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New Proton Beam Cancer Center Could be the Nation's Ninth

Cheryl Clark, for HealthLeaders Media, June 22, 2010

Scripps Health and Scripps Clinic Medical Group are allowing their name and their doctors to help build a $185 million proton beam center for cancer therapy, a for-profit venture in San Diego that could be the ninth accelerator in the nation when it opens in 2013, and the second in the Western United States.

The Scripps Proton Therapy Center will be financed and owned by Advanced Particle Therapy (APT) LLC of Minden, NV, but will be managed by Scripps Clinic physicians. The 102,000-square-foot center will be built starting next month about 5 miles east of the Scripps campus. When complete, it will have the capacity to treat 2,400 patients a year for cancers of the prostate, pancreas, lung, head and neck, breast, colon, eye, and digestive system. The only other such center in the West, at Loma Linda University, was the first in the U.S. in 1990.

The proton beam approach delivers radiation more directly to the tumor site and avoids collateral damage to surrounding cells and tissue, says Prabhakar Tripuraneni, MD, head of radiation oncology at Scripps Green Hospital in La Jolla.

That collateral damage is believed responsible for secondary tumors that often occur after more generalized doses of radiation treatments. He said proton beam is increasingly used for deep-seated but localized tumors—those that have not spread—that are difficult to remove surgically, including ocular and lung cancers.

Proton beam radiation treatment is perhaps the least well known of radiation cancer strategies, because there are only seven such installations centers in the country. Also, at about $45,000 for a course of treatments, it is perhaps the most expensive radiation therapy offered today.

The center will be equipped by Varian Medical Systems of Palo Alto, Varian's first proton beam installation in the U.S.

While the center plans to accept patients from all health systems in the region, clearly attaching the name Scripps to the center will bring the five-hospital healthcare system prestige and stature, several proton beam experts note.

Besides Loma Linda, proton beam accelerators operate at the following locations:

  • Francis H. Burr Proton Center at Massachusetts General Hospital in Boston
  • Roberts Proton Therapy Center at the University of Pennsylvania in Philadelphia
  • ProCure Proton Therapy Center at the INTEGRIS Cancer Center in Oklahoma City
  • Proton Center at M.D. Anderson Cancer Center in Houston
  • Proton Therapy Institute at the University of Florida in Jacksonville
  • Midwest Proton Radiotherapy Institute at Indiana University

Four other centers are trying to launch proton beam centers, but some have been delayed, in part because of difficulty raising money during the recession, says Leonard Arzt, executive director of the National Association for Proton Therapy.  An eighth center in Hampton, VA, is scheduled to open this August.

However, proton beam treatment is controversial. Some policymakers and researchers worry that there has not been the kind of clinical trial validation to assure that proton beam approaches are really better than standard radiation, brachytherapy, CyberKnife, or Image Guided Radiation Therapy (IMRT).

Last September, the National Cancer Institute said in a bulletin that of the estimated 1.47 million Americans who will be diagnosed with cancer in 2009, 60% to 75% will undergo radiation therapy for their disease.

"In select cities around the country, some of these patients who are hoping to improve their odds for a cure and minimize the long-term adverse effects of radiation therapy will be treated with a relatively new form of it called proton therapy.

"Public interest in proton therapy has grown substantially since the FDA approved it in 2001. However, there is concern among members of the medical and research communities that enthusiasm for this promising therapy may be getting ahead of the research.

The NCI paper continued, quoting Kevin Camphausen, MD, chief of NCI's Radiation Oncology Branch, who has referred patients to be evaluated for the treatment when he felt it might work well for their tumor type. "Proton therapy has wonderful potential as a treatment for some cancers. But I don't think its use should become widespread until we can validate where it's needed, and where it has the greatest potential benefit for patients."

Added Norman Coleman, MD, associate director of the Radiation Research Program (RRP) at NCI, "Theoretically, proton beams are much more exact than x-rays. On the computer screen, the calculations look great, and the enthusiasm is understandable. But is that what's really happening in the patient?"

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