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How many proton beam therapy centers are enough? The United States now has 5 in operation with at least 10 more on the horizon (see Table 1). The price tag is mind-boggling, upward of $200 million for a single PBT facility. To justify this huge capital investment, a proton center needs a strategic model, in other words, a high-volume disease, such as prostate cancer.
Promoted as reducing the risk of the side effects men fear most—such as impotence—more and more prostate cancer patients are choosing proton therapy, raising concern that proton centers are being built using prostate cancer as a de facto business model.
“Proton therapy has theoretical advantages in prostate cancer, but it should be thoroughly investigated by those with no commercial bias,” Anthony Zietman, MD, Department of Radiation Oncology, Massachusetts General Hospital, told Oncology News International in an interview. The Francis H. Burr Proton Therapy Center is located at Mass General.
|Table 1. Proton facilities operating in the US|
• The James M. Slater, MD, Proton Treatment and Research Center - Loma Linda, California
• Midwest Proton Radiotherapy Institute at Indiana University - Bloomington, Indiana
• Francis H. Burr Proton Therapy Center - Massachusetts General Hospital-Harvard, Boston
• M.D. Anderson Proton Therapy Center - Houston
• University of Florida Proton Therapy Institute - Jacksonville, Florida
Selected proton facilities under development in the US
• The Roberts Proton Therapy Center at University of Pennsylvania Health System, Philadelphia
• Hampton University, Hampton, Virginia
• Seattle Cancer Care Alliance
• The Oklahoma ProCure Treatment Center, Oklahoma City
• Siteman Cancer Center – St. Louis, Missouri.
• The Northern Illinois Proton Treatment and Research Center -- Chicago
Proponents of PBT contend that its unique dose-distribution makes it the best option in several anatomically difficult cancers, such as skull-based tumors, ocular tumors, and pediatric malignancies. For example, researchers at Harvard reported excellent long-term results with minimal side effects in treating skull-based tumors with proton therapy (Hoch et al: Am J Surg Pathol 30:811-818, 2006). However, the cancers in which proton therapy have proven efficacy over other therapies are relatively rare.
Dr. Zietman stressed that while there is increasing enthusiasm for proton therapy, there have been no randomized trials comparing the efficacy of protons and IMRT in localized prostate cancer.
“PBT has tremendous promise in prostate cancer, but there’s a high price tag, so we need to be certain that it’s better than any alternative treatment,” Dr. Zietman said.
Since 1990, when Loma Linda University Medical Center (LLUMC) opened the world’s first hospital-based proton center, about 8,000 US men with prostate cancer have undergone proton therapy. There are 5 proton centers operating in the United States, 3 under construction, and about 10 in the planning stage (Table 1).
According to Jon Slater, president and CEO of Optivus, the US market is ripe for growth. Optivus is the company that engineered hospital-based proton therapy at Loma Linda. The Loma Linda proton center was recently named for proton therapy pioneer James M. Slater, MD, who is Jon Slater’s father.
“Looking at the history of radiation oncology, in which new modalities offer more precise treatment, I see proton beam therapy as a replacement for x-ray radiation therapy,” Mr. Slater told ONI.
Asked whether the costs of PBT to our healthcare system are justified, Mr. Slater said, “This year, proton therapy will generate about $100 million in clinical revenue out of a system that spends $2 trillion on healthcare. I think if there is interest in cutting costs, one of the last places you should look is proton therapy.”