Proton therapy is an advanced radiation treatment that precisely targets tumors, with the goal of minimizing radiation to healthy tissue and improving the lives of patients while they’re fighting cancer and after. You probably have a lot of questions about this treatment, this FAQ will hopefully answer some of them.
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Proton therapy is an advanced and highly precise form of radiation treatment. It allows our doctors to focus radiation directly into the tumor, minimizing damage to surrounding tissue and the risk of short- and long-term side effects from treatment. Currently available at only a small number of centers in the United States, including ours, proton therapy is beneficial in treating a broad range of tumors. Those include tumors of the brain, central nervous system, gastrointestinal tract, head and neck, left breast, lung, and prostate cancer, as well as sarcomas and certain childhood cancers. Please see the Diseases Treated section of our website for a more comprehensive list.
Research has repeatedly shown higher doses of radiation are associated with better cure rates. But as the dose increases in standard X-ray treatment, there is greater damage to healthy tissue and complications (side effects) increase dramatically. This is because X-rays lose most of their energy just as they penetrate the skin, and continue to lose energy on the way to the tumor and beyond. Protons, on the other hand, release most of their energy in the tumor rather than when they first enter the body.
Protons are charged particles rather than beams of energy. The energy distribution of protons can be directed and deposited in tissue volumes designated by our radiation oncologists. Protons are energized to specific energies which determine how deeply in the body protons will deposit their maximum energy. Additionally, the maximum interaction with electrons occurs as the protons approach their targeted stopping point. Thus, maximum energy is released within the designated cancerous area. This greater control and precision of treatment protects surrounding healthy cells from excess radiation, lessening short- and long-term side effects.
Proton beams deposit much of their energy directly in the tumor, reducing damage to healthy tissue and allowing patients to receive higher, more effective doses. Less damage to healthy tissue and organs can result in fewer side effects than are sometimes experienced with standard X-ray radiation therapy, thus improving patients' quality of life and long-term health. As compared to protons, X-ray radiation deposits more radiation in healthy tissue as it enters and leaves the body.
Since their bodies are still growing, children are more sensitive to damage to healthy tissue caused by radiation. Proton therapy’s precision reduces the amount of radiation to healthy tissues. Therefore proton therapy can reduce the side effects children suffer from radiation, such as growth and developmental problems, as well as secondary tumors later in life. Our center has radiation oncologists who specializes in proton therapy treatment for children.
X-rays and protons can be equally effective in destroying benign and malignant tumors. The difference is that X-ray treatments damage more healthy tissue in the process. X-rays release their maximum dose of radiation soon after penetrating the skin, potentially damaging healthy tissue and organs on their way to the tumor and again as they pass through the body beyond the tumor. Protons can be precisely directed to release most of their energy when they reach the tumor. Because there is much less exposure to healthy tissue with protons, a higher dose often can be delivered if needed, leading to more effective treatment.
Because proton beams deposit more of their energy directly in the tumor, less radiation reaches the healthy tissue in front of the tumor, and almost none reaches the healthy tissue behind the tumor. Patients often experience fewer short- and long-term side effects that typically accompany standard X-ray radiation therapy.
Patients with tumors in locations near critical structures and vital organs benefit most from proton therapy. Proton therapy has a broad applicability to a number of solid tumor sites: brain, lung, prostate and many childhood solid tumors. Patients who suffer from recurrent tumors or who have exhausted other treatment options can also benefit from proton therapy.
Proton therapy is especially important for children because children are more sensitive to radiation effects in the long term. A pediatric radiation oncologist is particularly interested in how to treat a child’s tumor with radiation while avoiding exposure to the healthy tissue. For example, when a child is diagnosed with a brain tumor, it is imperative to avoid irradiating the child’s growing brain. This is important because the healthy part of their brain needs to continue to develop as the child gets older and by using proton therapy we can minimize the effects that may impact their learning in the future.
Protons are charged particles rather than rays of energy. With X-rays, radiation goes in the body and exits out the other side of the body. Proton therapy radiation goes into the body, releases its energy at the tumor and stops right there. There is no exit dose.
The energy distribution of protons can be directed and deposited in tissue volumes designated by our radiation oncologists. Protons are energized to specific energies which determine how deeply in the body protons will deposit their maximum energy. Additionally, the maximum interaction with electrons occurs as the protons approach their targeted stopping point. Thus, maximum energy is released within the designated cancerous area. This greater control and precision of treatment protects surrounding healthy cells from excess radiation, lessening short- and long-term side effects.
Since every tumor is different, the Care Team starts by doing a scan of the patient to see exactly where the physician needs to deliver radiation and what parts he or she needs to avoid with the radiation. Then our physicists, dosimetrists and radiation oncologists work together to make an individualized treatment plan that maps out the direction, angle and dosage of the proton beam.
PBS stands for Pencil Beam Scanning. PBS is a relatively new innovation within proton therapy that can "paint" a tumor with multiple very thin, very precise beam of protons that are accurate within millimeters. PBS sends rapid pulses of protons to each planned spot within the tumor until the whole tumor is treated. “PBS is the most advanced way to deliver proton radiation and allows us to more precisely sculpt protons to treat more complex tumors, such as in the head and neck, lung, abdomen, and pelvic areas,” says Smith “Jim” Apisarnthanarax, MD, radiation oncologist at the center.
PBS is usually used for patients with complexly-shaped tumors because it allows doctors to better shape the proton radiation. Fred Hutchinson Cancer Center - Proton Therapy offers PBS in all of our treatment rooms, including the gantry, which allows doctors to target and treat tumors at nearly any angle.
In many cases, yes. Proton therapy can be used in combination with chemotherapy, as a follow up to surgery and in combination with X-ray radiation. Our physicians can talk to you about what other treatments you might need in conjunction with proton therapy.
As of February 2022, there are 38 proton therapy centers operating in the United States, with more in planning and construction stages. Worldwide, more than 200,000 patients have been treated with proton therapy.
Yes. Proton therapy centers fall within state and federal regulatory statutes that require all radiation-production facilities to be licensed. Proton therapy at Fred Hutch meets the standards required federally and within Washington State. The regulations are the same as those for X-ray therapy.
Your Insurance Questions Answered
Some of the most common questions we are asked at Fred Hutchinson Cancer Center – Proton Therapy deal with insurance coverage and financial aspects of receiving care. It’s important to note that the answers below can vary widely based on the patient’s cancer type and stage, insurance company and policy, and the state in which the insurance company is based, among others.
What is the financial process people go through when they come to the proton facility for treatment?
Prior to a consultation, we review each patient’s insurance benefits and prepare an estimate of their out-of-pocket costs. We review this with the patient during their financial consultation. Sometimes “prior authorization” is requested by the insurance company prior to treatment. If so, we will also request this authorization.
What disease sites are most likely to be covered?
Coverage for childhood cancers and ocular cancers are generally covered by most insurance plans. Sometimes other cancer types receive an initial insurance rejection. When this happens, our dedicated Appeals Coordinator can work to have that rejection overturned, depending on the type of cancer. Because appeals win rates vary so much by cancer type and insurance company, it is easiest to speak to each person individually about their chances of having their insurance denial overturned.
How often do patients proceed with treatment after an initial denial?
Almost all of our patients opt to pursue treatment despite encountering an initial denial. Our Appeals Coordinator may have options to help get your treatment covered after a denial by your carrier.
Typically, how many claims are initially denied?
Only about 15% of our patients receive an initial denial which we subsequently appeal.
What percentage of insurance companies tend to cover proton therapy?
In general, all insurances will allow coverage of proton therapy for a selected list of cancer types. The types of cancer which are covered vary widely from insurance to insurance. During your financial consultation, your patient care coordinator will review the criteria that your specific insurance uses to determine coverage with you. This will ensure you are informed of the likelihood of coverage, prior to starting treatment.
How long does an appeal tend to take?
It can take up to 18 months to complete an appeal.
What will a patient’s out-of-pocket cost be?
Depending on the insurance company and the policy, the out-of-pocket cost can vary widely. Our patient care coordinator will estimate each patient’s out-of-pocket cost and present this information to them at their financial consultation.
We hope that these answers addressed the majority of your insurance-related questions. If you have further questions on your case, or have a question not addressed here, please give us a call at 206-306-2800.