Miami embraces proton therapy
Some hard-to-treat cancers respond to the technique
Dr. Michael Chuong in the gantry with the proton machine at the Miami Cancer Institute.
When 30-year-old Olga Alarcon Cruz learned she had invasive breast cancer, she was terrified. A mother of two, Cruz pondered her treatment options, seeking one with fewer side effects than chemotherapy and less drastic than a mastectomy.
She explored the possibility of proton therapy, which uses a powerful machine to target radiation in the form of protons to the exact location of the tumor with a pencillike beam. Now, after 36 treatments ending in November, her breast cancer is gone, and she will follow up with a year of immunotherapy, a treatment that boosts the body’s immune system to fight cancer. “It was a commitment to go back for treatment every day, but I really had no side effects,” said Cruz of Miami.
Over the past three years, Miami Cancer Institute at Baptist Health South Florida has used proton therapy on more than 500 patients for a variety of hard-to-treat cancers. Because the 200,000-pound machine allows doctors to target high doses of radiation at the tumor with precision, patients with tumors in the brain, head and neck, spine, breast, lung, esophagus, pancreas, liver, prostate, anal canal and chest are seeing better results and fewer side effects than other cancer treatment options, according to doctors at
the facility.
“The main difference between proton therapy and x-ray therapy [traditional radiation] is that protons will stop exactly where we want them to stop so there is no dose that will go through the other side of the tumor,” explains Dr. Michael Chuong, director of Clinical Research & Education at Miami Cancer Institute.
Each week, the oncologists at Miami Cancer Institute, the only South Florida hospital using the treatment, meet to determine which patients will benefit most from proton therapy, limited by the hours in a day patients can access the three multi-million dollar machines the center has purchased.
The machines direct a proton beam into an area less than a millimeter in diameter to treat tumors that are inoperable, close to critical parts of the body or in difficult locations such as behind the eye or in the anal canal. Small pencil beams of protons are delivered one layer at a time until the entire tumor is treated.
Traditional X-rays penetrate healthy tissue and organs on their way in and out of the body, but protons can target the tumor without that damage. Proton therapy also creates less chance of a recurrence of cancer from excessive radiation exposure.
For women like Cruz, with breast cancer on the left side, proton therapy is particularly effective because she would be at greater risk of cardiac disease if heart tissue is compromised during other types of radiation.
Chuong said physicians like to treat childhood cancers with proton therapy because it reduces the risk of damage to healthy tissue and decreases the odds of other tumors later in life from radiation exposure. Children from nearby Nicklaus
Children’s Hospital are being brought to Miami Cancer Institute for proton therapy treatment. Of the 500 patients treated thus far at Miami Cancer Institute, 67 have been children. Most patients have been from Florida, with about 5% from outside the United States.
Proton therapy is performed on an outpatient basis, typically over a six-week period.
“Not every patient that needs radiation needs proton therapy,” Chuong said. “Probably 20 to 30% will have a clinically significant benefit with proton therapy. A lot of the trials to clarify who those patients are, are being developed out of Miami Cancer Institute.”
Chuong, for example, treats patients with gastrointestinal cancers and difficult to treat anal cancer. “Anal cancer is treated predominantly with radiation and chemotherapy,” he said. “I am running a trial that will look to show proton therapy is better in terms of reduced side effects and high cure rates. I’m hoping to open it up in the next year or so. “
Like most cancer treatment, proton therapy is costly — typically from about $30,000 to $120,000. In contrast, a course of treatment with radiosurgery costs about $8,000-$12,000, according to estimates published in medical journals. Chuong said the hospital charges the same price as x-ray therapy and works to get insurance coverage for patients by making a case for the benefits over other treatments. Cruz said insurance covered her proton therapy treatment for breast cancer.
Michael Zinner, CEO of Miami Cancer Institute, said patients from Broward and Palm Beach counties are driving to Miami Cancer Institute, the only South Florida facility that offers proton therapy and other advanced radiation technologies. Orlando, Gainesville and Jacksonville are Florida’s other cities with proton therapy centers.
In July, Lynn Cancer Institute in Boca Raton became part of Baptist Health South Florida. Now, medical professionals at Lynn are training on the proton therapy machines in Miami. “We are meeting with them regularly,” Zinner said. Plans are in the works for Lynn to get its own proton therapy machine, but until then, doctors from Boca Raton may bring some of their patients to Miami to receive treatment.
From 2010 to 2015, the number of proton treatment centers across the U.S. doubled, but not all were successful as doctors struggled to prove the superiority of the therapy and treat enough patients to support the costly machinery.
Today, the technology has improved and Zinner notes that Miami Cancer Institute offers the most advanced type of proton therapy using pencil beam scanning. “We are able to give more aggressive treatment in a safer manner,” he said. “We are proud that people don’t need to leave South Florida to get state-of-the-art cancer treatment.”
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