Proton therapy

2024

A vertical proton therapy system has been released for the treatment of cancer. She takes up some space in the hospital

On September 27, 2024, ProTom International introduced the Radiance 330-C vertical proton therapy system. The complex is intended for treatment of various types of malignancies. Read more here

Innovative proton therapy saves the lives of 83% of neck and head cancer patients

In early June 2024, researchers at the University of Texas MD Anderson Cancer Center presented the results of a Modulated Intensity Proton Therapy (IMPT) study, which allows meaningful improvements in head and neck cancer outcomes.

The study involved 440 patients observed at 21 research centers in the United States. Progression-free survival (PFS) was 83% at the three-year follow-up with a significant reduction in malnutricity compared to other therapies. In addition, in proton therapy, patients were less likely to depend on probe nutrition.

The results of the study of proton therapy with modulated intensity are presented

The results of this study suggest that IMPT could become a new standard approach to treating head and neck tumors, the researchers said. This is especially important in view of the fact that proton therapy is not inferior in effectiveness to conventional radiation therapy, but is accompanied by fewer side effects.

Proton therapy has both biological and physical advantages over conventional photon radiotherapy. Unlike photons, protons have mass and can be stopped by the tissues of the human body. This allows the tumor focus itself to be irradiated directly, limiting the adverse effect on the surrounding healthy tissues.

Historically, conducting such large-scale studies has been difficult, partly due to the low availability of proton therapy centers, the researchers note. - The results demonstrate the advantages of the new technique, and we hope that thanks to these data, proton therapy will become more accessible to all patients in need of treatment[1]

2022

1600 cancer patients underwent proton therapy

According to the results of 2022, more than 1,600 people with cancer underwent a proton therapy course in Russia. On March 23, 2023, the director of the Department of Organization of Medical Care and Sanatorium-Resort Affairs of the Ministry of Health Ekaterina Karakulina.

Three clinics provided such treatment by the end of 2022:

• MRNC named after A.F. Tsyba - branch of the National Medical Research Center of Radiology (Obninsk);
• FMBA Federal Scientific and Clinical Center for Medical Radiology and Oncology (Dimitrovgrad);
• Berezin Sergey Medical Institute (MIBS) (Petersburg).

Treatment with proton therapy is currently available in three clinics in Russia

MIBS has reached full load and conducts proton treatment to 800 patients a year. This figure includes not only services provided at the expense of compulsory medical insurance - according to information on the clinic's website, citizens of Kuwait, Turkey, Canada, Great Britain, the USA and Israel received proton therapy at the MIBS.

The first domestic proton accelerator works in our branch - the A.F. Tsyba Medical Radiological Scientific Center in Obninsk, - says the chief oncologist of the Russian Ministry of Health, head of the National Medical Research Center for Radiology, academician of the Russian Academy of National Research and Science Kaprin. - When I made a presentation in Japan, our apparatus was also recognized as very promising. The main plus of domestic development, in addition to import substitution, is that we have the right to refine and improve the car ourselves. In particular, a special table is made to expand the scope of proton therapy. This is a step towards engaging in pediatric proton therapy, including for those tumors that have to be irradiated under anesthesia.

According to the Medical Bulletin, the costs of proton therapy courses not included in the basic compulsory medical insurance program (VMP-II) in 2022 amounted to more than 3.2 billion rubles - in the state guarantee program, the average financial cost ratio ranged from 2 million to 2.6 million rubles per patient.^[2]

Scientists at the Moscow Polytechnic helped determine the properties of proton beams accelerated by a laser pulse

On February 18, 2022, it became known that the calculations of scientists from the Moscow Polytechnic helped determine the properties of proton beams accelerated by a laser pulse. This knowledge is essential for the development of proton therapy.

Scientists at the Moscow Polytechnic helped determine the properties of proton beams accelerated by a laser pulse

As reported, proton beam therapy allows you to destroy cancer tumors, practically without damaging neighboring healthy tissues. But for this you need to generate a precisely directed beam of protons: for example, so that it goes through the skull and allocates a maximum radiation dose at a certain depth - directly into the tumor, would kill cancer cells there and not penetrate deeper into healthy brain tissues.

For February 2022, to organize proton therapy, you need to fill an expensive room the size of a whole gym with expensive equipment. Physicists are working so that this room can be reduced to the size of a laboratory table. And this can be done with a laser. says Stepan Andreev, head of the Mathematics department of the Moscow Polytechnic

This is not about an ordinary laser beam, but about ultra-short and super-powerful laser pulses. The shorter the pulse, the more powerful the radiation is. Thus, modern lasers generate pulses lasting several femtoseconds (1/1015 split second). The power of one such pulse may be greater than that of all power plants on the planet.

When a super-intense laser pulse affects a target, interesting physical processes occur in it, including nuclear reactions. I am modeling these processes, and as a result of our work, a relatively small and inexpensive apparatus for proton therapy may appear: a laser on the table sends pulses to a specific target on which a proton beam is formed, with the energy necessary for therapy energy. If such technology appears, proton therapy centers can be organized in each hospital. supplemented by Stepan Andreev

In his work, Stepan Andreev calculated what happens when a laser pulse interacts with an aluminum target, on the back surface of which there is a layer of protons. Calculations have shown that proton acceleration occurs not only in the area of ​ ​ the laser pulse "spot," but also on the entire rear surface, the length of which in the model is six times the diameter of the laser "spot."

This is due to the fact that "hot" electrons, which create an optimizing electrostatic field on the rear surface of the target, making vibrational movements and repeatedly passing through the target and back, cover almost the entire volume of the target with their trajectories, and not just the laser impact area. explained professor

Most protons move perpendicular to the target and form a beam, the angle of spread of which does not exceed 15-20 degrees. Such a proton beam has a proper degree of laminarity, that is, it moves in space without mixing. It extends over relatively long distances without changing the transverse size. According to Andreev, the reason for this behavior may be the quasi-neutrality of the beam, in which the Coulomb forces of pushing positively charged protons are compensated by the forces of attraction on the part of electrons moving with protons.

The question of quasi-neutrality has not been sufficiently investigated, and this state of proton beams is of interest not only for basic science, but also for material sciences and laser medicine. noted Andreev

2020: Proton therapy reduces risk of heart disease in lung cancer patients

At the end of October 2020, it became known that proton therapy administered to patients with lung cancer reduces the risk of certain forms of heart disease. In particular, the researchers identified a reduction in the risk of transient ischemic attacks and myocardial infarction over the next two years in this group of patients.

Proton therapy minimizes irradiation of surrounding healthy tissues and organs, such as the heart, and thereby reduces the risk of developing cardiotoxicity. The results of the new study suggest that this treatment method has other advantages over conventional radiotherapy.

Proton therapy may reduce risk of heart disease in lung cancer patients

The Penn Medicine study enrolled more than 200 patients with locally advanced non-small cell lung cancer. With an average follow-up of 29 months, transient ischemic attack (TIA) was observed in 1.1% of patients after proton therapy, while among patients receiving photon radiation therapy this figure was 8.2%. Myocardial infarction was reported in 2.3% of patients who received proton therapy and in 9% of patients who received traditional radiation therapy. There were no differences in the risk of atrial fibrillation, coronary artery disease, heart failure, or stroke.

The researchers intend to continue to study these forms of therapy. Specifically, they participated in a large prospective phase III clinical trial evaluating differences between proton and photon therapy in lung cancer patients. The study has been conducted since 2014 and should show whether proton therapy reduces cardiac morbidity and mortality in these patients. Patient recruitment is expected to be completed by 2022.^[3]

2018: Inclusion of proton therapy in the program of state guarantees for the provision of medical care

On September 7, 2018, the Ministry of Health of the Russian Federation published the draft budget of the Federal Compulsory Health Insurance Fund (Compulsory Medical Insurance) for 2019 and the planning period of 2020 and 2021. For the first time, the document mentions proton therapy for cancer, which from 2020 will be funded under the program of state guarantees for the provision of medical care at the expense of the compulsory medical insurance system. As noted in the explanatory note to the budget of the FFOMS, proton therapy will be included in the list of types of high-tech medical care that are not included in the basic compulsory medical insurance program.

Протонная терапия впервые включена в программу госгарантий оказания медпомощи.
Центр протонной терапии MIBS in St. Petersburg. Photo: mosreg.ru

According to the document, in 2020, 5 billion rubles will be allocated for proton therapy, in 2021 - another 5.5 billion rubles. Thus, this type of treatment will appear in the state guarantee program a year earlier than the Minister of Health of the Russian Federation Veronika Skvortsova announced in July 2018 at a meeting with the President of Russia. Every year, such medical care is planned to be provided to 2 thousand patients. At the same time, the need for this type of treatment is estimated much higher: 30-50 thousand people.

As of September 2018, only the proton center of the Berezin Sergey Medical Institute, launched in September 2017, operates in Russia. By the end of 2018, the center plans to provide assistance to more than 200 cancer patients, in 2019 - 500, and in 2020 to reach the design capacity - up to 800 patients per year. It is also assumed that at least half of the flow of patients will be children.

In addition, the country has several experimental installations in scientific centers and the construction of the Federal High-Tech Center for Medical Radiology of the FMBA of Russia in Dimitrovgrad with the department of proton therapy is underway, but the deadline for this object has been repeatedly postponed. According to the latest data, it will open in December 2018. By mid-2019, the proton center may appear in Chelyabinsk.

In addition, on September 6, 2018, plans to build a proton therapy center Khabarovsk declared in GC "Region" and. "Rusatom Helskea" They sent to Government of the Khabarovsk Territory the proposal to conclude a concession agreement. The volume of investments in the project is estimated at more than 4.5 billion rubles.^[4]

You can get acquainted with the draft budget of the FFOMS for 2019 and the planning period of 2020 and 2021 departments = 11 & npa = 83767 here.

2017: In Russia, about 100 people a year receive proton treatment

Proton cancer treatment for 2017 is the most accurate, effective and safe method of radiation therapy. JSCS «Proton», unlike photons used in traditional radiation therapy, release all energy at the end point of the run. This makes it possible to increase the dose of tumor radiation and more reliably destroy the DNA of malignant cells, while not damaging healthy tissues and minimizing the side effects of treatment.

Proton therapy does not provoke the occurrence of secondary cancer, the risk of which is quite high 15-20 years after photon treatment.

Proton therapy is indicated by 7-8% of adult cancer patients and 90% of children. In the Russian Federation, 30-50 thousand people a year need such treatment, of which more than 2 thousand are children. As of March 2017, the country has three experimental installations in various research institutes, at which about 100 people a year receive proton treatment.

There are no clinical centers for proton treatment equipped with modern equipment.

In 2017, the first proton beam therapy clinical center in Russia, equipped with a modern Gantry system, is being built in the Primorsky district of St. Petersburg, on the basis of the Medical Institute named after Berezin Sergey (MIBS). The opening of the center is scheduled for autumn 2017.

For comparison: there are 45 proton therapy centers in the world, represented mainly in USA,,. Japan To Europe According to market analysts, by 2019 their number will grow to 88. Proton treatment in the United States has been ongoing since the early 1990s.

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