Proton Beam Therapy in the UK: A Perspective From The Christie

Siobhan Harris

Disclosures

February 26, 2019

The world's newest proton beam therapy centre is up and running at The Christie NHS Foundation Trust in Manchester, providing a pioneering therapy to treat cancer.

Proton beam therapy (PBT) targets tumours more precisely than current standard treatments and cuts the risk of side-effects. It will also be offered at University College Hospital in London from 2020.

The Government is investing £250 million for both NHS proton beam therapy centres. This includes the buildings, the cyclotron and gantries and six NHS treatment rooms, three at each centre.

Up until now, British patients wanting the treatment have had to travel to other countries for it, including the US.

Proton beam therapy hit the headlines in 2014 when the parents of the British boy Ashya King, who was due to undergo chemotherapy and radiotherapy at Southampton General Hospital, fled with him to Spain. They were arrested in Spain but were eventually able to take him for proton beam treatment in Prague.

   

Dr Daniel Saunders

Medscape UK spoke to Dr Daniel Saunders, a consultant clinical oncologist who works at The Christie.

Q&A

Medscape UK: What are the clinical benefits of proton beam therapy?

Dr Saunders: Proton beam therapy is a form of high energy radiation therapy which uses protons rather than photons (conventional X-ray therapy). The advantage of protons is that you can precisely control how deep into the tissue the protons stop (a phenomenon known as the 'Bragg peak'), leaving almost no dose of radiation deposited beyond this point.

Medscape UK: Which patients can potentially benefit most from proton beam therapy and why?

Dr Saunders: The principal advantage of using proton beam therapy is reduced dose beyond the tumour target. This is most useful in younger patients where one is aiming to reduce the potential long-term side effects of radiation therapy. The cure rate of PBT and conventional X-ray therapy is the same in most cases. There is a small number of rare tumours where it is possible to give a higher dose of radiation using PBT than one can deliver safely with X-rays as it allows us to avoid dose to nearby sensitive critical structures, and in these cases the chance of cure can be increased with PBT.

For NHS patients, there is a nationally approved list of indications for treatment where evidence indicates that proton therapy is more beneficial than photon therapy. Referrals for indications outside of this list cannot be treated on the NHS, unless on a clinical trial.

Medscape UK: What does the treatment at The Christie involve and how is it delivered?

Dr Saunders: The treatment with PBT does not really look or feel much different to conventional (X-ray) radiotherapy in that the patient needs to be able to lie still on a couch for the period of treatment and that treatments are given daily over a number of weeks. We use special immobilisation devices to help the patient stay in the best possible position for treatment, again this is similar to X-ray therapy. The main difference is that the treatment delivery each day takes longer, perhaps up to 40 minutes per treatment compared to approximately 10 minutes for X-ray therapy. Patients from outside Manchester will need to stay in Manchester for the duration of their treatment which may take 6-7 weeks to deliver.

Medscape UK: What's the process for referrals from oncologists?

Dr Saunders: Patients must be seen initially by their local clinical oncologist (radiation therapy specialist) for a discussion about the pros/cons of proton therapy.  If suitable then a referral is made via the NHS England Proton Beam Therapy Clinical Reference Panel who consider the suitability of treatment with PBT and funding by the NHS. Self-referrals or referrals from GPs cannot be accepted.  

Medscape UK: The first patients have now been treated at The Christie. How many people will the centre aim to treat?

Dr Saunders: We are aiming to treat up to 750 patients per year at The Christie. University College Hospital in London is also building a PBT centre which will be very similar to our own and will also treat up to 750 patients per year so the total NHS capacity will be about 1500 patients per year.

Medscape UK: What does the future hold for PBT in the UK?

Dr Saunders: Whilst we are still building up our practice, and until UCLH is fully open, the NHS will continue to send some patients abroad. The main use of PBT in the NHS will be for relatively uncommon tumours as this is where the most established evidence base lies and is consistent with international best practice. However, we also have an active clinical research programme which is aiming to evaluate the benefit of PBT for other forms of cancer by performing rigorously quality-controlled clinical trials.

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