1. A Proton Therapy Overview Richard Eckart And David Turberville Richard Eckart And David Turberville

2. Modality Method and How It Works  Three Dimensional- Tumor Conformity  Bragg Peak Effect  Lower dose to normal tissue  No exit dose  Maximum Energy Deposit  Increase dose deposited  Three Dimensional- Tumor Conformity  Bragg Peak Effect  Lower dose to normal tissue  No exit dose  Maximum Energy Deposit  Increase dose deposited

3. Cancers Treated  Prostate Cancer- Highly effective  CNS Tumors- Minimizes unwanted dose  Ocular Cancers  Lung Cancers  GI Cancers  Pediatric Cancers- Growth Development  Prostate Cancer- Highly effective  CNS Tumors- Minimizes unwanted dose  Ocular Cancers  Lung Cancers  GI Cancers  Pediatric Cancers- Growth Development

5. Effectiveness/Results  Inconsistent Data from Clinical Trials  Constantly Changing Technology  Worldwide Collaboration  Rapid exchange of information  Validation of current technology  Long Term Documentation  Not enough collected at this time  Inconsistent Data from Clinical Trials  Constantly Changing Technology  Worldwide Collaboration  Rapid exchange of information  Validation of current technology  Long Term Documentation  Not enough collected at this time

6. Benefits and Drawbacks  Can still be combined with other treatment modalities  Health Insurance  Coverage  Medicare currently covers treatments  Cost  All or Nothing Approach-100% or 0% dose delivered  Can still be combined with other treatment modalities  Health Insurance  Coverage  Medicare currently covers treatments  Cost  All or Nothing Approach-100% or 0% dose delivered

7. Advantages  Fine tuned targeting of the beam  Utilizes pencil beam scanning  Even with IMRT there is a Leaf stepping effect  Treating small volumes and minimal depths- Ex. Eye  Reducing the risk of secondary malignancies  Quality of life  Pediatrics  Fine tuned targeting of the beam  Utilizes pencil beam scanning  Even with IMRT there is a Leaf stepping effect  Treating small volumes and minimal depths- Ex. Eye  Reducing the risk of secondary malignancies  Quality of life  Pediatrics

8. Patients Eligible and Sites Available  As of fall 2012, there are 10 centers operating in the U.S.  8 more centers being developed  Cost limitations have resulted in a severe shortage in capacity. 137,000 patients each year stand to benefit from proton therapy. Only 11,270 can currently be treated.  As of fall 2012, there are 10 centers operating in the U.S.  8 more centers being developed  Cost limitations have resulted in a severe shortage in capacity. 137,000 patients each year stand to benefit from proton therapy. Only 11,270 can currently be treated.

10. Current & Future Research Considerations  More research becoming available for comparison:  Side effects- acute and chronic  Survival rates  Secondary malignancies  Quality of Life  More research becoming available for comparison:  Side effects- acute and chronic  Survival rates  Secondary malignancies  Quality of Life

11. References Atkinson, J. (2013, February 8). Treating Cancer with Pinpoint Accuracy. Retrieved from nasa.gov: http://www.nasa.gov/centers/langley/news/researchernews/rn_Butuceanu.html Calabro, A., & Hamstra, D. A. (2012). EPIC: Proton therapy appears highly effective for men with prostate cancer. HemOnc Today - Clinical News in Oncology and Hematology, 1,5-6. Dinesh Mayani, D. (2011). Proton therapy for cancer treatment. Journal of Oncology Pharmacy Practice, 186-190. Gridley, D. S., Grover, R. S., Loredo, L. N., & Slater, J. D. (2010). Proton-beam therapy for tumors of the CNS. Expert Review of Neurotherapeutics, 319-30. Mayo Clinic. (2013). About Proton Therapy. Retrieved March 6, 2013, from Proton Beam Therapy Program: http://www.mayoclinic.org/proton-beam-therapy/about-proton-therapy.html Mayo Clinic. (2013). Questions and Answers. Retrieved March 6, 2013, from Proton Beam Therapy Program: http://www.mayoclinic.org/proton-beam-therapy/faq.html Olsen, D. R., Bruland, Ø. S., Frykholm, G., & Norderhaug, I. N. (2007). Proton therapy – A systematic review of clinical effectiveness. Radiotherapy & Oncology, 123-132, 10. Palta, J. R. (2008). Understanding the Uncertainties in Proton Therapy Planning and Delivery. Australasian Physical & Engineering Sciences in Medicine, 448-449. Slater, J. D., & Schulte, R. W. (2008). Proton-Beam vs Intensity-Modulated Radiation Therapy: Too Soon for a Randomized Trial. Oncology, 754, 757. The National Association for Proton Therapy. (2013). How It Works. Retrieved March 6, 2013, from The National Association for Proton Therapy: http://www.proton-therapy.org/howit.htm Volansky, R., Lee, A. K., Lawrence, T. S., & Tepper, J. E. (2012). Proton beam therapy holds 'great promise' at a steep cost. HEM/ONC Today, 1,10-12.