Breast cancer is the most common malignant disease in women and the second most common cause of death from cancer. About 10% of female patients are less than 45 years old and 20% are under the age of 50 years. About 75% of women have stage I or stage II disease at the time of diagnosis, with a long life expectancy.

While breast cancer is, of course, a disease that can have fatal consequences, early diagnosis and new technologies increase the chances of successful treatment. These chances are also increased by proton therapy.

Today the treatment of breast cancer often combines multiple treatment modalities, such as surgery, hormonal therapy, chemotherapy, biological therapy and radiotherapy (irradiation).

If you have been recommended to have radiation therapy, this treatment can be done more gently than conventional radiation. Compared with conventional (photon) irradiation, proton therapy allows for a reduced exposure of the surrounding tissues, especially heart and lungs. Delivery of the necessary dose to the tumor bed increases the chance of permanent cure.

Proton therapy gives a chance even in the case of second radiation. If a tumor recurs after conventional radiotherapy, the possibility of treatment is limited and the second series of radiation therapy is often not possible due to the high risk of damage to vital organs and tissues. However, proton therapy may be used in cases requiring repeated irradiation.

Appropriate information is important in order to make the right decision. You should not forget that your decision will have a significant impact on your next life. Our physicians and the entire PTC team are ready to answer all your questions related to PROTON THERAPY.Do not hesitate to contact us immediately.

By simply comparing the risks and benefits generally associated with radiation therapy, you come to the conclusion that proton therapy increases the patient’s chances of cure without unnecessary risks and complications associated with conventional irradiation.

Irradiation is recommended in cases where only a part of the breast is removed, or if breast cancer is advanced or has spread to the lymph nodes, even after mastectomy. Often, irradiation must be done by delivering radiation dose to the chest wall and to the lymph nodes located in the armpit, alongside the collarbone and to the internal mammary gland alongside the sternum. In cancer that develops in the left breast, this otherwise effective method is problematic because it carries a high risk of exposure to the heart due to its anatomical proximity to the breast tissue. Similarly, this also applies to a part of the lungs in cases where a part of the chest wall needs to be irradiated. If irradiation of the lymph nodes is indicated, then conventional irradiation would also unnecessarily affect the heart and lungs. In these cases, we are talking about cardiac or pulmonary toxicity of cancer treatment, or in other words, side effects on the cardiovascular or respiratory system. After completed therapy, even successful in terms of cancer treatment, cardiac toxicity can manifest as heart failure, arrhythmia, hypertension, heart attack, and so on, over a period of several years.

Toxicity or harmfulness is a key factor when choosing the treatment modality, just because of the fact that early treatment is highly effective and gives the chance of long-term survival.

Proton therapy meets the requirements for dose reduction to both critical organs (heart and lungs) at the same time. It reduces the risk of secondary tumors from radiation by reducing the total dose to the body.

Proton therapy uses the physical properties of the proton beam, which has the advantage of precisely targeting and releasing energy directly into the tumor with minimum damage to the surrounding tissues.

If conventional irradiation was selected, a large percentage of patients could experience late and very late toxicity. The effects of unwanted radiation to the healthy tissues and organs, including their damage, or secondary tumors from radiation may occur or develop in many patients long after the end of treatment. Therefore, it is necessary to choose a treatment that minimizes these risks. These requirements are best met by proton therapy.

The advantages of proton therapy include accurate targeting of the proton beam, excellent coverage of the target volume or irradiated area, protection of the heart, lungs, spinal cord and the second breast, reduction of the risk of secondary tumors, and the fact that only protons can be used for repeated radiation. Proton therapy can be used to avoid side effects of conventional irradiation, such as myocardial infarction, heart problems, and development of pulmonary fibrosis. In this way, proton therapy gives a chance to enjoy good quality of life after treatment without increased risk of late side effects.

The exact dose distribution has its name: Pencil Beam Scanning (PBS) and is currently the absolute peak of proton therapy. Pencil Beam Scanning (PBS) works such that it only irradiates a defined area. Not more. By delivering repeated high-precision radiation targeted with millimeter accuracy directly to the tumor bed after resection, PBS destroys the tumor cells without damaging any surrounding organs and tissues due to the physical properties of the protons. PBS preserves healthy tissues. This also applies to the tissues in the direction of the beam in front of the tumor, which are only minimally irradiated.

To compare PBS with other techniques, imagine your focus and meticulous care when you are using crayons to paint a defined object on a piece of paper. For example, a circle. You will always try consistently not to cross its borders. That is how PBS works. In addition, you will have 100% confidence that they will “paint” only what is needed. This is why the adverse effects of proton therapy are minimal

The toxicity of treatment is a key factor in choosing the treatment modality, due to the chances of long life after the treatment. In women with breast cancer, the main side effects are cardiac toxicity, pulmonary toxicity, and increased risk of secondary tumors.

Proton therapy is a way to avoid these risks. The proton beam, due to its physical properties, allows dose reduction to both critical organs, the heart and the lungs, and together with a significant reduction in the integral dose, it reduces the risk of secondary tumors.

BENEFITS OF PROTON THERAPY

• protects the heart, lungs, spinal cord and the second breast
• accurate coverage of the irradiated area
• reduces the risk of secondary tumors

BENEFITS OF PROTON THERAPY when irradiating the left breast compared to conventional RADIOTHERAPY:

• exposure to the heart is lower by 99%
• exposure to the lungs is lower by 81%
• exposure to the second breast is lower by 96%

Proton therapy is safer and more effective than conventional irradiation. The aim of irradiation is to deliver the necessary dose to the breast while protecting healthy tissues. This can be done by proton therapy, unlike the commonly used conventional irradiation. Conventional irradiation always affects a portion of healthy tissue in the surrounding, where irradiation is not desirable.

However, proton beam can irradiate the tumor such that a zero dose is delivered to the respective critical organ. A zero dose also means a zero risk of side effects. Because of its physical properties, the proton beam can stop just in the tumor, thus significantly reducing the unwanted radiation of healthy tissues and organs.

Some advocates of conventional (photon) radiotherapy sometimes use a “magic formula” of “limit doses” to the critical organs. What does it mean? A patient is told that a limit dose to the critical organs will be observed. This is actually an “agreement” that we are admitting exposure of vital organs to unwanted radiation, but with a certain limit. But the patient is further told that adherence to the “limit dose” is associated with up to a 5% risk of adverse reactions?! In addition, the risk increases with time, which means the longer a patient survives after irradiation, the higher the probability of adverse reactions.

Think well. The limit dose may not always be safe. And more importantly, a safer and easily accessible proton therapy is available to rule out the risk

You can find the difference with the naked eye in the graphical representation of irradiation plans.

In breast cancer, it is usually needed to irradiate not only the tumor itself but also the surrounding breast tissue to prevent possible microscopic spread of the tumor.

The schematic diagram shows the radiation dose distribution in the body when using photon and proton therapy. It is obvious that proton beam irradiates only the affected breast, in which the target lesion is marked, so the radiation is aimed almost exclusively to the tissue that is affected or likely to be affected. In contrast, photon radiation, due to its physical properties, significantly affects the surrounding healthy structures, which in this case are the lungs and the heart. However, irradiation of these healthy tissues may have consequences, since more significant doses increase the probability of undesirable effects of treatment. We are talking about cardiac toxicity or pulmonary toxicity, which may manifest by the development of ischemic heart disease, various arrhythmias or pulmonary complications.

Proton therapy is an increasingly recognized and preferred method in the world. The advantages are obvious and therefore new and new centers are opened and planned. At present, 71 centers are opened, 42 centers are just before the opening, and dozens more are planned. In visionary terms, we could predict with a relatively high degree of probability that proton beam irradiation will replace now frequently used conventional radiation therapy in the future.

The results and experiences of proton centers in the worlds and in the Czech Republic clearly confirm that proton therapy opens completely new possibilities of cancer treatment. It offers patients a chance for complete cure. Proton therapy can deliver as much radiation as possible to the tumor, safely and without any risk to the surrounding tissues. The added value of proton therapy over conventional (photon) therapy is that it spares healthy tissues around the tumor.

Did you know that…?

A study conducted at the Memorial Sloan-Kettering Cancer Center in New York has shown that post-operative proton therapy is well tolerated, and doses delivered to the healthy tissues (heart, lungs, and breast) are significantly lower than can be expected from conventional photon radiotherapy.*

* John J.Cuaron et al. : Early Toxicity in Patients Treated with Postoperative Proton Therapy for Locally Advanced Breast Cancer,  Int. J of Radiation Oncol Biol Phys, Vol. 92, No.2, pp.284-291, 2015