Coming soon to Oncologics, Inc. is Louisiana's first Clinatron-250™ proton beam radiation therapy system. Manufactured by Still River Systems, this state-of-the-art PBRT technology will allow oncologists to treat patients by delivering the maximum dosage of radiation to cancerous tumors, while sparing surrounding tissue, organs and bones. Oncologics is one of the few centers in the U.S. to commit to this system. Most physicians use the external beam standard photon therapy for treating malignant tumors. Photon therapy delivers a high radiation dose at the point of entry into the body, then gradually delivers lower doses along the beam path until photons leave the body. But, this method can cause damage to tissue surrounding the cancerous tumor. With PBRT, doctors can pinpoint the beam of protons directly into the tumor, preventing destruction of healthy areas. "The difference between a proton beam and a photon beam is that the proton beam does not release the energy until it gets to a tumor," explained Dr. M. Maitland DeLand, radiation oncologist and president of Oncologics, a group of 11 cancer treatment centers. "The proton beam will get to the point where it is shaped exactly in the shape of the tumor, and that is where it deposits all of its energy. That is a characteristic of a proton beam –it will only deposit its energy within a certain area." The proton beam allows physicians to use a higher dose of radiation to target tumors. "Because you don't injure the surrounding tissue, you can get 25 percent more dosage," DeLand said. "And, if you can imagine, in something that's so hard to eradicate, to be able to get 25 percent more dose and not hurt surrounding tissue – that is an amazing thing for our field." Protons are produced by the use of an ion source. Initially, they are produced at a low speed, then spun around and accelerated up to the treatment energy through a cyclotron. Once the protons reach the treatment energy, they are extracted outside of the cyclotron into the treatment beam. At that point, the proton beam goes through a series of modifiers which shape it three-dimensionally – longitudinally, horizontally and by depth – to penetrate into the body. "We use that to shape the beam to actually treat the tumors," explained John Duhon, director of medical physics. "The protons will actually go into the tumors and nowhere else. That is main advantage of treating with protons, is that they will penetrate to a certain depth, deliver all of their energy, and will not pass through the body any further – they stop. So, no more dose is given beyond the point where all of the protons stop, which is contrary to our traditional treatment beams – X-rays or photon beams – which have some exit dose." Before the procedure, patients undergo preliminary steps similar to those involved in traditional photon or X-ray therapy. Technicians perform a CT, MRI or PET scan to identify the exact location of the tumor in the body. The patient will then enter a treatment room, lie down on a flat couch and move into position with the machine. Once the patient is in proper place, the therapist will leave the room, and the device will beam on. The entire process is expected to take 20 minutes. "It will be comparable to the photon," Duhon said. "This machine was designed to work similarly to our current devices." This gold standard in cancer treatment is particularly effective for treating cancers in the brain, eye, head and neck, lung, spine and prostate. "So, for example, the prostate is right between the rectum and the bladder, and it is very small – the size of a walnut," DeLand explained. "With the proton beam, because the energy just goes to that area, everything else is spared. The patients have no side effects." Side effects with PBRT are less than with the photon beam because of the ability to stop protons completely, and not treat normal tissues. PBRT is also the preferred radiation method for treating pediatric patients. "I am very excited to be able to use that for very difficult areas to treat and for children, because, even though we treat children right now, and we have forms where we can spare normal tissue, it's wonderful to know that you are not treating the heart of a child in the treatment of the spinal cord for a spinal cord tumor," DeLand said. "It's wonderful that you don't have radiation going in other places. So, to be able to tell somebody that it has essentially no side effects is magic for me. And, you can't imagine how excited I am about it. For me, it's the next biggest step ever in radiation oncology." Previously, DeLand referred patients to Boston for treating difficult tumors or cancer recurrences. Currently, only a handful of U.S. centers have large-scale proton beam radiation therapy systems. These units weigh more than 440,000 pounds, require almost 100,000 square feet of space, and cost from $130 to $240 million for the equipment and building. Because of the high cost and large space requirements, only 20 of these proton therapy centers exist worldwide. The brand-new Monarch250 PBRT system purchased by Oncologics is much smaller – and more affordable at $25 million. Among the other facilities committing to this new technology are the M.D. Anderson Cancer Center - Orlando, Washington University School of Medicine's Barnes-Jewish Hospital, Oklahoma University's Cancer Institute, and Tufts Medical Center in Boston. "These new systems are much more affordable for the community," DeLand said. "And frankly, not everyone can afford to go to Florida or Houston, and there are huge waiting lists there." DeLand is proud that Oncologics was one of the few facilities in the country to receive this advanced technology. She explained that this new technology is not available to just any facility. "They (Still River Systems) come in and interview the doctors and the physics staff. And, if they do not think you can handle it, then they will not sell it to you," she said. "That's unlike any machine I know. They don't typically interview you before selling a machine to you." Duhon is impressed that a small city like Lafayette was able to snag this system. "Up until just a couple of years ago, I would have never believed that this kind of technology would ever be able to be brought to a town of this size," he said. "It was always large national and international centers that could only offer such advanced-type treatments. It is just amazing that we are now at a point in the technology where we can bring it to towns of this size." DeLand is excited about bringing this new technology to Louisiana. Oncologics hopes to install the machine next year, and have it up and running in the fall of 2010 or spring of 2011. "When I get mine, I am going to start out treating those people that need it the most – that have side effects which affect the quality of their lives forever," she said.
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