half of all cancer patients cured of his / her illness. According to a report by the health concerns the total number of patients eligible for proton therapy approximately 7,000 per year. Cancer treatment consists of three pillars; each type of cancer has its treatment or combinations thereof:
- Chemotherapy, this is the treatment of cancer with drugs meant.
- Surgery, this is the treatment of cancer by performing operations intended
- Radiotherapy, this is the treatment of cancer with ionizing radiation intended.
In radiotherapy cancer cells with high energy X-rays are (packets of energy without mass, photons) irradiates with the intention that they cannot recover the accumulated radiation damage and death. The principle of radiotherapy is the difference in sensitivity to radiation between cancerous and healthy cells. Generally surrounding healthy cells can recover better than cancer. The ability of recovery of the healthy cells, therefore, determines how the irradiation is fractionated. To a great extent Conventional radiation therapy and proton therapy differ in the type of radiation used. In conventional radiation therapy, the radiation is composed of photons, packets of energy without mass, while the radiation is made up of a beam of protons in proton therapy. Protons are subatomic particles with an electric charge and a small mass. Due to these differences, the two types of radiation also another effect on tissue.
How does proton therapy
Protons and photons have different physical properties and therefore have a different effect on tissue. Protons must be accelerated and focused and this is done through a particle accelerator (cyclotron or a synchrotron). This particle accelerator relatively little energy. Do the protons below the limit then give them all abruptly energy (physics call this the “Bragg peak”). By taking into account of the inhibitory capacity of tissue, doctors can the point at which energy should be therefore properly determine issued. Since protons are in contrast to X-ray energy issuing at one time, there was less damage to surrounding tissue. X-ray shows the whole way through the body energy to surrounding tissue.
What types of cancer are treated with it
Which types of cancer are eligible for treatment with protons and are therefore heal than with conventional radiotherapy better? These are mainly the tumors that are located in critical areas of the body, such as the brains (chordomas and chondrosarcomas) or eyes (melanoma). Also areas where you want to limit such children. Much as possible damage to other tissue for meningiomas treatment case should be. Case basis in other tumors such as prostate cancer are still divided opinions among physicians. In other tumors, such as, for example, “moving tumors” in the lungs again is still required further investigation. To assess whether the treatment of cancer by means of proton therapy provides a benefit depends, in addition to the above points, on the following points:
- The type of tumor: radiation therapy is not a treatment option than proton is probably not.
- The radio sensitivity of the tumor: the tumor is relatively sensitive to radiation and the dose higher than the surrounding organs can tolerate, then proton or an option
- Metastases: proton does not lend itself metastases because it is more effective in defined areas.
- All irradiated tumors: tumors in these organs often have already had their maximum radiation dose. With proton surrounding tumors are only taxed less.
The types of cancer that are to be treated by means of proton therapy in the first are:
- Intra-ocular tumors (eye),
- Lung tumors,
- chordoma / chondrosarcoma (skull base)
- pediatric malignancies (children)
- head and neck tumors,
- breast cancer,
- lung carcinoma
- prostate cancer
Benefits proton therapy
The biggest advantage of proton therapy is that the healthy tissue can be spared even than when irradiated with conventional radiotherapy better. The new technology is very precise and sharply defined dose delivery possible. Sometimes tumors are located too close to certain organs and can be damaged by radiation. In proton therapy, the surrounding tissue so better saved so that the dose of the radiation can be increased, thereby enabling more chance of cure of cancer. Due to harm the surrounding tissue less severity of any side effects may be reduced.
Disadvantages proton therapy
One of the drawbacks of proton therapy is the high costs it entails. For the four new centers primarily the particle accelerators to be as large as twice the conventional radiation equipment. A second but important drawback (or money) is related to the benefit of proton therapy. The abrupt release of energy is not well focused beam; healthy tissue can become severely damaged. Bee this can also occur if, for example, the patient is moving too much during the irradiation.