
Radiation oncologist Oren Cahlon leads MSK's program in proton therapy.
Traditionally, particle accelerators have been used to conduct elaborate physics experiments by propelling charged particles at very high speeds. In addition, some medical centers, including Memorial Sloan Kettering, employ these massive machines to produce molecules for PET imaging. But these giant devices have another important use: creating cancer-fighting energy in the form of a proton beam to kill or shrink tumors while minimizing harm to healthy tissue.
Proton therapy, a highly sophisticated form of radiation, is currently available at only 14 locations in the United States. In the fall of 2013, MSK physicians began using proton therapy at a facility in Somerset, New Jersey, to treat a variety of cancers under the leadership of Oren Cahlon, MSK’s Director of Proton Therapy, and radiation oncologist Nancy Y. Lee, Vice Chair for Experimental Therapeutics. Dr. Lee also serves as the medical director and president of the New York Proton Center (NYPC), an affiliation of three New York City hospitals, including MSK.
Here, Dr. Lee explains how proton therapy delivers its dose so precisely and why it represents a leap forward in patient care.
How does proton therapy work, and how does it complement more conventional radiation therapies?
Traditional radiation uses beams of x-rays, which are waves of high-energy light. MSK has always been at the forefront of developing ways to optimize this treatment. In fact, over the last 15 years MSK radiation oncologists, including myself, have been leaders in showing the benefits of intensity-modulated radiation therapy (IMRT), a technique that targets tumors with multiple beams at different angles and intensities that now is widely used.
Proton therapy, by contrast, targets a tumor with charged particles, called protons. While proton therapy kills cancer cells through a process similar to that used in x-ray radiation — by damaging their DNA — the unique physical properties of protons allow them to deliver the dose at a specific depth in the body. With proton therapy, all energy has been released when it reaches the tumor site, so there is no dose beyond that point. This lowers the impact to normal tissues surrounding the tumor and reduces the risk of treatment-related side effects. There also are hints that proton therapy may work on recurrent tumors that are resistant to conventional radiotherapy, although this has not been confirmed.
Back to topWhat types of tumors can be treated with proton therapy?
Contact an MSK physician for a consultation.
-
For pediatric cancers, contact Suzanne Wolden:
212-639-5148 -
For head and neck cancers contact Nancy Lee:
212-639-3341 -
For all other cancers, contact Oren Cahlon:
212-639-5219
Proton therapy is most useful for localized cancers that have not spread from the original site. We have used it most often for head and neck tumors and for pediatric cancers. Head and neck tumors are surrounded by many critical structures, such as the brain stem, spinal cord, optic structures, tongue, and esophagus, so it’s essential to confine the particles to the cancerous tissue. Proton therapy is also beneficial for pediatric cancers because developing tissues in children are incredibly sensitive to radiation.
Other cancers also lie near important organs or tissue. When treating breast cancer, you obviously don’t want to damage the heart, and in some patients, proton therapy can reduce unwanted exposure to that area.
In fact, proton therapy might be useful for any disease site and is increasingly being considered as an option for all cancer types. In addition to the cancers I already mentioned, our doctors are using it to treat select spinal tumors, soft tissue sarcoma, prostate cancer, and lung cancer.
Back to topHave you already seen a reduction in side effects in patients receiving this therapy?
In our patients with salivary cancer in particular, there has already been a noticeable benefit. Almost all of these patients used to lose their sense of taste and have soreness on the inside of their cheek following conventional treatment, but it does not seem to happen with proton therapy. More broadly, we are conducting a study that compares side effects of proton therapy with IMRT in patients with head and neck cancer, and our preliminary findings indicate those treated with proton therapy have a better quality of life.
Back to topIs proton therapy covered by insurance?
Many insurers recognize that proton therapy has proven effective. It is covered by Medicare and by many of the private insurance companies for things like pediatric cancers and brain tumors, and in patients requiring re-irradiation [radiating new tumors that emerge in the same location as tumors that already received radiation]. However, for many diagnoses, it is dependent on the particular insurer, the patient’s benefits, and the clinical scenario. Sometimes the patient’s physician needs to communicate with a physician at the insurance company in order to obtain approval.
Back to topWhat are the most common misconceptions about proton therapy?
Probably the biggest is that this technology is new or investigative. Patients actually have been treated with proton therapy in the United States for several decades, but it has been limited to a handful of centers. Another misconception is that the actual treatment experience is dramatically different from x-ray radiation. In reality, proton therapy typically involves the same number of treatments with the same session times as conventional radiation therapy, and the day-to-day experience is indistinguishable. I continue to be a very strong proponent of IMRT, but it’s important that patients realize proton therapy is now an option through MSK.
Back to topComments
Mary1233
Feb 17, 2015 • 11:25 AM
Mary, thank you for reaching out. We consulted with Dr. Cahlon, and he responded that proton therapy would be appropriate In rare cases, only after multiple prior courses of radiation to the brain. We would encourage you to come see someone at MSK for a full evaluation. If you are interested in making an appointment, you can call 866-886-9807 or go to:
http://www.mskcc.org/cancer-care/adult/brain-tumors-metastatic/appointm…
Call 866-886-9807
Jeanne Corvan
Feb 17, 2015 • 4:06 PM
I am a patient here with pancreatic cancer. I know that florida univ. is doing trials on pancreatic cancer. Other locations may be using proton therapy on pc. Is that done here or being considered. I did not see it on the list
I read on a page of another institution that proton therapy can be used on liver metathesis (and probably cancers that have metathesized. Why is that not being done here? or will it be?
thanks
Memorial Sloan Kettering
Feb 17, 2015 • 5:31 PM
In reply to I am a patient here with by Jeanne Corvan
Ann
Feb 18, 2015 • 6:28 PM
Helene RAUDASCHL
Feb 18, 2015 • 9:29 PM
Memorial Sloan Kettering
Feb 19, 2015 • 12:08 PM
In reply to Does this therapy treat CLL? by Helene RAUDASCHL
Helene, thank you for reaching out. Proton therapy is not being used to treat chronic lymphocytic leukemia. You can learn more about how MSK treats CLL at this link:
http://www.mskcc.org/cancer-care/adult/chronic-lymphocytic-leukemia/tre…
Mary1233
Feb 19, 2015 • 8:59 AM
Memorial Sloan Kettering
Feb 20, 2015 • 9:43 AM
In reply to Thank you for the response. I by mary1233
Belinda
Feb 19, 2015 • 3:17 PM
Belinda, thank you for reaching out. Yes, proton therapy can be used for parotid cancer in a patient with a pacemaker.
If you are interested in proton therapy for this cancer, you can call 212-639-3341.
YV
Feb 21, 2015 • 12:01 AM
Thank you for reaching out. To find out whether proton therapy might be appropriate for your case of lipo-leiomyosarcoma, we suggest you contact the MSK office of Oren Cahlon to inquire about a consultation at:
212-639-5219 extension 5219
Linda Salleroli
Feb 21, 2015 • 11:42 AM
Linda Salleroli
Feb 21, 2015 • 11:42 AM
Memorial Sloan Kettering
Feb 23, 2015 • 9:19 AM
In reply to I have Ocular Metastatic by Linda Salleroli
MUNISH GUPTA
Feb 22, 2015 • 7:58 AM
Memorial Sloan Kettering
Feb 23, 2015 • 9:21 AM
In reply to how is it different from DART by MUNISH GUPTA
Shubha Bajpay
Feb 22, 2015 • 6:56 PM
Memorial Sloan Kettering
Feb 23, 2015 • 9:37 AM
In reply to My mother had uterine cancer by Shubha Bajpay
Shubha, thank you for reaching out. We consulted with Dr. Cahlon, who says that proton therapy would not be the right treatment for this particular situation.
If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.
Wendy
Feb 26, 2015 • 5:20 PM
Wendy, thank you for reaching out. Gamma Knife is a form of highly focused radiosurgery—-it uses x-rays rather than proton beams. Gamma Knife is also limited by the size of the tumor, i.e. larger tumors are very difficult to treat with Gamma Knife. Proton therapy definitely can be used to treat chondrosarcoma. The best published outcomes for this tumor are with protons. We encourage you to contact Nancy Lee for a consultation at: 212-639-3341.
Jan Szulc
Feb 26, 2015 • 6:05 PM
I am surprised by one of your answers.
Proton Therapy is used in prostate cancer but not in metastatic prostate cancer.
I understand the part that they are at different locations.
My friend (in Poland) have prostate cancer.
Prostate was removed manually by surgeon.
Latter hormonal therapy.
With time, cancer went to sacral bone, removed by gamma radiation.
Time passes, highly active otherwise healthy 76yo man.
His PSA is starting to raise, cancer is back.
When is the right time the new cancer location will be found.
Hopefully another gamma radiation will be possible.
But I was hoping that in case that gamma radiation is acceptable then proton therapy should also be acceptable but less damaging to surrounding tissue.
Please comment.
Memorial Sloan Kettering
Feb 27, 2015 • 9:22 AM
In reply to I am surprised by one of your by Jan Szulc
CheryL Hersh
Feb 26, 2015 • 9:28 PM
Memorial Sloan Kettering
Feb 27, 2015 • 9:50 AM
In reply to Have you ever heard of Proton by CheryL Hersh
Michael Huang
Feb 26, 2015 • 9:38 PM
I am a 67 y.o Dx. local recurrent prostate cancer after radical prostectomy in 2002 and external pelvic radiation for chemical recurrent prostate cancer in 2004. slowly PSA rising from 2009.a 7-8 mm nodule of local recurrent prostate cancer Dx.by MRI .between bladder and rectum and confirmed by Bx. march,2014,PSA was 2.I have been getting lupron injection every 3 montjhs.plus CASODEX 50mg po daily past year.PSA my radiology oncologist is considering local radiation treatment .PSA now is 0.2.Am I a candidate for proton treatment?
Memorial Sloan Kettering
Feb 27, 2015 • 9:17 AM
In reply to I am a 67 y.o Dx. local by Michael Huang
Graciela
Feb 26, 2015 • 11:06 PM
Mi hija de 32 años tiene carcinoma neuroendocrino en el cuello del útero de 2,5 sin metástasis aparentemente. se podría aplicar terapia de protones???? Indican cirugia radical y quimioterapia tradicional porque donde vivo no hay otra cosa. Ella quería preservar su maternidad. que me puede decir???? Tenemos pensado llevarla al lugar que mas nos dé posibilidades. Gracias
Graciela
Querida Graciela, sentimos que tu hija ha sido diagnosticada con cáncer. No podemos ofrecer consejos médico a través de nuestro blog. Si ella quiere hacer una cita con uno de nuestros especialistas para discutir sus opciones de tratamiento, por favor llame a nuestro servicio de acceso médico: 800-525-2225. El personal del sevicio pueden contestar sus preguntas sobre la posibilidad de preserver su fertilidad ántes de recibir tratamiento. Puedes leer más sobre la fertilidad y cáncer en ésta página: http://www.mskcc.org/cancer-care/survivorship/fertility
Gracias por su comentario y desamos lo mejor para tu hija.
Mariela
Feb 27, 2015 • 11:58 AM
I had state 3 lung cancer in 2007 and was cured with lobectomy, chemotherapy (before and after surgery) and radiation. In 2012 I developed a a right supraclavicular metastatic node, and was again saved by surgery, followed by chemo and radiation. I am healthy, active and feel great . . . . but - should the cancer return at some point, might I be a candidate for proton therapy?
Memorial Sloan Kettering
Feb 27, 2015 • 12:09 PM
In reply to I had state 3 lung cancer in by Mariela
NORMAN LIEBERMAN
Feb 27, 2015 • 4:50 PM
Memorial Sloan Kettering
Feb 27, 2015 • 4:55 PM
In reply to Is this procedure available by NORMAN LIEBERMAN
Ann
Mar 9, 2015 • 3:54 PM
Ann, thank you for reaching out. Yes, proton therapy can be used for this condition. If you are interested in a consultation, contact the office of Oren Cahlon at 212-639-5219.
John Hunting
Mar 11, 2015 • 12:52 PM
Memorial Sloan Kettering
Mar 12, 2015 • 9:54 AM
In reply to Can proton therapy be used by john hunting
John, thank you for reaching out. Proton therapy very recently started to be used for anal cancer at some centers, although Memorial Sloan Kettering is not currently using protons for this cancer. We suggest you contact University of Pennsylvania and Massachusetts General Hospital, who may have begun using proton therapy for anal cancer.
REV
Mar 27, 2015 • 4:30 PM
Chris
Mar 30, 2015 • 6:01 PM
My mother has non hodgkins Lymphoma and we are looking at further treatments after it seems chemotherapy has failed with a view to a cure.
Having read up on Proton therapy, it seems that this targeted treatment is a viable option. Can you confirm if that is so and if MSK would provide such treatment? Currently, I have contacted MD Anderson in Texas but they only provide this treatment if the mass is located around the medial stynal or sturnam. She has the growth pushing against to her upper bowel. Thank you in advance for your help.
Chris, thank you for reaching out. MSK currently does not use proton therapy for the specific condition you are describing. If you are interested in a consultation for your mother regarding other treatment options, you can contact our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.
Sue Ann Oaks
Apr 7, 2015 • 9:45 PM
Brenda Zucchi
Apr 20, 2015 • 9:56 PM
Memorial Sloan Kettering
Apr 21, 2015 • 1:30 PM
In reply to Can proton therapy be used on by Brenda Zucchi
Brenda, thank you for reaching out. We consulted with Dr. Cahlon, and he responded that proton therapy is not typically used for metastatic cancers such as what you describe.
If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.
Anonymous
May 9, 2015 • 11:23 PM
Memorial Sloan Kettering
May 10, 2015 • 3:03 PM
In reply to Hello, how long after surgery by Anonymous
Hi, we are not able to answer personal medical questions on our blog. This is something you should discuss with your healthcare team. If you’d like to make an appointment for consultation at MSK, you can call 800-525-2225 during regular business hours or go to http://www.mskcc.org/experience/become-patient/appointment for more information. Thank you for your comment.
Anonymous
May 11, 2015 • 3:39 PM
I have been diagnosed with prostate cancer in the right side of the prostate gland. My PSA was 8.8 and the Gleason score was 3+4. I am debating the pros and cons of IMRT vs. Proton Therapy vs. high dose brachytherapy. I'm interested in knowing if there is an article which compares the results and side effects of each.
Thank you for reaching out. There are a few studies that may be of interest, examining the use of IMRT combined with brachytherapy:
Comparison of high-dose (86.4 Gy) IMRT vs combined brachytherapy plus IMRT for intermediate-risk prostate cancer.
http://www.ncbi.nlm.nih.gov/pubmed/24447404
Combined brachytherapy with external beam radiotherapy for localized prostate cancer: reduced morbidity with an intraoperative brachytherapy planning technique and supplemental intensity-modulated radiation therapy.
http://www.ncbi.nlm.nih.gov/pubmed/18299108
For a consultation about whether proton therapy may be appropriate, contact the office of Oren Cahlon:
If you want to make an appointment with a Memorial Sloan Kettering physician, you can call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment.
Can this be used when the cancer has spread to the brain?