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Health Innovations: Killing Cancer with Protons
December 21, 2006
MPRI oncologists at IU use proton therapy to save lives
One of just five proton treatment facilities in the United States and the only such facility in the Midwest, the Midwest Proton Radiotherapy Institute has been treating cancer patients in Bloomington since 2004.
Ten years ago, when one of his cancer patients had to sleep at a campground because in-town housing in Boston was so expensive, world-renowned oncologist Allan Thornton began to rethink his career. At that time Thornton was the director of the Central Nervous System Division and Stereotactic Radiosurgery Program at Harvard Medical School, Massachusetts General Hospital Department of Radiation Oncology.
“This patient had to stay at a campground 60 miles south of the Harvard Cyclotron for two months,” said Thornton, who is now medical director of Bloomington’s Midwest Proton Radiotherapy Institute (MPRI). “That left a rather sour taste in my mouth. I thought ‘Maybe we can build something more affordable in Bloomington.’”
The idea of creating a center in a non-urban setting with affordable short-term housing for patients appealed to Thornton, as did the opportunity to both deliver the life-saving proton beam and continue research that will improve the technologies over time.
“That’s what’s unique about this facility,” said Thornton, who says MPRI has the most experienced proton therapy staff in the world in terms of clinical expertise. “It’s ongoing research—not only clinical, but physical and technical research. Part of my attraction here was to build something that would support the basic science of physics research. I’m already seeing that come out in biomedical imaging and through collaborative work with the IU Cyclotron Facility.”
Proton therapy is a precise form of radiation that limits damage to surrounding, healthy tissue, efficiently treats resistant tumors, and can be administered in higher doses than standard radiation. Proton energy can be more precisely guided than X-ray radiation, making proton therapy an optimal treatment for localized cancers. As the proton beam penetrates the body, a low dose of radiation is released at the surface and a sharp burst of radiation is released as the proton nears the end of its range. The beam can be specifically placed so that, unlike standard radiation, it hits exactly where needed and spares healthy tissue around the tumor.
The patient is fitted with a special immobilization device to keep the body perfectly still and is positioned lying down while a radiation therapist operates the beam from a neighboring control room.
About 15 percent of all cancer patients are candidates for proton therapy, and some benefit from a combination of proton and traditional X-ray radiation. Because it reduces irradiation to normal tissues, minimizing growth defects and secondary malignancies, proton therapy is often appropriate for treating tumors in children, for whom traditional radiation may not be considered optimal. The patient feels nothing during proton treatment and the potential side-effects of radiation—nausea, vomiting, or diarrhea—are minimized.
The treatment is so effective, it has turned a 90 percent fatality rate for patients with certain types of brain tumors into an 80 percent survival rate.
Most patients seeking proton therapy have unusual tumors that cannot be treated by standard radiation. “We have a unique tool and with it come patients with very unique tumors,” said Thornton. “When we see these patients, they offer potential for collaboration with surgeons at the IU School of Medicine and Clarian ... There’s also the need for long-term follow-up. I essentially follow my patients forever.”
Thornton initially learned of the Indiana University Cyclotron Facility (IUCF) in 1995 through Paul Nelson, director of neurosurgery at the IU School of Medicine. Less than two years later, two oncologists—Dr. Newell O. Pugh from Clarian and Dr. James Morphis from the IU School of Medicine—suggested that Thornton help start a new proton therapy center in Bloomington. He was subsequently approached by John Cameron from the IU Cyclotron Facility, who officially asked Thornton to join the effort.
Ten years after the first proton therapy treatment was performed at the IU Cyclotron Facility in 1993 and after several years of planning, MPRI officially opened in 2003 with a radiation machine designed and constructed by the IUCF. MPRI is currently one of only five proton treatment facilities in the United States.
MPRI is a joint venture between Clarian Health Partners and Indiana University Research and Technology Corporation and is affiliated with the IU School of Medicine. “This is an opportunity for the IU School of Medicine, Clarian and the university to come together and bring a unique resource to Indiana and the Midwest,” said Thornton. In an effort to connect with multiple centers around the Midwest, Thornton makes frequent trips to medical facilities in Chicago and Indianapolis, where he is a frequent visitor to the pediatric tumor rounds at Riley Hospital for Children.
Since it opened, MPRI staff has done more than treat patients—they have infused life into the local economy and established the facility as a regional resource for other proton-therapy based initiatives. For example, the staff at MPRI was instrumental in helping establish a new proton-based radiation therapy program at Ivy Tech University in Bloomington in August 2006.
Collateral fundraising efforts have also contributed to establishing MPRI as a world-class facility. Bud and Peg Howard—who lost a son to bone cancer more than 35 years ago and have been active volunteers with the American Cancer Society and Ronald McDonald House—began raising money in 2001 to fund Jill’s House, a temporary residence for MPRI patients undergoing treatment. Located within walking distance to MPRI, the two-story cottage, with amenities including 20 bedrooms with private baths, four kitchens, laundry services, dining areas, and a landscaped garden, will be a home away from home for patients.
“One of the best things about the home is the opportunity for actual camaraderie between patients,” said Ed Dickey, director of clinical operations at MPRI.
Bloomington offers additional benefits for out-of-town visitors, who so far have come from 24 states outside of Indiana and three countries, said Dickey. IU sets aside affordable housing units and provides translators—including sign-language translators—for patients who need them. The city and university offer an array of musical, cultural, and athletics events. IU students and community groups have put on numerous events to raise money for Jill’s House.
Patients normally return for annual checkups after their initial treatment. In Bloomington, Thornton believes they have a better experience than they would in a larger city.
“I’ve had patients from the East Coast tell me they’d never heard of a community opening up like this,” he said. “I call it Midwestern values.”
MPRI by the Numbers
- MPRI employs nearly 50 people, with plans to eventually add at least 20 additional staffers, including more full-time physicians.
- Currently, about 15 patients are treated at MPRI each day; eventually, up to 85 patients will be treated each day.
- MPRI is currently one of only five proton treatment facilities in the United States.
