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How To Choose The Optimal Treatment

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How To Choose The Optimal Treatment

The aim of modern cancer treatment is to provide patients with the maximum chance of cure while minimizing treatment-related side effects. This can be achieved with proton therapy.

In order to select the optimal treatment, it is imperative to get comprehensive and comprehensible information. Ask not only about the most advanced treatment methods but also treatment-related side effects. They may significantly affect the quality of your child's life during and after treatment.

We are here to help you.

 

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How To Choose The Most Suitable Treatment

If radiation is considered as part of your child's treatment, inquire about all the options available. Our main goal is not only to cure children but also to accelerate their return to a normal, good-quality life.

Our physicians have many years of experience in radiotherapy. Moreover, they are experienced in both standard (photon) and proton radiation therapy; therefore, they will be able to answer all your questions pertaining to your decision on your treatment.

You can send your child's medical documentation for assessment of the suitability of proton therapy by e-mail to pacient@ptc.cz. Alternatively, you can contact our treatment coordinators, who are prepared to answer all of your questions related to proton therapy. You can call them at +420 222 999 031.

Proton Therapy Represents The Gentlest Radiation Method
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Unlike commonly used radiation therapy, proton therapy is gentler and safer. Due to the precise proton beam targeting, we are able to significantly reduce the risk of adverse effects and to mitigate potential risks such as damage to the heart and lungs, the incidence of endocrine problems, growth disorders, impairment of sensory functions, intellectual impairment, damage to the kidneys and urinary tract, fertility impairment, and the emergence of secondary tumors.

Modern Diagnostic Examinations
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Part of the Proton Therapy Center is also the Department of Radiodiagnostics and Nuclear Medicine. In addition to treatment, patients can undergo diagnostic examinations such as Magnetic Resonance Imaging (MRI) and Positron Emission Tomography in combination with Computed Tomography (PET/CT).

An accurate diagnostic process is fundamental for the right decision about treatment, the correct indication for radiation therapy, determination of the target volume and doses.

 

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How Proton Therapy Works
How Proton Therapy Works
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What Is Proton Therapy?

Proton therapy is an effective, accurate and gentle cancer treatment method with minimal side effects. Thanks to the precise targeting of the proton beam directly to the tumor, the occurrence of side effects is significantly reduced. This gives proton therapy patients a chance to enjoy a quality life even after cancer treatment without an increased risk of late toxicity, which can appear several years after irradiation (10, 15 or even 20 years).

Proton Therapy Provides A High Chance Of Being Cured
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Modern, Effective And Safe Oncological Treatment

The goal of modern oncological treatment is to ensure the maximum chance of recovery for patients while minimising adverse effects related to the treatment. Currently, this can be achieved by proton therapy. Unlike conventional radiotherapy, which uses photons for tumor cell irradiation and destruction, proton therapy is more advanced and uses protons. These particles give proton therapy its many advantages. The biggest advantage, compared to conventional radiotherapy, is its accuracy and its ability to protect healthy tissues.

The commonly used photon beam goes through the body and emits a significant portion of its energy in the regions in front of and behind the tumor.

Protons have a certain physical property called the Bragg peak, which means they emit significantly lower amounts of energy on their way to the tumor, thus minimising their impact on healthy tissues behind the tumor.

How We Treat You
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Few patients are aware of the complexity of the technology hidden below the Proton Therapy Center, which ultimately allows us to treat cancer gently. Protons, the positively charged elementary nuclei of the hydrogen atom, are accelerated in the cyclotron to approximately half the speed of light. This provides them with energy to destroy tumours up to 30 centimetres deepThen the protons are directed via a strong magnetic field into a very narrow beam and transferred to the tumour with high precision. As protons impact tumour tissue, they release energy, ionise, and damage the DNA of the affected cell. When the protons damage the tumour repeatedly, the cancer cells stop dividing or immediately die.

 

How We Can Irradiate Tumors With Millimeter Accuracy

Pencil Beam Scanning (PBS) marks the exact distribution of the proton beam dose and is currently the absolute peak in proton therapy technology. PBS irradiates the target area with millimeter accuracy with minimal damage to surrounding healthy tissues and organs. With this irradiation method, the thin (pencil) beam is directed to the appropriate point of the target volume by means of a magnetic field. Highly precise control of this magnetic field achieves gradual irradiation of the entire tumor site.

To illustrate how PBS works, imagine the task of colouring in a circle on a piece of paper with a pencil. As you fill in the circle, you will focus on making sure that you do not cross the borders. PBS also focuses on staying within the borders of the area being treated. That is why side effects with proton therapy are minimal.

Why Choose Proton Therapy?

Advantages Of Proton Therapy Over Conventional Radiotherapy

Tissues and organs in children are very sensitive to radiation exposure. Moreover, children are more prone to developing secondary tumors than adults. If we want to increase the child’s chance of healthy development also after treatment, it is vital to make every effort to prevent the adverse effects of radiation exposure. In this respect, proton therapy is of extraordinary benefit for them.

  • Less exposure of the spinal cord to radiation - Proton therapy reduces the radiation dose affecting the spinal cord for tumors located in its proximity. The risk of spinal cord damage is thus minimised.
  • Preserved mental performance - Thanks to proton therapy, mental performance is preserved to the fullest degree possible.
  • Reduced risk of hearing loss - Proton therapy reduces the dose affecting the middle and inner ear, which mitigates the risk of damage to the hearing or hearing loss.
  • Reduced risk of visual impairment - Proton therapy minimises the exposure of the visual system to radiation. Consequently, it reduces the risk of the emergence of visual complaints and complications.

Unlike commonly used radiation therapy, proton therapy is gentler and safer. Due to the precise proton beam targeting, we are able to significantly reduce the risk of adverse effects and to mitigate potential risks such as damage to the heart and lungs, the incidence of endocrine problems, growth disorders, impairment of sensory functions, intellectual impairment, damage to the kidneys and urinary tract, fertility impairment, and the emergence of secondary tumors.

 

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The diagram shows the radiation dose distribution in the body when using proton and photon therapies. It is apparent that the proton beam irradiates only the target volume (craniospinal axis region), i.e., the radiation is targeted almost exclusively only at the tissue which is affected or likely to be affected. On the contrary, photon radiation, owing to its physical properties, significantly affects also the surrounding area of the healthy structure, which in this case includes the spinal cord, heart, lungs, liver, and intestines.

Clinical studies comparing proton and photon therapies have demonstrated that IQ declined in children treated with photon therapy. Specifically, their IQ decreased by approximately 10.3 points per year for a period of three years after radiation exposure whereas following proton therapy, their IQ remained almost stable for a period of three years. It decreased by only 0.1 points per year.

 

Did you know that the benefits of proton irradiation are based on the physical principles and properties of protons?

Protons target the tumor directly, which allows us to protect healthy tissues and organs from adverse effects.

Unlike conventional radiotherapy, which uses photons for tumor cell irradiation and destruction, proton therapy is more advanced and uses protons.

The commonly used photon beam goes through the body and emits a significant portion of its energy in the regions in front of and behind the tumor. Protons have a certain physical property called the Bragg peak, which means they emit significantly lower amounts of energy on their way to the tumor, thus minimising their impact on healthy tissues behind the tumor. The greatest advantage of proton therapy is that, unlike common radiotherapy, it is precise and able to protect healthy tissues.

How Proton Therapy Is Conducted

A pediatric patient is admitted for treatment based on the pediatric oncologist's recommendation. The Proton Therapy Center in Prague cooperates with the Clinic of Pediatric Hematology and Oncology at the University Hospital in Motol, and the Clinic of Pediatric Oncology at the University Hospital in Brno.

If proton therapy is performed under general anesthesia, pediatric patients are hospitalized at the University Hospital Motol and commute to the Proton Therapy Center only for radiation treatment.

Although proton therapy is painless, we know that the child's psyche is an important part of the treatment. From the first moment, everything is adapted to the child‘s needs as much as possible.

When not anesthetized, children can wait for their radiation session or check-ups in a children's room with lots of toys, which looks nothing like a hospital. Cheerful coloring books and puzzles with "Professor Proton" provide distraction and guide them together with trained staff throughout the treatment.

 

Initial Assessment

In order for our medical team to assess a patient for suitability, we require some medical information from you. Your treatment coordinator will inform you of exactly what information we require. Usually, we will also request to see scans, such as an MRI, CT or PET scan. This information can be requested from the hospital or clinic and is often given to the patient on a CD. We can provide you with login details to upload the CD to our secure server. Alternatively, you can mail it to us. For pediatric patients we also require the referral for radiotherapy (it doesn't need to be specifically for proton therapy) by the treating pediatric oncologist.

Any information you already have about your child's diagnosis and previous treatments is very helpful and it is a good idea to provide us with as much information as possible in your initial enquiry. Your child's case will then be reviewed by our medical team at the daily indication board meeting. The Proton Therapy Center also cooperates with the Clinic of Pediatric Hematology and Oncology at the University Hospital in Motol, and the Clinic of Pediatric Oncology at the University Hospital in Brno. Your treatment coordinator will get back to you with the outcome, or possibly a request for more information if the oncologists require it to make their final decision.

You do not need to travel to Prague for the assessment.

 

Treatment Planning

When you come to Prague for treatment, you will first have a consultation to discuss the side effects and outcomes of treatment in your child's specific case, as well as the concrete treatment plan. The doctor also explains what to expect during and after the treatment. Finally, all of your questions are answered.

The first stage of treatment involves the diagnostic scans here at the Proton Therapy Center (MRI and/or CT, preparation of the fixation device, etc.). Precise treatment planning is crucial for treatment success. Therefore, a team of clinical physicists and physicians prepares a radiation plan tailored to each patient according to which proton therapy will take place. The irradiation plan also determines from which directions and with what intensity the proton beam will irradiate the tumor. This process is very complex and it typically takes one week to finalise before treatment can commence.

 

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We Use The Pencil Beam Scanning Technology

Pencil Beam Scanning (PBS) marks the exact distribution of the proton beam dose and is currently the absolute peak in proton therapy technology. PBS irradiates the target area with millimeter accuracy with minimal damage to surrounding healthy tissues and organs.

 

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The treatment is outpatient, and you come to the Proton Therapy Center for radiation and regular check-ups during treatment.

One visit takes 15–90 minutes while the radiation is a matter of a few minutes. In case of treatment under general anaesthesia, the stay at PTC is extended to approximately 2–3 hours, which the child spends together with either parent in the anaesthesiology room and in the recovery room under the supervision of nurses and the physician/anaesthesiologist until the anaesthesia wears off.

Prior to each radiation session, we carefully check the child’s position using X-ray scans and carry out certain other checks necessary to commence irradiating. At least once a week, the child undergoes check-ups with the physician who will go through the treatment progress with you and check the child’s condition. If the child is not hospitalised, they are checked by the paediatric oncologist at the same time during outpatient visits.

 

The treatment is outpatient and, in most cases, lasts from 30 to 35 business days, according to the regime determined by the physician on the basis of the initial assessment and other diagnostic tests.

The World Prefers Protons

The World Prefers Protons

The results and experience acquired at proton centers around the world and in the Czech Republic unambiguously confirm that proton therapy opens up entirely new ways of treating cancer. Proton therapy is an ever more recognised and preferred method worldwide. The benefits are obvious and, therefore, many new centres are being opened and planned. Currently, there are 71 centers in operation, 42 are just about to be opened, and dozens more are planned.

Technological developments and continual enhancement of therapeutic methods have extended the range of diagnoses where proton therapy plays an important role. The treatment of pediatric patients is undoubtedly one such diagnosis.

In the set of proton radiotherapy indications, paediatric patients form a group on which emphasis is placed globally. The Prague Proton Therapy Center is engaged in international cooperation in pediatric proton radiotherapy.

Published studies evaluating the results of proton therapy from proton centers worldwide, including the Prague Proton Therapy Center, show that in the case of treatment of pediatric patients with selected oncological diseases, proton therapy offers effective and gentle treatment by means of radiation.

Standard photon radiation may result in intellectual impairment of a child due to undesirable exposure of the brain to radiation. At the annual meeting of the American Cancer Society, physicians from the MD Anderson Center in Texas published results comparing proton and photon therapies in the treatment of paediatric brain tumors from the point of view of intellectual impairment after radiotherapy.

About Pediatric Cancer

Today, Over 80% Of Pediatric Cancer Patients Are Successfully Cured

In the Czech Republic, approximately 350 children and teenagers are diagnosed with cancer every year. Solid tumors, which can be treated with proton therapy, represent approximately 2/3 of all cases. Leukaemia represents 1/3 of all types of cancer (proton therapy is not indicated for leukaemia).

Although paediatric tumors are much more aggressive in comparison with tumors in adults, they are also more sensitive to radiation and chemotherapy. The progress achieved in therapeutic methods and technology has considerably enhanced treatment outcomes. Treatment methods are based on specific diagnoses and are often combined when treating paediatric cancer patients.

 

Protection Of Healthy Organs Is The Priority

Children are much more susceptible to the development of secondary tumors caused by radiation than adult patients, and they are more sensitive in terms of the occurrence of adverse effects. While commonly used radiation may cause serious adverse effects and complications, proton therapy is gentler for paediatric patients because it can reduce the exposure of the surrounding tissues and organs to unwanted radiation and thus limit (but not entirely exclude) the risk of treatment-related complications. In many situations, it becomes the first-line therapeutic method.