Cancer is a complex and challenging disease, and patients need to explore the most effective treatment options available. One approach that has captured attention in the field of cancer treatment is proton therapy, a specialised form of radiation therapy.

In this blog, we will delve into the benefits of proton therapy, providing you with valuable insights to help you make informed decisions about your cancer treatment journey.

What is Proton Beam Therapy?

Proton therapy is a form of radiation therapy that utilises protons—positively charged particles—instead of X-rays used in conventional treatments. This form of therapy has been authorised for use by the U.S. Food and Drug Administration and is employed worldwide.

The main feature of proton therapy is its method of focusing intense radiation directly on the tumour with minimal impact on the surrounding healthy tissues. This approach helps to focus the treatment effects on the tumour itself, reducing the exposure of non-cancerous cells to radiation, aiming to limit side effects and enhance patients' quality of life during and post-treatment.

Which Cancers Are Treated With Proton Therapy?

Proton therapy provides a targeted radiation treatment that is particularly beneficial in managing cancers located near critical structures such as spinal cord and skull base tumours or in paediatric cases where precision is crucial. This treatment approach is also useful for both malignant and benign tumours that require careful handling to preserve surrounding healthy tissues.

Proton therapy is also used in treating various cancers, including:

• Brain tumours, including those at the base of the skull
• Spinal cord tumours
• Head and neck cancers
• Breast cancer
• Lung cancer and other thoracic cancers
• Liver cancer
• Pancreatic cancer
• Rectal cancer
• Prostate cancer
• Certain sarcomas
• Tumours that come back and need repeat courses of radiation (reirradiation)
• Eye cancer, such as ocular melanoma

Cancer specialists carefully evaluate each case to determine the suitability of proton therapy, adapting treatment plans to the unique needs of each patient.

How Does Proton Beam Therapy Treat Cancer?

As mentioned, proton therapy uses tiny particles called protons to target and destroy cancer cells. Special machines speed up these protons, giving them enough energy to reach deep inside the body and target the tumour while sparing nearby healthy tissues.

Proton beam therapy involves the proper control of proton beams that doctors can carefully control to target tumours. This beam is guided by magnets, allowing it to reach the cancerous cells from different directions. Doctors can also adjust the intensity of the beam to deliver the right amount of radiation to the tumour.

The protons cause minimal damage to healthy tissues as they travel through the body. They release most of their energy when they reach the tumour, disrupting the DNA of cancer cells. This prevents the tumour cells from repairing themselves and inhibiting their ability to multiply, which effectively leads to the tumour's reduction or elimination. Beyond that, proton therapy ensures that the surrounding healthy tissues receive significantly less radiation compared to traditional radiation therapy, which continues beyond the tumour, potentially affecting other areas.

This targeted treatment capability makes proton therapy an option to treat cancers located near critical structures or within sensitive areas of the body, as it minimises the risk of damage to vital organs. However, the effectiveness and impact of proton therapy can vary, influenced by factors such as the tumour's size, type, and location within the body.

Therefore, while proton therapy can be employed as a standalone treatment, it can also be leveraged in combination with X-ray radiation therapy, surgery, chemotherapy, or immunotherapy, providing a comprehensive approach to fighting cancer.

Benefits of Proton Therapy

Proton therapy can offer advantages in the treatment of various cancers by using a focused beam of protons, differing fundamentally from traditional X-ray radiation therapy in several key ways:

• Focused Radiation Delivery: Proton therapy offers a lower risk of radiation damage to healthy tissues surrounding the tumour. Its targeted nature allows for higher radiation doses to be delivered to the tumour, increasing the likelihood of destroying all cancer cells while minimising harm to surrounding organs.
• Preservation of Critical Functions: For tumours located near vital organs or functions such as speech and memory, this therapy minimises the risk of damage, preserving essential neurological and physiological functions.
• Less Radiation to Vital Organs: Proton therapy limits radiation exposure to important organs like the heart, lungs, and spine when treating nearby cancers, reducing potential long-term complications.
• Milder Side Effects: Proton therapy has shown potential for fewer and milder side effects during and after treatment. Common side effects such as low blood counts, fatigue, and nausea are often less severe compared to traditional radiation therapy. This may improve the overall quality of life for patients undergoing treatment.
• Suitable for Paediatric Use: The reduced radiation exposure is particularly advantageous for children, whose developing bodies are more vulnerable to the harmful effects of radiation. It decreases the risk of developmental delays and other severe long-term effects commonly associated with traditional radiation treatments.
• Lower Risk of Secondary Cancers: With less radiation reaching healthy tissues, the therapy might lower the likelihood of developing secondary cancers, a significant concern with conventional radiation methods.
• Feasibility for Retreatment: Proton therapy can be safely used to treat areas that have previously been irradiated. This capability is especially beneficial for recurrent tumours, allowing previously treated regions to be targeted again without excessive risk of damage to already affected tissues.

What Are the Disadvantages of Proton Radiation Therapy?

While proton therapy offers can offer many benefits, there are several factors to consider that might limit its accessibility and suitability for some patients:

• Limited Availability: Proton therapy centres require significant investment and infrastructure. The costs associated with establishing proton beam facilities are substantial, with investments reaching millions of dollars. This might mean that there are fewer treatment centres compared to standard radiation therapy facilities. Patients might have to travel significant distances for treatment, sometimes even internationally.
• High Costs: The technology used in proton therapy makes it more expensive than conventional radiation therapy. The construction and operation of proton therapy centres involve substantial financial investment, often reflected in higher treatment costs.
• Extended Planning Time: Preparing for proton therapy can be more time-consuming than for other forms of radiation treatment. This includes tumour mapping and custom treatment planning, which can delay the start of the therapy.

Steps to Prepare for Proton Therapy

Proton therapy is a meticulous process that involves several stages of planning to ensure the treatment is as effective as possible. Here's an overview of what to expect during the preparation phase:

• Financial Counselling and Insurance Coordination: Before starting proton therapy, it's important to understand the costs involved and how your insurance coverage applies. Not all policies cover proton therapy, and there are specific criteria for MediShield Life coverage, such as cases where other treatments carry an unacceptable risk of severe side effects. And Integrated Shield Plans offer varying levels of coverage with a maximum cap. Therefore, work with your healthcare provider and insurance provider to determine your financial obligations and explore available options.
• Imaging and Mapping: Initial steps include detailed imaging, such as CT scans, to determine the tumour's location and size. These images help the radiation oncologist to map the tumour's dimensions and the surrounding critical tissues.
• Simulation and Positioning: Using the imaging data, the team simulates the treatment to finalise the patient's position during therapy.
• Dose Planning: Dosimetrists and the radiation oncologist work together to calculate the exact radiation dose needed, how the proton beam will be positioned and how deep it should penetrate to optimally treat the tumour while sparing healthy tissue.

Overview of Proton Beam Treatment Sessions

Proton beam therapy is a controlled treatment process conducted in specialised centres designed to maximise patient comfort and treatment efficacy. Here’s what you can expect during each session of proton beam therapy:

• Setting Up: Each treatment session typically begins with you being positioned on the treatment table, using the same setup determined during your simulation to ensure accuracy.
• Gantry Alignment: The radiation oncologist adjusts the large mechanical arm known as the gantry. This equipment rotates around you, aligning the proton beam with the markings on your skin that indicate the tumour's location.
• Imaging: Before the treatment starts, an X-ray or another imaging scan is performed to verify your position and ensure everything is aligned.
• Operation of the Proton Beam: The medical team operates the proton beam machine from a separate room. They monitor you via a video camera, ensuring they can see and communicate with you.
• Beam Activation: The proton beam, directed by the gantry, focuses a narrow beam of protons at the tumour. The gantry may rotate around you, targeting the tumour from various angles.
• Sensation During Treatment: You will not feel the proton beam as it treats the tumour. However, you might hear noises from the equipment as it operates and moves around you.

Managing Side Effects of Proton Therapy

However, like all treatments, proton therapy may have side effects. These are generally milder compared to traditional radiation, but awareness and management are key:

• Skin Reactions: The treated area might show redness or resemble a sunburn. These symptoms are typically mild and manageable.
• Hair Loss: You may experience hair loss specifically in the area where the proton beam is applied.
• Fatigue: It's common to feel a general sense of tiredness after sessions, which gradually improves.
• Localised Side Effects: Depending on the treatment area, you might encounter headaches, digestive issues, or other localised symptoms.

Does Singapore Have Proton Therapy?

Proton beam therapy is currently available at Mount Elizabeth Novena Hospital, Goh Cheng Liang Proton Therapy Centre and Singapore Institute of Advanced Medicine Holdings (SAM.). With the availability of proton therapy in Singapore in 2023, patients with cancers located in sensitive areas, such as the brain, head/neck, and prostate, will no longer need to seek treatment abroad in countries like Taiwan or South Korea, as local oncologists can provide this therapy.

OncoCare's Proton Beam Therapy Cancer Treatments

At OncoCare, we understand the importance of providing effective treatment options to our patients. We work with radiation therapy specialists to offer proton therapy for various types of cancer, including prostate cancer, head and neck cancer, and more. Our dedicated team of cancer specialists in Singapore is committed to providing personalised care and guiding you through your treatment journey.

To determine if proton therapy is suitable for you, we encourage you to consult with our cancer doctors at OncoCare. Together, we can explore the appropriate treatment options tailored to your specific needs, ensuring quality care throughout your cancer treatment.