Walk into one of the treatment rooms at Penn Medicine’s Roberts Proton Therapy Center, and the first thing you’ll notice is the massive machine in the middle. An opening in the center of the gargantuan gantry, which is several stories tall, dominates the room and has the look of a futuristic device you might see in an old sci-fi movie.
Perhaps that’s fitting.
The space age device is the centerpiece of the world’s most precise radiation therapy. And just like a crowd gathering to watch a shuttle launch, medical professionals from all over the world recently came to Philadelphia to get a glimpse for themselves. Except this group wasn’t just here to observe; they came to learn all the details of proton therapy in hopes of bringing the treatment techniques home with them to other cancer centers that are embarking on using this new technology for the first time.
Home, it turns out, meant a lot of different things to the people who gathered in Philadelphia for this course in early November. Attendees came from all across America and from all over the world. They represented 12 different states and more than 18 different countries spread across five continents. And with physicians, physicists, and administrators all in the crowd, their backgrounds and areas of expertise were just as varied as their points of origin on the map. Despite their diversity, they shared a mutual thirst for knowledge about this innovative treatment.
“When we opened, we were only the fifth proton center in the country,” said James Metz, MD, the chair of the Radiation Oncology and one of the directors of the course. “Now there are 24. But as these new centers pop up, there is still a paucity of knowledge and experience out there. So this goes beyond being a leader from a clinical standpoint. We also have to be a leader in training.”
Proton therapy has a few key differences from traditional radiation. Traditional therapy uses x-rays, which are a form of photon radiation. The rays go into the body from one side and come out the other, touching more than just the cancer cells and potentially damaging healthy tissue along the way. X-rays also have no mass or charge, meaning they can’t penetrate completely through the tissue. This means the waves that can kill cancer are constantly losing energy – and their cancer-killing power – as they make their way to tumors deep inside the body.
Proton therapy uses particle radiation. The proton beam is positively charged and enters the body at a low dose of radiation. When it hits the cancer it’s targeting, the dosage increases. The beam then stops, preventing the radiation from moving through healthy tissue and exiting the other side of the body. This gives it the ability to spare healthy tissue while maximizing the chances of attacking tumors.
Over the course of a packed weekend, the international group of medical professionals learned the logistical and technical components of establishing a proton therapy center with both clinical and research capabilities.
“Because there’s so much diversity here, we got into all of the roles that make up a radiation oncology department,” said course co-director Neha Vapiwala, MD, an associate professor and vice chair of Education in Radiation Oncology in Penn’s Perelman School of Medicine. “That means everyone got to learn everyone else’s jobs as well. It leads to a multidisciplinary approach that can really benefit everyone. And it’s not just doctors. We also had executives and administrators here, meaning there will be an understanding of proton therapy at every level.”
Vapiwala also says the national and international backgrounds of the attendees meant that everyone brought their own unique knowledge and perspective in their interactions with the course instructors and each other.
"It shows that people are hungry for this knowledge,” Vapiwala said. “It’s a chance to network with people doing great work all over the world.”
The Roberts Proton Therapy Center opened its doors in 2010 at a time when the clinical uses of the treatment were still limited and the potential was widely untapped and even unknown. Around the world, there are still just a few dozen of these centers, and some focus overwhelmingly on prostate cancer. Vapiwala says it’s important to keep pushing forward with research to show proton therapy’s effectiveness in other areas, especially with cancers that have limited treatment options or a poor prognosis. Penn radiation oncologists treat pancreatic cancer patients, for instance, and they’re using radiation to re-treat patients whose cancers come back – something that’s not typically possible to sites that have been treated with conventional radiation therapy.
“It’s not just the cancers people think we can treat,” Vapiwala said. “When we continue to keep adapting the clinical disease sites we focus on, we’re showing what is possible.”
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That desire to keep pushing has turned Penn Medicine’s Roberts Proton Therapy Center into the largest integrated proton therapy center in the world. In addition to the more than 75,000 treatments doctors delivered last fiscal year, the center has also taken part in 83 clinical trials, including 17 that were newly opened in 2016. All told, more than 5,500 patients have taken part in a clinical trial here since the center first opened.
But leadership in the field goes beyond numbers. It also means shaping the future of treatment through training courses like the one in proton therapy.
“This is really for people who are just starting out and want to know the basics of proton therapy,” Metz said. “But our training continues with web-based and on-site programs geared toward people who have already bought in but still need the expertise.”
This was the third year for the course, and organizers say it felt like this year turned a corner.
“The first year, we really didn’t know what to expect, but this course just continues to draw such a varied, international crowd,” Vapiwala said. “This year it really became clear this is something we’re going to keep doing. That’s a role we should be playing. People everywhere want our techniques, and we have resources here under one roof that you can’t recreate in other places. Sometimes you forget you’re surrounded by awe-inspiring people.”