Protontherapy
"Protontherapy is the most precise external radiation therapy that protects healthy tissue as much as possible because it does not expose them unnecessarily to radiation".
DR. JAVIER ARISTU DIRECTOR. RADIOTHERAPEUTIC ONCOLOGY DEPARTMENT
What is proton therapy?
Proton therapy or proton beam radiotherapy is a very precise treatment that minimizes damage to healthy neighboring tissues, structures and organs close to the tumor. Proton therapy is displacing classical photon radiotherapy as the first choice treatment in many tumor sites due to its lower toxicity and high precision.
The Proton Therapy Unit at the Clinica Universidad de Navarra in Madrid is one of the most advanced in Europe and the first in a Cancer Center, with all its assistance, academic and research support.
Proton therapy generates a more efficient distribution of energy than photons, making it possible to direct higher doses to the tumor area without increasing the doses in other areas, minimizing the potential damage that radiotherapy can cause in healthy or very sensitive tissues, or in growing tissues, as in the case of children.
More than 300,000 patients have already been treated with this therapy worldwide. It provides very promising results with minimal side effects in pediatric tumors, ocular melanoma, skull base tumors, brain tumors, head and neck tumors, esophageal cancer, lymphomas, and spinal and paraspinal sarcomas.
In addition, research is underway to extend its indications to other types of tumors such as breast, lung, liver, prostate and gynecological tumors.
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What types of cancer is proton therapy for?
Recommended Indications for Proton Therapy
1. Pediatric patients
- Indicated for most pediatric tumors where cure or long-term survival is anticipated.
2. Adults
- Intraocular and orbital tumors.
- Primary tumors located at the skull base, including chordoma and chondrosarcoma.
- Primary paraspinal and retroperitoneal sarcomas.
- Hepatocellular carcinoma, especially in patients with impaired liver function.
- Cases requiring craniospinal irradiation.
- Low-grade gliomas of the CNS.
- Benign CNS tumors located near radiosensitive structures where the full dose cannot be delivered using conventional techniques.
- Head and neck tumors, mainly advanced nasopharynx, oropharynx, paranasal sinuses, nasal cavity, and salivary glands.
- Mediastinal lymphomas.
- Re-irradiation.
- Tumors showing a dosimetric benefit and currently under clinical investigation: breast, lung, prostate, gynecologic, and bladder cancers.
It is considered the radiotherapy treatment of choice for children suffering from cancer, since proton therapy, unlike conventional radiotherapy, respects healthy tissues (which are still forming) and minimizes the medium and long-term sequelae, which is essential for the child's future development and quality of life when he or she becomes an adult.
In addition, for elderly people who generally have other pathologies (diabetes, cholesterol, hypertension, kidney problems...) it is also a great advance since the use of protons does not add additional damage to the tissues that are already chronically affected.
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PROTON THERAPY CENTER IN SPAIN
The most advanced Proton Therapy Unit in Europe
The Clínica Universidad de Navarra allies with Hitachi to offer for the first time in Europe the same technology already present in 27 leading international cancer treatment centers.
How does proton therapy work?
How proton therapy is performed
Before starting treatment, a dosimetric planning process is performed on a computer (Treatment Planning System) to determine the most optimal plan for each patient. This process determines and selects the number of proton beam incidences, their energy, and other necessary parameters to achieve the best performance in dose distribution.
Proton therapy uses protons extracted from hydrogen gas molecules, which are injected into a linear accelerator.
In the particle accelerator, either a cyclotron or a synchrotron, four magnets move the protons in a circular path, and an electric field gradually increases their speed. When they reach sufficient velocity, they are diverted for use in treatment.
Before beginning treatment, a cone-beam CT scan is performed to visualize the patient’s internal anatomy, which is then fused with the planning CT scan to precisely locate the tumor, verify any anatomical differences, and make millimeter-level adjustments to the patient’s position if displacement has occurred.
Once the patient is positioned exactly for optimal treatment delivery, the proton beam deposits nearly all of its energy in the tumor from different fixed angles (generally three incidences). It causes minimal damage to healthy tissues located in front of the tumor and no damage to tissues behind it.
Proton therapy sessions have an average estimated duration of about 35 minutes, depending on their complexity and support requirements (such as anesthesia). Most of this time is devoted to placement, positioning, and verification using image guidance (CT integrated into the gantry). The actual irradiation time is, in most cases, 2–3 minutes.
The number of sessions will depend on each case and the tumor’s characteristics, such as location, type, and size. On average, treatment consists of 20 to 30 sessions.
This entire process makes proton therapy the best alternative for tumors that are difficult to access or are surrounded by healthy vital structures and organs that must be preserved from receiving radiation doses.
Advantages of proton therapy
Proton therapy offers several advantages over conventional radiation therapy, such as intensity-modulated radiation therapy (IMRT) or external beam radiation therapy (EBRT). Some of the advantages of proton therapy include:
Precision: protons have unique physical properties that allow them to deposit most of their energy in a specific area called the Bragg peak. This means that proton therapy can more precisely target tumors, which reduces the risk of damaging surrounding healthy tissues and organs.
Fewer side effects: Because of the greater precision in radiation delivery, proton therapy generally causes fewer side effects than conventional radiation therapy. Patients may experience less skin irritation, fatigue and other symptoms associated with radiation.
Reduced risk of radiation to healthy tissues and organs: Proton therapy allows for a more focused radiation dose distribution, which reduces the amount of radiation received by healthy tissues and organs near the tumor. This may decrease the risk of developing long-term complications and radiation-related side effects.
More effective treatment for certain types of cancer: Proton therapy may be especially beneficial in treating certain types of cancer, such as brain tumors, pediatric tumors, skull base tumors, head and neck tumors, and prostate tumors, among others. These tumors can be difficult to treat with conventional radiation therapy because of their location near critical organs and tissues.
Shorter treatment: Proton therapy often requires fewer treatment sessions compared to conventional radiation therapy. This can translate into less disruption to the patient's daily life and faster recovery.
Potential to treat radiation-resistant tumors: Some tumors may be resistant to conventional radiation therapy, but may respond better to proton therapy due to the ability of protons to deliver higher doses of radiation to the tumor.
Lower risk of secondary cancer induction: Proton therapy may decrease the risk of developing a second radiation-induced cancer compared to conventional radiation therapy, especially in pediatric patients and those requiring treatment to sensitive areas of the body.
Despite these advantages, proton therapy is not suitable for all patients and is not available at all treatment centers. It is critical that patients consult their physician to determine if proton therapy is an appropriate treatment option for their specific situation.
Efectos secundarios de la protonterapia
Proton therapy minimizes the toxicity experienced by patients and is one of its most well-established advantages.
Although no cancer treatment is completely harmless to the patient, proton therapy presents fewer side effects because it causes less toxicity in the irradiated area, making it one of the best-established advantages compared to other types of external radiation therapy.
The side effects associated with proton therapy are multifactorial and depend on the interaction between the radiation itself on the tissues and the patient’s overall condition and the tissues exposed to radiation.
- Fatigue: Fatigue is a common side effect of proton therapy and can last for several weeks after completing treatment. It is important for patients to get adequate rest and follow their doctor’s recommendations to manage fatigue.
- Skin irritation: If the tumor is located close to the skin, some patients may experience redness, dryness, itching, or peeling in the treatment area. These symptoms are usually temporary and resolve after completing therapy.
- Loss of appetite: Proton therapy may cause loss of appetite in some patients. It is important for patients to try to maintain a balanced diet and consume enough calories and nutrients to support recovery.
- Nausea and vomiting: These side effects may be more common in patients receiving treatment in areas near the stomach or brain. Doctors may prescribe medication to control nausea and vomiting if they persist.
- Hair loss: Hair loss may occur when proton therapy is applied to the cranial area.
The expected toxicity of each radiation therapy treatment is individualized and highly predictable. All of this is explained in advance and in detail to each patient before obtaining informed consent.
Proton therapy Center in Madrid
The Proton Therapy Unit
of the Clínica Universidad de Navarra
The Proton Therapy Unit of the Clínica Universidad de Navarra in Madrid is the most advanced in Europe and the first in a Cancer Center, with all its assistance, academic and research support.
The Clinic's Proton Therapy Unit incorporates a Hitachi synchrotron, this technology is present in 32 clinical and academic centers, among which are international references in cancer treatment, such as the Mayo Clinic, MD Anderson, John's Hopkins, St. Jude's Children's Research Hospital or Hokkaido University Hospital.
More information about the Proton Therapy Unit
Why at the Clinica?
- Expert professionals of international reference.
- Greater accessibility for national and international patients.
- Integrated within the Cancer Center Universidad de Navarra with the most advanced diagnostic technology, services and the latest advances in cancer treatment.
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