Target Insight VIII – Proton Therapy in Canada

Pros and cons of acquiring proton therapy in Canada

Special thanks to Young Lee for this story

Target Insight VIII: 4PRT – Photons, Protons, Particles and Progress in Radiation Therapy held at the University of Toronto created a unique environment in which many who work in the field of radiation therapy were exposed to the current practices and research in particle therapy. The fact that we do not have a high energy particle therapy machine to treat deep-seated, large tumors in Canada when many other countries around the world have or are currently building multiple, multi-million dollar centres, has brought up many questions such as are we treating our patients suboptimally and would we be having this conference if the cost of particle therapy equaled photon therapy. The two-day conference not only created discussions on what is particle therapy and how is it delivered but also the financial and ethical questions that should be answered before such machines are introduced to a publically-funded healthcare environment.

It was clear from the conference that treating patients with particle therapy does not benefit all patient population. However, many agreed that for a set population, such as the paediatric patients, the physical properties of particle therapy have the potential to reduce dose to tissues surrounding the treatment volume. Due to the sharp Bragg peak of particle therapy, there may be a huge advantage in using particle to photon therapy. The discussions on uncertainties associated with treatment (e.g. range determination) and relative biological effectiveness have brought up the need for research and development that are still on-going. This brought up how we as a nation, that wants to lead in cutting-edge research, could fall behind due to the lack of a particle therapy facility. There were also discussions on how the current research that is being conducted in particle therapy may be biased due to how the centre and the research have been financed. This indicates the potential advantage and efficacy research and development work that are conducted by a publically-funded centre could bring to advancing this field.

To achieve treating the patient population that would gain the most from particle therapy and to allow the as many Canadians as possible to benefit from this technology, many felt that it was important to carefully choose where the centre should be and whether a single, large centre was an ideal solution. Particle therapy machines now come in various geometries (e.g. huge multiple gantry machines or single gantry machines that resemble current photon therapy delivery) and many felt that perhaps having multiple single centres in populated parts of Canada would be best suited for not only clinical delivery but also to further Canadian scientific research. The conference successfully increased our knowledge on particle therapy technology but also the impact it has had and will have in radiation therapy.