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The Superiority of Proton Therapy

February 1, 2017

Proton beam therapy is the wave of the future because of its accuracy and reduced side effects. Can x-rays and surgery achieve the same results? Some radiologists make that claim, but the statistics say otherwise. Urologists often call surgery the "gold standard," yet that does not prove to be the case. Some critics say protons are unproven, even though 160,000 people have been treated worldwide and new centers are being built all around the country at great cost.

Intesity Modilated Radiation Therapy (x-rays) minimizes morbidity by using numerous rays of a smaller dose directed from around the target so that healthy tissue gets a lower dose while the target gets the total accumulated dose. Some types of x-radiation send rays from all 360 degrees around the target. Virtually the entire area is bathed in x-rays of one energy or another.

As a result, secondary cancers are far more common with x-rays than PT. That was one of the “scary” facts that steered me away from considering x-radiation. IMRT costs less but produces 59% more secondary prostate cancer. A study by Nancy P. Mendenhall published in The International Journal of Radiation, Biology, Physics (Vol. 88, Issue 3, pp. 596-602) reports that IMRT increases the risk of potential recurrence for prostate cancer by fifteen times! Given the above statistic of 59% for IMRT, that would make recurrence for protons about 4%. But that’s for the older version of proton therapy. Recent improvements have lowered that number even more. M. D. Anderson Clinic in Houston calculated for esophageal cancer X-rays have a 96% additional cancer risk.

And surgery? A survey carried out by Bryant Research profiled 755 men, ages 50-75, who were surveyed at least 12 months after treatment. Among the findings were these statistics.

★ The proportion of proton therapy patients reporting that their treatment had NO impact on their sexual function was almost double that of the next best scoring treatment in this survey.

★ Ninety-seven (97%) percent of proton therapy patients said they would recommend their treatment to other men with prostate cancer, significantly higher than the other treatment options.

★ Ninety-seven (97%) percent of proton therapy patients said they would select this same treatment option should they have to make the decision today compared to brachytherapy (68%), conventional radiation therapy (66%), and surgery (58%) patients.

Oops, it doesn't look like people liked surgery very much. The claims made for proton therapy are criticized in some quarters because of the small number of blind trials comparing it directly to other modalities. Most of the "proof" is self-reported or anecdotal. A few years ago, a study sponsored by the American Society for Radiation Oncology (ASTRO) claimed that x-radiation was just as effective at a much lower cost. Given that their 10,000 members mostly use x-rays, such a finding seems a bit self-serving, although no more so than the studies reported by proton therapy advocates.

The Red Journal, a highly respected publication of ASTRO, dedicated the entire 500-page May, 2016, edition to particle therapy, mostly protons. (There are other particles, neutrons, carbon ions, etc.) While largely favorable to protons, even then there was a study that seemed to show that under certain conditions, x-rays can achieve the same results for certain cancers. I will dedicate a future blog to reviewing that issue of the journal.

Blogs are for expressing opinions, and mine is clear. Protons, while not perfect, are more perfect than other treatments that I have investigated. Hence, my choice.

As I do at the end of all blog posts, let me ivite you to check out my other related proton therpay sites:
This is dedicated to Robert Ferre's book Best Prostate Cancer Treatment: Proton Beam Therapy. It has updates and additional information, photos, and more.
This site has an up-to-date list of proton therapy centers in operation in the United States, as well as a number planned or under construction.