Proton therapy technology is the least of your worries.

Proton therapy lived in large research institutes for almost half a century. The method used to convert a current of protons into a beam that could be used to treat tumors was limited by the technology that was available from the 1950’s onwards. In 1986 pencil beam scanning (PBS) was introduced at the Paul Scherrer Institut. PBS allows for the maximal reduction in integral dose. With the PBS delivery technique of  Intensity Modulated Proton Therapy (IMPT) it also provides greatest flexibility in shaping the dose distribution.

It took two more decades — and further advancements in especially imaging — before PBS was fully recognised as the way forward. Today all vendors provide PBS as their main or even only method of treatment delivery. As all protons are created equal there are only marginal differences in the quality of the dose distributions delivered by the various vendor solutions.

Of course there is still enough to choose between, and identifying the right vendor for an initiative is still important. But it is important to realise why proton therapy initiatives have stalled, and why too many proton therapy centers have struggled to the point of bankruptcy1. The reasons include the following:

  • Not having made transparent how offering proton therapy aligns with the mission of the organisation
  • Overestimating how many of their own radiotherapy patients would benefit from proton therapy
  • Assuming the mere offering of proton therapy treatments would result in substantial patient referral
  • Underestimating the time the organisation needed to climb the learning curve
  • Failing to engage with stakeholders in a structural and timely fashion

There are still other reasons too, but “because of failing equipment” is not among them.

 

***

If you found this to be of interest perhaps you may want to read the following original contributions: Solutions in proton therapy — for initiatives (a report), Procuring proton therapy equipment (a case) and A Business Case for a proton therapy initiative (a case).

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This is how we make proton therapy a success

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Patient selection and patient referral are pivotal.

Many proton therapy centers struggle because of an unrealistic projection of the number of patients that will be treated. In the past, and even in the present, the number of patients projected to be treated was simply the number that was required to make the business case look good. Today we know that the most successful centers treat, on average, no more than 300 patients per treatment room. But to achieve even this number takes great effort. There is the challenge of identifying the patients who will benefit from proton therapy, and there is the challenge of getting these people referred to the center.

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