The investment in proton therapy for cancer

Written by Prof. Stein Kvaløy, senior physician and Head of Research at the Division of Cancer, Surgery and Transplantation, Oslo University Hospital and University of Oslo.
First featured in

In 2012 there were just above 30,000 new cancer cases in Norway. The number of cases is increasing by 1-2 percent each year, so that more than 40,000 cases are expected in 2030.

More cancer survivors

Fortunately, treatment results are improving. During my time as a cancer specialist (from 1976) the healing improved significantly – from 40 percent survival to 70 percent for both men and women. There are several reasons for this improvement.

We can roughly divide cancer treatments into three methods; surgery, radiation therapy and medication. Nowadays various specialists jointly discuss the treatment program and the best use of the three modalities of treatment for each case. Often will all three methods be used in a well-planned combination to best suit the patient. This is referred to as a multi-disciplinary approach.

Radiotherapy is used both as treatment for cancer cure and for symptomatic relief. This is a local treatment with photon beams that have high enough energy to reach tumors located deep inside the body. This procedure resembles the similar idea of surgery, sterilization and removal of the tumor with minimal damage to the healthy tissue located around a tumor. Modern radiation machines allow optimization of the radiation dose against the tumor and thus reduce the dose for the healthy tissue. Damage of the healthy tissue cannot, however, be completely avoided and is the “price” one must pay to stay healthy. My impression is that most patients understand and accept this if they are informed about it.

Radiation can cause damage

As more patients are cured and we gather observations over a long time period (more than 20 years), we see that patients can develop long-term side effects and damage due to the treatment they received a long time ago. This may often be as far back in time that one no longer sees the connection to previously given treatment. Such an example is patients who received radiation therapy for Hodgkin’s lymphoma.

Some of these patients may among other things suffer of heart disease which results in significant distress and reduced quality of life. It is important to emphasize that this is not due to errors in medical treatment.

Proton treatment reduces side effects

Other types of radiation therapy that can reduce side effects do exist nowadays. The development of radiation devices that can provide particle irradiation with protons or ions has been tremendous in recent decades. It is like shooting at the tumor with small bullets. The particles can be more precisely directed at the tumor, and the biggest benefit of this is that we can reduce the dose to the healthy tissue.

This reduces short-term and long-term side effects, which for some patients implies avoiding a new disease after being cured of cancer. However, it should be mentioned that not all cancer patients will benefit from this type of radiation therapy compared with current treatment.

Where radiation center be placed?

A national team of specialists have worked with the question of whether we should get proton therapy to Norway. The group agreed on the idea and has estimated that 8-10 percent of cancer patients who should have radiotherapy should get it as proton therapy.

This would be applicable for approximately 12-1500 of cancer patients each year. International estimates are somewhat higher. Benefits will probably be greatest for children and adolescents who have a long life expectancy.

Why not just do it? The health benefits seem obvious. The Ministry of Health and Care Services gave a remarkably quick positive signal to the establishment of costly buildings and equipment.

It is now being examined how construction should be carried out.  All regional health authorities are included in these plans. The South-Eastern Norway Regional Health Authority has a group working on plans to add such a facility to Oslo University Hospital.

The main question has been localization: Should the unit be established in hospitals that already offer radiotherapy (such as Radium Hospital or Ullevål Hospital), or should we adapt a new center with proton facility into the plans for the new OUS – Campus in Oslo? There are drafts for different exciting localization possibilities at Rikshospitalet. This is exciting plans.
It is clear that we must consider carefully the appropriate location for such a large investment (about two billion NOK). It is important that the plans for OUS-Campus, do not delay the establishment of a proton facility in Oslo University Hospital, which at the earliest could be completed in 2020.

This has great significance for the individual patient.