This blog discusses the latest in proton radiation therapy focusing on pediatric applications. This blog supports the Pediatric Proton Foundation.
Monday, May 19, 2014
Ama(yo)zing Mayo Clinic Visit
Tuesday, September 24, 2013
Proton therapy is a cost-effective treatment for pediatric brain tumor patients
Proton therapy is a cost-effective treatment for pediatric brain tumor patients

Due to decreased side effects, it may also be cost-saving
Proton therapy, an external beam radiotherapy in which protons deliver precise radiation doses to a tumor and spare healthy organs and tissues, is cost-effective in treating medulloblastomas, fast-growing brain tumors that mainly affect children, when compared to standard photon radiation therapy, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 55th Annual Meeting.
The study used a first-order Monte Carlo simulation model to examine a population of 18-year old survivors of medulloblastoma brain tumors who were assumed to have been diagnosed at age 5 and at risk of developing 10 adverse health events, including various hormone deficiencies, coronary artery disease, congestive heart failure, ototoxicity, secondary malignant neoplasm and death. Primary institutional information on the cost of investment and Medicare data regarding the cost of management of the various adverse health conditions, in addition to peer-reviewed publications analyzing incidence of side effects were used in the simulation model to perform a cost-effectiveness analysis comparing proton and photon therapy from the societal perspective. Outcomes were measured in incremental cost-effectiveness ratios, with costs measured in 2012 U.S. dollars (USD), and effectiveness measured in quality-adjusted life years (QALYs). A societal willingness-to-pay (WTP) threshold of $50,000/QALY was the benchmark.
The clinical benefits of proton therapy have been recognized in reducing side effects when compared to photon therapy, but the significant expense of building and maintaining proton facilities and the high treatment costs have been areas of concern. The study’s results demonstrate that by avoiding years of costly side effects, proton therapy can be cost-effective for children with medulloblastoma. Using current risk estimates and data on required capital investments, proton therapy for pediatric medulloblastoma treatment was not only cost-effective compared to standard photon radiation, but also found to be cost-saving in many simulations.
Results from the base case analysis showed that due to the prevention of side effects, proton therapy was cost-saving. In sensitivity analyses, proton therapy strongly remained the more appealing treatment, in part due to decreased risks of hearing loss, secondary malignancy and heart failure, resulting in cost-savings in more than 95 percent of simulations.
“We believed that proton therapy might prove to be cost-effective in treating pediatric brain tumors, and we were intrigued that it also proved to be cost-saving in the base case and in almost all of the sensitivity analysis simulations,” said Raymond Mailhot Vega, MD, MPH, the presenting author of the study; a resident at Mount Auburn Hospital, the teaching hospital of Harvard Medical School; and a 2014 radiation oncology resident at New York University’s Langone Medical Center. “Proton therapy might prove to be both cost-effective and cost-saving for other malignancies, too, and consequently, more cancer patients may benefit from proton therapy.”
ASTRO’s 55th Annual Meeting, held in Atlanta, September 22-25, 2013, is the premier scientific meeting in radiation oncology and brings together more than 11,000 attendees including oncologists from all disciplines, medical physicists, dosimetrists, radiation therapists, radiation oncology nurses and nurse practitioners, biologists, physician assistants, practice administrators, industry representatives and other health care professionals from around the world. The theme of the 2013 meeting is “Patients: Hope • Guide • Heal” and will focus on patient-centered care and the importance of the physician’s role in improving patient-reported outcomes and the quality and safety of patient care. The four-day scientific meeting includes presentation of four plenary papers, 363 oral presentations, 1,460 posters and 144 digital posters in 70 educational sessions and scientific panels for 19 disease sites/tracks. Keynote speakers include: William B. Munier, MD, Director of the Center for Quality Improvement and Patient Safety at the Agency for Healthcare Research and Quality; Darrell G. Kirch, MD, President and CEO of the Association of American Medical Colleges; James Cosgrove, PhD, Director, the U.S. Government Accountability Office; Otis W. Brawley, MD, Chief Medical Officer of the American Cancer Society; and Peter Friedl, MD, PhD, of St. Radboud University Nijmegen Medical Centre at the University of Nijmegen and MD Anderson Cancer Center.
Tuesday, January 15, 2013
Dr. Kevin McMullen Appointed to the Pediatric Proton Foundation's Board of Directors
Dr. McMullen is currently medical director of radiation oncology for Indiana University Health Hospital in Indianapolis, Indiana and a radiation oncologist at Indiana University Health Proton Therapy Center in Bloomington, Ind. Dr. McMullen is an associate professor of radiation oncology at the Indiana University School of Medicine, where he also holds the Indiana Lions Endowed Scholar in Cancer Survivorship. He also serves on two late effects task forces within the Children’s Oncology Group.
He completed his residency at Wake Forest University School of Medicine, with further residency and post-residency pediatric radiation oncology training at St Jude Children’s Research Hospital and Memorial Sloan-Kettering Cancer Center. Dr. McMullen served his country in the U.S. Army in progressively increasing levels of medical leadership including being a Brigade Flight Surgeon for the Aviation Brigade of the First Cavalry Division headquartered in Fort Hood, Texas.
“The addition of Dr. McMullen will further enhance the outstanding talents and wide-ranging experience that our Board of Directors brings to the Pediatric Proton Foundation,” said Susan Ralston, Executive Director. “Dr. McMullen is widely respected and deeply experienced in pediatric cancer treatment through his past experience at Wake Forest and in his current positions at the IU Health Proton Therapy and with Riley Hospital for Children at IU Health.
Dr. McMullen is determined to continue to contribute to pediatric proton therapy advancements stating, “Because of my research in survivorship issues and prevention of late effects of cancer therapy, I believe I can offer insight as we further develop the scientific basis for appropriate use of this technology for cancer stricken children – one of IU Health Proton Therapy Center’s main focus and that of the Pediatric Proton Foundation. I am proud to volunteer my time for such a worthy organization.”
Click Here for Full Press Release
Friday, December 28, 2012
Pediatric Proton Foundation Objects to 55% Reduction in OPPS Payment Rates for Level II Proton Beam Radiation Therapy
Pediatric Proton Panel Set to Meet Feb. 12th in Washington, D.C.
Thursday, August 2, 2012
Treating Brain Tumors in Children
Of all the different kinds of solid tumors that a child might get, the brain tumor is the most common one. What causes brain tumors in children?
As with any other kind of tumor, a brain tumor comes about when a cell somehow gets out of control and multiplies uncontrollably. For the most part, science doesn’t yet have an answer to what causes brain tumors in children exactly. But scientists do suspect genetic reasons and environmental influences.
When a pediatrician suspects a brain tumor in a child, the first thing he does is to order an MRI or CT scan. A child needs be very still for any one of these scanning devices to work properly. Most of the time, with very young children, the doctor sedates the child so that she’ll stay still enough. Sometimes, if the results of the scan don’t seem conclusive enough enough, they’ll even try to do a biopsy – where they actually take out material from the brain.
It can take a whole team of specialists to successfully treat brain tumors in children. Most of the time, a child who is affected in this way will need surgery, chemotherapy and even radiation therapy. Treatment techniques have improved considerably now. Most of the time, the child will come out in one piece.
But it can be a very complicated process treating brain tumors in children. Typically, the team of doctors treating the child will include a neurosurgeon, a neurologist, a pediatric radiation therapist, a neuro-oncologist who specializes in children and so on.
Medical science is now clear about how brain tumors in children should be treated – it should be treated aggressively. And so, pediatric neurosurgeons are usually able to produce better outcomes – now that they know what exactly they need to do. The fact that there is all this high-tech equipment that they have at their disposal, helps too.
These days, they usually conduct pediatric brain tumor surgery in stages. They don’t go in and remove the tumor all at once. They do it a little bit at a time, over several operations. When they do it this way, they are able to make use of intervening periods to apply radiation therapy to the tumor so that it will shrink. The doctors hope that when they do this, they can be as non-invasive is possible. The third new techniques coming online all the time.
Instead of using radiation traditional radiation, the doctors use something called proton beam therapy.
In the future, all brain tumors in children will be treated this way. Proton beam radiation is a far more precise a way of going about it. There is no collateral damage to tissue that’s close to the tumor.
www.thehealthguide.org/tumors/treating-brain-tumors-in-children/
Monday, May 21, 2012
Tuesday, October 11, 2011
Pediatric Proton Foundation Supports ASTRO's Annual Meeting
The Annual Meeting of the PPF was held at the Miami Beach Convention Center on Oct. 3, 2011 in attendance included founders, Dr. Sameer Keole, ProCure - Oklahoma City and Dr. Cynthia Keppel, Hampton University Proton Therapy Center. Other top notch professional volunteers include proton therapy consultant Dr. Andrew Chang and Dr. Daniel Indelicato of the University of Florida Proton Therapy Center. Dr. Vivian Porche, from MD Anderson, was unable to attend this year. New applicants for the board were considered (stay tuned) and other important topics were discussed to include the 2011 Pediatric Proton Therapy Survey.
Many thanks to the supporters of our foundation. We are reminded daily about those special children and their parents who are fighting cancer today and every day. Our mission is clear - we want to see every child that qualifies for proton therapy to get it because it reduces the radiation long term effects to healthy surrounding organs and tissues. We support more proton centers to be able to serve the need. We support proton therapy as the standard of care for appropriate cases of pediatric radiation cancer treatment.
Monday, August 8, 2011
Breaking News...State of Pediatric Proton Therapy 2010 Soon to be Released!
The survey of the State of Pediatric Proton Therapy 2010 is about to be completed. We had 100% participation!
The survey is currently undergoing peer review and will be presented by Dr. Daniel Indelicato of the University of Florida Proton Therapy Institute (volunteer for the Pediatric Proton Foundation) during the Fall Meeting of the Children's Oncology Group (COG) in Atlanta September 13 - 16, 2011.
The National Association for Proton Therapy (NAPT) and the Pediatric Proton Foundation will issue a joint press release immediately after Dr. Indelicato presents the survey results at COG. Highlights from the survey will include the total number of pediatric cases, the various types of diseases treated, and the age groups treated.
Sunday, July 31, 2011
Wednesday, May 18, 2011
Pediatric Proton Foundation Active in Advocacy
*Denial is common for advanced treament usually due to "experimental/investigative/unproven treatment" The Pediatric Proton Foundation does not support traditional clinical trials in the case for protons as it relates to appropriate pediatric cases. Most pediatric radiation oncology experts agree that protons have a far superior treatment plan for children since protons have no exit dose, and less radiation is needed to get to the targeted tumor. No one needs extra radiation, but certainly not growing and still developing children!
* Appeals can take up to 180 business days, yet most pediatric protocols call for radiation in the early phase of the overall treatment plan.
*Insurers threaten,"if you decide to receive this service, you can be financially responsible for the total cost." A parent's inability to pay for medical treatment for their child is a top reason cited for financial bankruptcy in American cancer families.
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The Pediatric Proton Foundation is currently working on a first on a kind effort with the National Association for Proton Therapy to collect data from the Proton centers to help transparently report on the "The State of Pediatric Proton in 2010." We are excited to provide this collaberative effort and know this data will go far in helping more kids get to protons in the future. We almost have 100% participation from all the centers once again proving that when it comes to the kids, we all have heart. Thank you proton centers!
Sunday, September 26, 2010
Thursday, June 24, 2010
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/.
Monday, June 7, 2010
Dr. Torunn Yock Presents Promising Use of Protons for Pediatric Medulloblastoma
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.
Friday, May 28, 2010
Yippee - Pediatric Proton Featured on CBS News!
URL: http://www.cbsnews.com/stories/2010/05/26/eveningnews/main6522037.shtml
This in itself is a major deal for pediatrics because hopefully with over 6 million viewers some parent out there that needed to know about proton for their child, found out about proton and is now asking the oncologist if proton is appropriate.
However, I was disappointed in several points that I make in my comments here:
Dr. Gupta,
I was looking forward to this story so much since I am a dedicated advocate for pediatric proton. My own son, Jacob, was diagnosed with spinal Ewing's sarcoma at the age of 2 in 2007. He was treated at MD Anderson's Proton Center in Houston, Texas. They have treated over 300 children in their pediatric program so far. Also, Boston has treated the most pediatric patients of any center and their research with protons is helping develop more advanced protocols for many rare pediatric cancers.
What a shame that your story left parents with the impression the only choice they may have for treatment is Philadelphia, when in fact all seven proton centers treat pediatrics. When parents are considering treatment for their child, often location makes a big difference in terms of travel and residency costs and also family/friend support. Please consider doing another story that would fully explore pediatric proton. So many cancer stricken kids lives are depending on accurate information.
The other thing that upset me as a mother is the impression that was left with the viewers that this treatment is "new." It is not a new treatment. It is simply becoming more available because of new centers opening such as Philadelphia. Hampton is due to open in August and also will have a pediatric program. Please consider adding my non-profit's website to your story links so that parents that are interested can obtain all the information they may need to get to proton treatment for their child. www.pediatricprotonfoundation.org.
Thank you for your consideration. And a sincere Thank you for highlighting proton treatment for pediatrics.
Hugs and prayers to the Keegan family.
Susan Ralston
Executive Director
Pediatric Proton Foundation
Monday, March 29, 2010
DON’T DELAY CALLING A PROTON CENTER: PEDIATRIC PROTON SPOTS ARE LIMITED!
Many parents are WAITING for their primary oncologist to make the referral. Please don’t wait for this measure. Doctors are busy and are juggling many cases. YOU must become your child’s advocate and make the call yourself. In a recent study over 85% of pediatric proton cancer patients were self-referred. Any parent can make a self referral to each of the proton centers. Our website here includes a variety of information to help you navigate the process. You will be required to obtain your child’s medical records for review by one of the proton centers for admission. Plan to obtain a complete copy of all medical records as soon as possible and continue to keep them updated throughout and after treatment. Please feel free to contact us at information@pediatricprotonfoundation.org if we can assist you in gaining acceptance to a center.
PATIENT ACCESS:
James Slater M.D Proton Treatment, Loma Linda, California 1-800-PROTONS
Francis H. Burr Proton Center, Boston, Massachusetts 1-617-726-0923
University of Florida Proton Treatment Institute, Jacksonville, Florida 1-877-686-6009
Midwest Proton Radiation Center, Bloomington, Indiana 1-866-ITS-MPRI
(1-866-487-6774)
M.D. Anderson Cancer Center's Proton Center, Houston, Texas 1-866-632-4PTC
(782)
ProCure Proton Therapy Center, Oklahoma City, Oklahoma 1-888-847-2640
Roberts Proton Therapy Center at the University of Pennsylvania Health System
Philadelphia, Pennsylvania 1-800-789-PENN
(7366)
Saturday, January 30, 2010
New Year - New Proton Centers
Numbers are staring to get updated from the various proton centers around the world.
See:
http://ptcog.web.psi.ch/ptcentres.html
As of right now in the U.S. we have the following reported:
Loma Linda founded 1990 treated 13,500 as of 12/08
Florida PTI founded 2006 treated 1,847 as of 12/09
MRPI founded 2004 treated 632 as of 12/08
MGH Boston founded 2001 treated 3,515 as of 10/08
MDA Houston founded 2006 treated 1,700 as of 12/09
I keep hoping these centers will report pediatric cases treated. Right now it seems to be everyone's best kept secret.
There will be lots happening in the proton world this year, we have Hampton coming up by August 2010. Philadelphia is getting itself off the ground. ProCure has several irons in the fire with new proton centers. It looks like Chicago will be there next center opening at the first of next year. Stay tuned!
Saturday, December 19, 2009
Retrospect on the Pediatric Proton Foundation's First Year!

Dear Readers,
I would like to wish everyone that follows this blog a very Merry Christmas! We have been blessed this year with Jacob's continuing good scans and stability regarding his back issues. We have also been successful in gaining our public charity status and followed with a news release debut viewed by over 75,000 people.
Indeed, the Pediatric Proton Foundation has made great strides this year. We were at two national conferences. We have made many important connections in the pediatric oncology world. We have also posted opinions when proton articles have run and been featured on t.v. and radio. Our most recent airing on www.whatmatters.tv. Check us out!
Our board of directors represent some of the best talent in the pediatric radiation oncology world and will be key players in grant decision making. Thank you so much to Dr. Keole, Dr. Keppel, Dr. Porsche, Dr. Indelicato and Dr. Chang! You are truly the best!
Not bad for a first year of operation, but we still need your help! We are seeking skilled volunteers and always financial supporters that believe in what we are trying to do to help other parents and their kids. We have been there done that and support is critical to our success.
Our 2010 goal is to continue to raise money to offer financial grants to pediatric cancer patients to receive proton therapy. If you feel it in your heart and have a charitable giving plan, won't you please consider the Pediatric Proton Foundation? You can donate online at www.pediatricprotonfoundation.org.
Again, Happy Holidays!
Susan Ralston
Executive Director/Founder
Pediatric Proton Foundation