There is a HUGE Unmet Need for Pediatric Proton Treatment

I was more than shocked to learn only 384 pediatric patients received proton treatment in 2009. WOW! Not a happy wow, but a sad wow. The number should be more like 3,000!!! Okay, Pediatric Proton Foundation you have your work cut out for you!

Consider the following comments from our board member Dr. Sameer Keole, Radiation Oncologist with ProCure's Oklahoma Proton Center.

"Our estimates are that ~3,000 children a year in the US would benefit from proton therapy. Best estimates are that, in 2009, 380 children received proton therapy in the United States. (Many of these patients are from abroad) With the addition of both our center and PENN now adding pediatric capacity, hopefully this number will climb to 500 in 2010. Still, more than 80% of children who would benefit from protons will not be able to receive this therapy."

There are many reasons that the number of pediatric patients numbers are limited. My main focus today is the number of centers. We need more. Each center has only so much capacity to treat children, and in previous blog I had estimated the number of kids treated based Boston's percentage of total pediatric patients treated at 1,000. I was wrong because I assumed everyone treated a similar percentage of peds. Boston actually treats the most percentage of peds and perhaps I should have used an average. Now I know the actual numbers by center, and some centers obviously have no focus on treating pediatrics. I know the kids don't turn the profit a prostate cancer patient does, but where is the morality of healthcare these days? Why aren't our children a priority for all centers? Why do all centers have a child squarely pictured on their brochures and their web if they have no focus on pediatrics? There is much to answer here for future blogs and I digress.

It was GREAT news then that plans for two new centers were announced over the past month. One in Knoxville, TN and the other in San Diego, CA.

1. A planned Knoxville cancer treatment center is set to become the first place in the state to offer proton therapy. The state's Health Services and Development Agency approved an application last week from Knoxville-based ProVision Trust to build a $118.8 million center and fill it with proton therapy cancer treatment equipment. ProVision has lined up support from the University of Tennessee Medical Center.

2. Scripps Health announced Tuesday that it will manage a $185 million proton center to be built in northern San Diego by Advanced Particle Therapy, a private health care company based in Minden, Nev. Construction is expected to start in July on a 7-acre site in San Diego's Carroll Canyon business district near Mira Mesa. The 102,000-square-foot facility is to include five treatment rooms, three with special gantries that allow a proton beam to be delivered to a patient at almost any angle. Officials said the project is expected to be finished in 2013.

My hope is that the new centers and the current centers will focus on the positive impact they can have on the pediatric cancer cases. We want all the centers to make it their priority to treat pediatrics, and report their numbers, not just show the kid's pictures on their web and brochures. Our kids our counting on us. Our kids need the voice of the Pediatric Proton Foundation to make their case to those that can change these statistics. Please visit and support us at http://www.pediatricprotonfoundation.org/.

Dr. Torunn Yock Presents Promising Use of Protons for Pediatric Medulloblastoma

Radiation therapy is integral in treatment of pediatric brain tumors. However, conventional photon radiation is associated with long-term neurocognitive effects, including decrements in IQ and difficulties with attention, processing speed, and other executive skills. Proton radiation provides better targeting of tumors than conventional photon radiation, sparing surrounding healthy tissue. It is expected that radiation-related neurocognitive impairments would be lower after proton radiation relative to reports of photon radiation.

The study presented at ASCO examined long-term neurocognitive outcomes of 56 patients with brain tumors treated with proton radiation at MGH. “Late effects of radiotherapy can be disabling and affect health, as well as hearing, neurocognitive functioning and psychosocial functioning,” said Torunn I. Yock, MD, director of pediatric radiation oncology at MassGeneral Hospital for Children. “Proton radiation radiates less normal tissue, which should result in fewer late side effects of treatment.”

Conclusions: At 2-year follow-up after proton radiation, neurocognitive performances were stable, with no significant change seen in most areas assessed. Overall, results compare favorably to reports from photon radiation treatment.

In addition, about 30% of patients had hormone deficits, but that compares with 50% to 70% of patients treated with photons.

Finally, although there was a statistically significant hearing loss found at 1 year at frequencies of 3,000 Hz and higher, these rates are still improved compared with the use of intensity–modulated radiation therapy and photon therapy reported in the literature, according to Yock.

For more information:

Yock TI. #CRA9507. Presented at: the 2010 ASCO Annual Meeting; June 4-8; Chicago.