<b>Proton Beam Therapy for Brain Tumors & Tumors in General </b>

http://cis.nci.nih.gov/fact/7_1.htm
about radiotherapy 


Proton radiation is a form of external-beam radiation treatment. Radiation oncologists (physicians who specialize in radiation treatments) can treat in two major ways: by implanting radioactive materials in the body [brachytherapy] or by using machines to generate beams that penetrate the body from outside [external beam]. Proton radiation is delivered by the second method. Other forms of external-beam radiation therapy include x-ray therapy and Cobalt-60 gamma-ray therapy.  External beam radiation does not remain in the body. Your body does not become radioactive, and there is no risk of radiation exposure to others. 

Proton beam therapy is a radiation treatment that delivers high dose radiation to a very localized site. Protons, being particles instead of x-rays, slow down faster than photons. They deposit more energy as they slow down, culminating in a peak (called a Bragg peak). This allows the majority of radiation to be delivered to the target site with less scattering of radiation around and beyond to the adjacent normal tissues.  

Proton beams can be conformed [shaped in three dimensions] to fit the target area.  The beam can be carefully shaped to the dimensions of the tumor, and so deliver most of the radiation to the targeted tumor mass, not to the surrounding normal tissue. This tissue-sparing is unique to proton beam therapy.  

Proton beam radiotherapy contrasts with conventional Xray or Gamma ray radiation therapy [often called PHOTON beam] due to the unique properties of minimal scatter as the proton beams pass through the tissue, and deposit  the ionizing energy at a precise depth (the Bragg peak). Thus radiation exposure to surrounding normal tissues is minimized, permitting higher radiation doses to the target area and improved local control, with less damage and side effects.

Protons, which are positively charged subatomic particles, deposit energy differently than x-ray beams do. Compared to an x-ray beam, a proton beam that is delivered with sufficient energy (or "modulated") has a low "entrance dose" (the dose in front of the tumor), a high-dose "Bragg peak" region, which is designed to cover the entire tumor, and no "exit dose" beyond the tumor. In contrast, X-ray beams may deposit most of their dose in tissues in front of the tumor, and continue to sleet through the body after passing through the target area. 
         
As of November 1, 2002, more than 32,000 patients around the world had been treated with proton beam radiotherapy.  The effectiveness of proton beams for treating cancer show in almost every tumor site examined. The higher tumor doses and lower normal-tissue exposure have improved local control and reduced acute and late complications as compared with x-ray therapy. [from Loma Linda website information]

As of November 2003 there are two major hospital-based facilities that treat patients with proton beams on a regular basis: Loma Linda University Medical Center (LLUMC), in southern California and the Northeast Proton Treatment Center, which opened in November 2001 at Massachusetts General Hospital in Boston.  Another U.S. facility, the Midwest Proton Radiotherapy Institute will open at Indiana University, soon. 

About Loma Linda
http://www.llu.edu/proton/
    

Current Opinion in Orthopaedics 2002; 13(6):434-439
<b>Proton beam therapy in the management of bone and soft tissue sarcomas</b>
Thomas F. DeLaney, MD

For cancer treatment, protons, the nuclei of hydrogen atoms, can be
accelerated to high energies, extracted, and transported to treatment rooms
where the proton beam undergoes a series of modifications (spreading,
modulation, and shaping) that conform the dose in a particular patient to
the tumor target. Because of their charge and mass, there is no dose
delivered beyond the desired target. Proton beam therapy thus provides a
means to reduce both the volume of irradiated normal tissues and the
radiation dose they receive. This may permit higher doses to the tumor and
achieve a higher tumor control probability without increasing the frequency
or severity of treatment-related morbidity. Additionally, the more conformal
treatment volumes of proton therapy should result in a reduced frequency and
severity of comorbidity between radiation and chemotherapy, thus allowing
for improved tolerance of the patient to therapy, better treatment
compliance, and increased treatment intensity.


For more information  

Search Pubmed &&url
Go To Proton Page
About proton beam
  http://www.protons.com/PROTONS.HTM


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The major problem we have is that Loma Linda and MGH are the only two facilities that will do Proton Beam Therapy on cancer metastases.  Loma Linda will not do it if there is other extensive disease.  I do not know about Mass General's policies, it has only been in operation a short time.  MGH and the midwestern facility are new arrivals on the scene, and their policies about metastases are currently unknown.

Other places might do primaries. Contact the proton beam centers and ASK. It might be possible to FedEx your scans and receive a preliminary opinion quickly.

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<b>Proton Beam Radiation at Loma Linda</b>
From Dave M 

I received Proton Beam Radiation information by calling 1-800-PROTONS. The video and pamphlets were sent from Loma Linda University Medical Center Proton Treatment Center. 
http://www.llu.edu/proton/ 
If you click on 'Publications' on the left side of the web page, you are taken to "Published Articles" where you can then find "Clinically Related Publications" by the center's faculty, with links to Medline when available.

<b>Before getting into why they say Proton beam radiation may be better than photon (x-ray) radiation, they state that the following sites are presently being treated:</b>

BRAIN AND SPINAL CORD, including isolated brain metastases, pituitary adenomas, and arteriovenous malformations (AVMs).
TUMORS AT THE BASE OF THE SKULL, including meningiomas, acoustic neuromas, chordomas, and chondrosarcomas.
EYE DISEASES, including uveal (choroidal) melanomas and neovascular formations resulting from the "wet" form of macular degeneration.
CANCERS OF THE HEAD AND NECK, including primary and recurrent nasopharyngeal cancers and locally advanced oropharyngeal cancers.
TUMORS OF THE CHEST AND ABDOMEN, including inoperable non-small-cell lung cancer and chordomas and chondrosarcomas of that region (usually abutting the spinal cord).
TUMORS OF THE PELVIS, including prostate cancers, other unresectable pelvic cancers, and chordomas and chondrosarcomas of that region (also below the spinal cord).
PEDIATRIC TUMORS, including brain and spinal cord tumors, orbital and ocular tumors, sarcomas of the base of the skull and spine, and abdominal and pelvic malignancies such as Wilm's tumor.
 
Loma Linda's Proton accelerator was built by Fermilab and was the first hospital-based proton center and has been in operation almost 10 years. In Boston, Massachusetts General Hospital, in cooperation with Harvard University, will have the second hospital-based system, to open in 2001.  (I am paraphrasing from their pamphlet, I personally know nothing about any of this)

Both the video and pamphlets explain how proton beam radiation is different from x-ray radiation. 
Photon radiation (x-ray) is delivered and most of its energy is deposited on the normal tissue on the skins surface, and some also is deposited beyond the targeted tumor which can result in unnecessary damage to healthy tissues. 
Protons are energized to specific velocities that determine how deeply in the body the protons will deposit their maximum energy. They state that "proton therapy is a <b>more precise form of conformal radiation, ... that can be shaped very closely to the tumor and allows them to deliver higher doses to the tumor while minimizing damaging side effects."</b>

The positive charged protons pass near the negatively charged electrons, pulling the electrons out of their orbits (ionization), this changes the characteristics of the atom, which in turn changes the characteristics of the molecule of the target. This is the basis for all forms of radiation therapy. Because protons have a heavier mass, and can be energized to a specific velocity, it can be determined how deeply in the body protons will deposit their maximum energy. As the protons move through the body they slow down, causing increased interaction with orbiting electrons until they reach their targeted stopping point.

Because of ionization, the radiation damages the DNA, which in turn destroys specific cell functions, which may include the ability to divide or proliferate. Enzymes attempt to rebuild the injured area of the DNA, but a cancer cell's ability to repair molecular injury is frequently inferior. As a result, cancer cells sustain more permanent damage and subsequent cell death than occurs in the normal cell population. (This is usually applicable to all forms of radiation therapy). 
A proton beam radiation oncologist can increase the dose to a targeted mass, while reducing the dose to surrounding normal tissue.
That's it in a nutshell. The pamphlet is 20 pages and explains much more.

I wish their web-site had as much information as this pamphlet.
Dave M 
December 2001

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<b>Erin, on the LMS List, researched proton beam therapy, and posted in October 2001: </b>

" Len Artz of the Association for Proton Beam Therapy wrote 3 months ago: 'it is the only medical facility in USA with proton center for cancer. Boston's Mass. Gen. hospital open end of this year. Houston's M.D. Anderson Cancer Center is in development and years away.' "
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<b>There is another proton beam therapy unit opening in the Midwest.</b>

Indiana University's Midwest Proton Radiotherapy Institute (MPRI) is the only one of its kind in the Midwest.  The new facility will have low cost family living facilities so the patient's family/caregivers can be with them during the timeline of treatment regimen.

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<b>Dick, on the LMS List, wrote to MGH: </b>

Date: Wed, 14 Nov 2001  
Subject: Massachusetts General Hospital Proton Facility - Status 
There has been some question as to the status of the Massachusetts General Hospital Proton beam facility. I decided the easiest way to find out the "facts" was to write them. The following is their response: 

=== Dear Mr. Whiting, 
The NE Proton Therapy Center started treating patients last week and will be treating patients on an ongoing basis. We will be accepting patients for new protocols soon. 
Our main focus will be on primary tumors, however I am not a clinician and medical issues may be better addressed to Katie Mannix, our Clinical Manager at CMannix@partners.org. 
Regards, Susan G. Woods, 
MSPH Business Manager / Research Grants Manager 
Northeast Proton Therapy Center (NPT-100) 
Massachusetts General Hospital 
Dept. of Radiation Oncology 
Boston, MA 02114 
(617) 724-9640 (617) 724-9532 FAX
swoods2@partners.org 
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<b>Medical Literature Search

Proton Beam Irradiation and sarcoma:</b>
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&term=proton%20beam%20AND%20sarcoma


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<b>David M, on the LMS list, compiled the following list of URLs. 

Some Proton Therapy Links </b>

Harvard Cyclotron Laboratory: http://neurosurgery.mgh.harvard.edu/hcl/ 
Northeast Proton Therapy Center: http://www.mgh.harvard.edu/depts/nptc/nptc.htm 
LLUMC, California: David Bush, 11234 Anderson Street, Loma Linda, CA 92354. 
Tel: 909 558 6000. This is the correct URL for Loma Linda Proton facility: http://www.llu.edu/proton/ 
U of California, Davis: http://crocker.ucdavis.edu/cnl/research/eyet.htm 
Midwest Proton Radiation Institute: http://www.iucf.indiana.edu 
National Association for Proton Therapy: http://www.proton-therapy.org 
TRIUMF, Canada protons: http://www.triumf.ca/welcome/proton_thrpy.html 
TRIUMF, Canada pions: http://www.triumf.ca/welcome/pion_trtmt.html 
CPO, Orsay, France: 
http://www-sop.inria.fr/epidaure/personnel/bondiau/CPO_base/cpo_base.htm
PSI, Switzerland: http://www.psi.ch/ 
Proton Oncological Therapy, Project of the ISS, Italy: http://top.iss.infn.it 
TERA foundation, Italy: http://www.tera.it 
Catania, Italy: http://lnsuni2.lns.infn.it/~catana/ 
GSI homepage: http://www.gsi.de 
The Svedborg Laboratory, Sweden: http://www.tsl.uu.se 
Clatterbridge Centre for Oncology: http://synaptic.mvc.mcc.ac.uk/simulators.html 
ITEP, Moscow, Russia: http://www.protontherapy.itep.ru 
Tsukuba, Japan: http://www-medical.kek.jp 
Tsukuba, Japan - new facility plans: http://www-medical.kek.jp/devnewfac.html 
HIMAC, Chiba, Japan: (ENG case sensitive) http://www.nirs.go.jp/ENG/particl.htm 
NAC, South Africa: http://medrad.nac.ac.za/index.htm 
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updated March 2003 doctordee, David M

