Pancreatic tumors are one of the most serious tumors and their prognosis is not good.

Every year, about 2,000 people are diagnosed with a pancreatic tumor in the Czech Republic, and the incidence increases in patients over 50 years of age. About 75% of patients will eventually succumb to this disease. This is partly because pancreatic tumors are diagnosed too late in 70% of cases. However, modern methods can modify the course and length of the disease as well as the quality of life.

Esophageal tumors occur most frequently between 50 and 70 years of age. Every year, about 500 people are diagnosed with an esophageal tumor in the Czech Republic. In addition to surgical procedures, irradiation plays an important role in treatment. Esophageal tumors are irradiated preoperatively or without a surgery if this is not possible for any reason. In conventional photon irradiation, it is very problematic to capture the entire irradiated area without a significant radiation dose to the lungs and liver. In contrast, the required dose in proton radiotherapy can be easily delivered to all the necessary areas and the curative effect can be achieved at significantly lower risk.

Proton therapy is also suitable for treatment of liver tumors that cannot be operated on and do not spread beyond the liver.

Proton therapy has been increasingly used in the treatment of anal canal tumors. In this disease, irradiation alone is used instead of surgery, but its possibilities are limited by serious side effects. In proton irradiation, the risk of side effects is significantly lower.

To make the right decision, it is important to have information about the results of the treatment you choose. You should not forget that your decision will significantly affect your future life. Our doctors and the entire PTC team are ready to answer all your questions related to PROTON THERAPY.Do not hesitate to contact us as soon as possible.

When using the state-of-the-art proton beam irradiation technique, it is possible to increase the dose of radiation to the pancreas and to extend the target volume even to the lymph nodes. The main advantage of proton radiation compared to photons is that organs around the pancreas are exposed to only a minimal dose or the dose is even zero, and therefore vital organs are protected against unwanted damage.

For pancreatic tumors, proton therapy is appropriate in the following situations:

• As a preoperative radiation for locally advanced tumors that may prospectively require surgery.
• As separate irradiation, for locally advanced tumors that are inoperable.
• As postoperative irradiation after complete or partial surgery.

Proton irradiation of pancreatic tumors has two major advantages:

1/ Proton radiation can be used to deliver a sufficiently high and effective dose of radiation to the area affected by a tumor, with a tolerable radiation dose to the surrounding and vulnerable organs such as the liver, kidneys, stomach, duodenum, small intestine and spinal cord.

2/ Proton radiation can be used to deliver an effective dose to the area of regional lymph nodes, which are also often affected by cancer.

For esophageal tumors, proton therapy is suitable in the following situations: 

• As preoperative irradiation, followed by surgical procedure.
• As irradiation alone, for diseases where surgery is not planned for any reason (localization of the tumor, patient’s condition, etc.)

For hepatic tumors (hepatocellular carcinoma), proton therapy is suitable for diseases that cannot be treated with surgery, where deposits are not built anywhere outside the liver and if the patient is not included in a transplant program.

For anal canal tumors, proton radiotherapy is suitable whenever the intent of treatment is to achieve the complete resolution of the disease and a permanent cure, while preserving the function of the sphincters.

Starting treatment early is the key for success of any treatment.

A less advanced disease is easier to treat. This applies to any radiotherapy. The special advantage of proton radiotherapy, compared to conventional photon radiotherapy, is based on a different, more favorable distribution of radiation doses in the body (a “dosimetric” benefit). And there are additional secondary benefits: radiation doses can be increased where beneficial. Moreover, the total irradiation time can be shortened by dividing the total dose into larger fractions.

How can we achieve the “dosimetric benefit”? Protons can accurately fractionate the dose of radiation that is needed for tumor destruction. 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.

“Dosimetric studies” are conducted to compare radiation doses in different tissues. Doses are modeled and calculated for irradiation of a certain volume (tumor) by proton radiation vs. photon radiation under the same anatomical and geometric parameters.

The results are as follows:

For irradiated volumes in the upper abdominal cavity, i.e. in the treatment of pancreatic or hepatic tumors, proton radiotherapy:

• reduces the dose to the abdominal cavity, in particular to the small intestinal loops. This reduces the severity of acute undesirable effects of radiation, such as nausea and diarrhea. Higher doses of radiation can also be used to achieve a greater antitumor effect (“dose escalation”);
• reduces the dose to the kidneys, which ultimately leads to a decreased likelihood of nephrosclerosis (renal vascular disease) and renal hypertension (increased blood pressure resulting from renal involvement);
• reduces the dose to the liver tissue, thus reducing the risk of hepatic failure.

For irradiated volumes reaching into the chest cavity, such as in the treatment of esophageal cancer, proton radiotherapy:

• reduces the mean dose to the pulmonary tissue by about 50% compared to photon radiation therapy, thus reducing the risk of developing inflammatory lung disease (“pneumonitis”);
• reduces the dose to the heart valves, coronary arteries and heart muscle. This reduces the risk of early ischemic heart disease, valve defects and heart muscle disease (“cardiomyopathy”).

For irradiated volumes reaching into the pelvis, such as in the treatment of anal canal tumors, proton radiotherapy:

• reduces the radiation dose to the urinary bladder, thus reducing the risk of post-radiation bladder mucosal inflammation (“cystitis”);
• reduces the radiation dose to the small intestine, thus preventing severe digestive problems;
• reduces the radiation dose to the pelvic bone marrow. This is a significant circumstance for co-administration of chemotherapy and irradiation. This is a significant and standard addition to the radiation therapy.  Lowering bone marrow doses may reduce the risk of complications from concomitant chemotherapy.

The differences between proton and photon irradiation are primarily dosimetric. This means that a different dose distribution is achieved in the body (in physical terms in the “living matter”).

Dose distribution is more favorable for proton irradiation. The prescribed (maximum) dose is delivered to the tumor, or in other words, to the target volume to be irradiated, while doses to the surrounding organs (often with vital functions) are small. Photon radiation also delivers the prescribed dose to the tumor, but at the expense of a higher dose exposure of the surrounding organs.

Permissible doses to various organs are specified in certain international systems of dose standards, maximum levels and limits. Proton radiotherapy usually meets the dose standards, while being well below the maximum limits for the organs.

For some diseases, such as pancreatic tumors, the “dosimetric benefit” will make it possible to use the secondary benefit of “dose escalation”. This means that if we meet the dose limits to the surrounding organs well enough, the dose to the target volume can be increased. This increase is known as dose escalation and will improve the antitumor efficacy of treatment.

There is also an additional secondary benefit: the low, favorable dose to the organs around the target irradiated volume will allow the total prescribed dose to be divided into fractions that are larger in conventional photon irradiation. The total duration of radiotherapy is shorter, while maintaining both efficacy and safety.

The difference is seen with the naked eye in the graphical representation of irradiation plans.

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 efficacy of proton therapy has been confirmed by worldwide studies of leading cancer centers, such as the American MD Anderson Cancer Center in Texas.

The Proton Center in Prague is one of the world’s leading healthcare facilities and the most modern proton center in Europe. Although the Prague Proton Center is primarily intended for Czech patients, its services have already been sought by clients from 25 other countries. In addition, the experience of Czech experts is also used by a number of foreign centers.

Both radiotherapy and proton therapy rank among the most cost-effective cancer treatments with a relatively high therapeutic effect. In advanced countries, radiotherapy is generally used with 50-60% of cancer patients and its share in comprehensive treatment is still growing. Of these, about one-third of cancer patients are treated with radiotherapy alone, while almost two-thirds of patients receive radiotherapy combined with surgery, chemotherapy, hormone therapy, or targeted biological therapy.

Did you know that…?

Czech experts from the Proton Center in Prague, together with similar centers in Vienna, Krakow and Uppsala, established the PACS group focused on proton therapy. In this way, they laid the foundations for future cooperation and development of this state-of-the-art radiotherapy. The Center also serves as a training facility for experts from other countries and cooperates with the First Faculty of Medicine, Charles University, the Faculty of Nuclear and Physical Engineering, CTU and a number of foreign educational institutions.