Proton Therapy Q&A with Dr. Naren Ramakrishna

In 2012, our team broke ground on a very special endeavor at the Orlando Health Cancer Institute. One that will surge our Cancer Center forward as providers of the latest and most effective technologies in healthcare and, more importantly, serve the community by giving our patients the best possible chance to win their fight against cancer.

Set to open in 2016, the Proton Therapy Center at the Orlando Health Cancer Institute will begin serving cancer patients throughout the state of Florida. Proton therapy is a type of radiation therapy that uses proton beams to reduce tumors in adult cancers, especially those located near vital organs. Proton therapy is also particularly useful in pediatric cancer patients whose young bodies are still growing. Our Proton Therapy Center will treat cancers of the brain, spine, lung and prostate, as well as an array of pediatric cancers. This revolutionary form of radiation is highly coveted and groundbreaking because it can precisely target tumors while significantly reducing the side effects of treatment.

Update: On November 2, 2014, the 58-ton Mevion S250, a superconducting synchrocyclotron proton accelerator, was delivered by crane to the Proton Therapy Center on Orange Avenue. The video of its delivery can be watched below:

We sat down with Dr. Naren R. Ramakrishna, director of Neurologic and Pediatric Radiation Oncology at the Orlando Health Cancer Institute, to learn more about this powerful new cancer treatment option coming to Orlando.

What is proton therapy?

Proton therapy is an advanced form of treatment used by radiation oncologists to deliver highly focused radiation to cancerous tumors. This new treatment option is amazing because it spares the healthy tissue surrounding the tumor and reduces side effects.

How does proton therapy differ from conventional radiation treatment?

Most radiation treatment is delivered using X-rays (photons), while proton therapy utilizes positively charged particles called protons, which consist of a hydrogen atom stripped of its electron. These particles are harnessed for treatment using complex devices known as cyclotrons or synchrotrons.

How are protons better for radiation treatment than X-rays?

When a tumor is treated with conventional radiation, the X-ray beams also deposit a great deal of radiation along their path through healthy tissue. Protons, on the other hand, deposit the bulk of their dose into the tumor, resulting in minimal damage along their path through the healthy tissue. This minimizes the acute and long-term side effects of treatment.

Radiation oncologists leverage the ability of protons to release their dose in a very narrow range of depth in tissue. This is known as the Bragg Peak. The depth in tissue of the Bragg Peak may be manipulated by the physicians, thus allowing a precise proton dose delivery into a tumor.

What are the advantages of proton therapy for a cancer patient?

First and foremost, the decreased dosage of radiation to healthy tissue surrounding the tumor reduces the acute and long-term side effects of treatment. This can significantly improve a patient's quality of life during treatment, while also improving the accuracy with which radiation is delivered.

Also, this decreased dose to healthy tissue along the entry and exit of the beam reduces the risk of developmental abnormalities in pediatric patients and the risk of radiation-induced illnesses.

Additionally, when a tumor is directly adjacent to a critical organ or structure, such as the spinal cord, optic nerves or heart, proton therapy may allow for preservation of function while delivering effective doses to the tumor. This is not possible with conventional radiation.

Next, improved dose shaping and sparing of normal tissue may allow for a larger, stronger dose to the selected tumors. This potentially improves efficiency and patient outcomes.

Lastly, proton therapy allows for retreatment of recurrent tumors that were previously irradiated. In some cases, the tight dose of protons allows for safe retreatment of tumors, which isn’t possible with conventional radiation.

What are the types of cancer that are best suited for proton therapy?

Many types of cancers may benefit from the superior dose-shaping characteristics of proton therapy. However, each case must be assessed individually by your radiation oncologist to determine the best and most effective therapy that is right for you.

The lower deposit of radiation into normal tissue is of particular benefit for pediatric cancers because a significant dose to normal tissue may result in growth or developmental abnormalities or even radiation-induced cancers.

Proton therapy could also benefit adult malignancies where the tumor is very close to a normal structure that is sensitive to radiation. Such structures or organs typically include the spine and brain.

Beginning-stage prostate cancer is a common scenario where the ability to shape the dose of protons may result in decreased side effects of treatment. With proton therapy, the dose to the rectum and bladder may be reduced in comparison to conventional X-ray radiation. Your radiation oncologist at the Orlando Health Cancer Institute will carefully evaluate your tumor and select from a range of advanced therapeutic options, including proton therapy.

The cancers most receptive to proton therapy are:

• Pediatric cancers
• Brain, orbital and skull base tumors
• Early-stage prostate cancer
• Gastrointestinal tumors
• Thoracic cancers
• Sarcomas

When will proton therapy be available at the Orlando Health Cancer Institute?

Our Proton Therapy Center is projected to be completed by Spring 2016. Please check our website for updates here.

The 15,000-square-foot Proton Therapy Center will be located on Orange Avenue between Orlando Regional Medical Center and the Orlando Health Cancer Institute in downtown Orlando. It will consist of three floors – two above ground and one below ground – in order to accommodate the MEVION S250 superconducting synchrocyclotron proton accelerator. We will begin treating patients with proton therapy in 2016.