As recently as 15 years ago, the treatment for certain types of cancer could be as frightening as the disease. Receiving radiation therapy was like going into a "high-energy tanning both," says Dr. Charles Vialotti, radiation oncologist at Holy Name Hospital in Teaneck, N.J. Cobalt machines that delivered the radiation beams left patients with skin burns, and could also damage the spine, intestine, and lungs. But over the past decade, engineers have learned how to shape high-energy x-rays from machines called linear accelerators, modulate the beams' intensity, and guide them straight to the patient's tumor with the aid of high-tech imaging systems. The result is better treatment outcomes, and a decrease in harmful side-effects.
Now, the $2 billion a year medical radiation equipment industry may be poised to capitalize on a newer wave of innovations. The most dramatic advance is called proton-beam therapy, which uses rays of atomic particles rather than x-rays. The advantage is that physicians can control where most of the radiation in the beam will be deposited as it passes through the patient's body. That means doctors can spare almost all normal tissue from being burned by the ray.
Varian Medical Systems (VAR), the leader in medical-radiation equipment, is buying its way into the proton-therapy business. Varian just completed the acquisition of proton therapy system manufacturer ACCEL Instruments for about $30 million. Its entry could signal the move of proton therapy into mainstream cancer care.
NEW CENTERS. Proton-beam therapy is currently offered in just five cancer centers across the U.S: The Loma Linda University Proton Treatment Center in California, the Northeast Proton Center at Massachusetts General Hospital in Boston, the Midwest Proton Radiotherapy Institute in Indiana, the University of Florida's Shands Cancer Center, and M.D. Anderson Cancer Center in Texas.
M.D. Anderson opened its 94,000-square-foot, $125 million proton beam center in May, 2006, and already the facility is buzzing. Dr. James Cox, head of radiation oncology at M.D. Anderson, says the proton center sees about 50 patients a day now, and expects soon to be treating about one-fifth of all its radiation patients this way.
For now, the facilities give priority to certain types of patients—those with tumors that are small and well defined, and who face the gravest risk of damage to sensitive organs. The list includes pediatric cases, people with cancers of the head and neck, and prostate cancer patients. Doctors hope to broaden the use to include more complex tumors by gaining better control of the proton beams, just as they learned to control x-ray energy delivered by linear accelerators. But so far, this work has been confined to the laboratory.
BIG INVESTMENT. The challenge for hospitals is the huge investment they must make in machines called synchrotrons, which produce the proton beams. Whole new buildings must be constructed to house these gadgets, which are far too large to be contained in existing facilities. Once the equipment is in place, the cost of treating patients is nearly three times that of ordinary x-ray treatments.
"When it comes to capital expense, this is the single largest undertaking that a hospital or a group could make," says Adam Harrington, a physicist at Hitachi America, which built M.D. Anderson's synchrotron. Harrington admits that cost is definitely a barrier for treatment centers that want to get into the business. But he says that prices and other barriers will come down as the technology improves, and as doctors grow more familiar with the technology.
"There are several prototypes of cheaper machines coming out," says Daniel Dosoretz, president and CEO of Radiation Therapy Services (RTSX), a radiation oncologist turned entrepreneur. Although he says he's intrigued by proton-beam therapy, Dosoretz intends to wait until the cheaper, smaller machines come out before making any investment. It will also be a while before the skills to support these machines become more widely available. You need "a couple of PhD physicists," he says. "There's not going to be one on every corner." By Nichola Saminather