Has anybody received the proton radiation therapy for BOT? From reading articles it seems that the proton therapy may not be effective for the neck lymph nodes since the radiation is more site-directed and localized (therefore less radiation induced side-effects). To treat the affected lymph nodes along with the BOT is IMRT a better option then? Any thoughts/suggestions?

If you are refering to Proton Beam Therapy (PBT), they typically combine it with IMRT since PBT is so precise. Loma Linda's website site has some pretty good explanations of the treatment modalities.

MY RO had recommedn PBT for me if the cancer wa back last decemeber when we had a positive PET. Thank the Lord it was a false positive and I did not have to go through that again.

PBT is unique as there are relatively fewer side effects then oxidizing radiation. I would imagine that the IMRT part of it would be substantially less, then if it was the only treatment modality.

PBT is unique in that it applys a charged particle that only reaches it's full potential when actually at the precise target - resulting in minimal collateral damage.

It must be good as MDACCC invested $200 million in a dedicated facility for it. There are only about 1/2 dozen PBT treatment centers in the US today.

The issue of PB came up recently at our local H&N support Group.

The Scripps Clinic is building a Proton Treatment center here.

An RO said at one of our recent H&N support group meeting that although we would be hearing a lot about PB, for now there are no plans or known significant advantages in using it for most OC.

He drew some dosimetry graphs on a whiteboard to sort of show us why - but I don't think anyone fully understood.

The exceptions he mentioned were nasopharynx cancers, and I beleive he mention cancers near the optic nerve and brain.

He did mention the possibility of using it like hi-dose SBRT (Cyberknife/Novalis) for recurrence.

It would seem to me that it might better spare the salivary glands - but I didn't bring this up.

Anyway it would be good to get an opinion from anyone treated with PB at MDA, Loma Linda, Mass General, Florida, or one of the other Proton Centers.

I have worked in the radiological medical device area for over 30 years, I worked directly for the Siemens applications development department for the nuclear physicist who invented the modern medical LINAC. During the course of my career (I am currently the Vice President of Regulatory Affairs for Direct Medical Systems and consult with other radiological companies on the side) I have met many doctors and PhD's that talk sh*t just so they dont appear stupid. They also tend to use what they have available (and they want the money too). I have personally witnessed patients die on the table during treatment (not H&N mainly lung cancer) while working on LINACS in the field. Many RO's are part owners in the RT treatment centers so a bias may also be present. A typical LINAC will pay for itself in 3 years and has a 6 year span.

Here are some references from the literature - you decide.

http://www.massdevice.com/news/mayo-clinic-gifted-100-million-proton-beam-therapy

http://www.health.state.ny.us/facil...emonstration_project/docs/memorandum.pdf

http://www.hemonctoday.com/article.aspx?rid=33481

http://www.communityoncology.net/journal/articles/0410599.pdf

http://www.astro.org/Research/CommentForm/documents/ProtonReport2010.pdf (scroll down to page 62)

http://www.protons.com/proton-therapy/conditions-treated/head-and-neck.html

Gary,
The RO I mentioned in my post works with, at and for The Scripps Clinic.

www.Scripps.edu


[quote=Gary]During the course of my career (I am currently the Vice President of Regulatory Affairs for Direct Medical Systems and consult with other radiological companies on the side) I have met many doctors and PhD's that talk sh*t just so they dont appear stupid.[/quote]

Thanks for your links to the Proton Treatment info. It seems consistent with what we were told.

FYI Scripps $185M Proton Center will use Varian's IMPT scanning pencil beam technology like the center that recently opened in Germany.

Thanks for the update Don. I am glad that they are finally bringing more PBT centers on line.

It actually started at the Cyclotron in LBL's where protons were first used for medical treatment. It was not practical in a clinical environment and it has taken a while to get it to that point.

Patient throughput is fairly high and the treatment durations aren't anywhere near as long as IMRT or XRT. Plus one Cyclotron can provide protons to multiple treament suites - but it is a hell of an investment. Had it been more accessible, when I was Dx'd in 2002, I wouldn't have hesitated to strongly consider PBT.