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The Highest Chance Of Being Cured

Proton Therapy For Gastrointestinal Tumors

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.

Proton radiotherapy is a gentle cancer treatment method with minimal side effects. It allows for accurate targeting of the proton beam to the target area (at the location of the original tumor), thus minimizing exposure of surrounding tissues and organs to radiation.

Pancreatic Tumors

From a technical and biological standpoint, irradiation of the pancreas is a quite difficult task. This is because the pancreas is surrounded by a number of organs that could be damaged by irradiation (liver, duodenum, kidneys, stomach, etc.). Proton therapy can solve this problem, making it the perfect tool for the job. Pancreatic tumor irradiation does not replace chemotherapy, but is rather used as a supplementary treatment.

Esophageal Tumors

The anatomic situation of the esophagus, between two lungs and close to the heart, requires application to a geometrically complex area in the midst of organs to which irradiation needs to be minimized. This is why the use of proton radiotherapy is beneficial.

Irradiation of esophageal tumors is rather complex and requires the irradiation of a large volume of tissue, including the esophageal area affected by the tumor, adjacent parts of oesophagus, as well as extensive areas of sentinel lymph nodes. This is why the irradiation of this area is difficult and can benefit from the use of proton radiotherapy. The radiation treatment is modified according to the procedure planned by the surgeon.

Anal Tumors

Radiotherapy of anal tumors is very difficult. For this reason, proton radiotherapy techniques have been developed to limit the adverse effects on the skin and mucous membranes of the sphincter and the surrounding tissue. This typically allows for the application of irradiation without needing to perform a temporary (relief) colostomy.

 

Benefits Of Proton Therapy

Proton therapy:

  • allows the use of radiotherapy even in conditions that are impossible to treat with conventional radiotherapy;
  • allows for the possibility to administer a higher radiation dose, thus increasing the chance of tumor eradication;
  • allows for a reduced number of fractions and shortened period of irradiation, which leads to further mitigation of the risk of various complications.
How To Choose The Optimal Treatment

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 life during and after treatment.

We are here to help you.

 

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How To Choose The Most Suitable Treatment

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 life during and after treatment.

If radiation is considered as part of your treatment, inquire about all the options available. 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.

  • Think about the options you have.
  • You don’t have to decide immediately.
  • The treatment you choose has a fundamental influence on the quality of life not only during but also after treatment. 

Keep in mind that your decision will significantly affect your future life. Our physicians are prepared to answer all of your questions related to PROTON THERAPY; therefore, do not hesitate to contact us immediately.

 

I Know My Chances Of Healing And Treatment Options

  • What treatment has my attending physician recommended?
  • Has the physician informed me about the risks and complications associated with currently used treatments?
  • Has the physician informed me about proton therapy?
  • Has the physician informed me about the risks and complications associated with standard radiation methods?

You can send your 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.

  

Protonová léčba

 

The only thing you need to do is to come to us in time. We are ready to help you.

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.

 

Proton Therapy Represents The Gentlest Radiation Method
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Unlike commonly used radiation therapy, proton therapy is gentler and safer. Thanks to precise proton beam targeting, we are able to significantly reduce the risk of adverse effects.

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 deep. Then 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

Proton therapy is more gentle because it can reduce the burden of unwanted radiation on surrounding tissues and organs and thus significantly reduce the risk of complications associated with treatment. It allows the use of radiotherapy even in diseases (conditions) that were previously impossible to treat with conventional radiotherapy.

Proton therapy:

  • in esophageal tumors, it significantly reduces unwanted radiation to the heart and lungs;
  • minimizes exposure of the bladder and kidneys, small intestine and other abdominal organs;
  • minimizes radiation doses to the spinal cord;
  • allows to reduce the number of fractions and shorten the irradiation time, which leads to a further reduction in the risk of various complications;
  • allows the delivery of a higher dose of radiation and thus increases the chances of tumor destruction.

 

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Based on worldwide experience and long-term results in treated patients, it is clear that patients after proton treatment have a higher quality of life compared to those who have undergone conventional (photon) radiotherapy.

Our physicians’ experience, our technology, excellent results, and professional attitude give you the maximum chance of being cured.

 

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

The experience of our doctors, our technology, excellent results and professional approach bring you the maximum chance of being cured.

 

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.

Any information you already have about your 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 case will then be reviewed by our medical team at the daily indication board meeting. 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 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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The treatment is outpatient, and you come to the Proton Therapy Center for radiation and regular check-ups during treatment. One visit takes about 60 minutes while the radiation is a matter of a few minutes. Prior to each radiation session, we carefully check your position using X-ray scans and carry out certain other checks necessary to commence irradiating. At least once a week, you undergo check-ups with the physician who will go through the treatment progress with you and check your condition.

Individual treatment doses are given each day, Monday to Friday. Treatment cannot be interrupted except for serious health reasons.

 

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 Controlled Breathing Method

As respiratory movements may impair the correct and precise execution of proton irradiation, in the treatment of GIT cancers we also use the method of controlled breathing. Patients whose tumor position changes due to respiratory movements are irradiated using a controlled breathing method. For this, we use the Dyn'R.

The controlled breathing method has been chosen because it is important that the irradiated area of the body and the target volume of the tumor are irradiated the same way during each fraction. Since this irradiated volume varies depending on breathing, we need to ensure that the patient's body is always in the same position. This is best done by holding their breath at a certain level. To determine this level, the patient first undergoes a controlled breathing training (Dyn'R training).

The controlled breathing training is done lying down on the back after being connected to the spirometer, using an antibacterial filter and a mouthpiece. The patient´s nose is held closed by a pin so that all exhaled air flows through their mouth. The patient also wears special glasses, where they see the breathing pattern to follow. The training is conducted by an experienced assistant and the patient has nothing to worry about.

 

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Esophageal tumors are typically treated in 25 fractions, liver tumors in 15 fractions, and pancreatic tumors in 18 fractions.

The World Prefers Protons

Proton therapy is an increasingly recognized and preferred method in the world. The results of the world's proton centers and the Prague Proton Therapy Center clearly confirm that proton therapy opens up completely new possibilities for the treatment of cancer.

Proton therapy is not a new method. Since 1991, the first exclusively clinical (not academic) workplace located at Loma Linda University, California, USA has treated many tens of thousands of cancer patients using proton therapy. Proton therapy is a technologically mature treatment proven by almost three decades of clinical operation. 

Despite many years of proton radiotherapy being used for the treatment of selected types of cancer, some healthcare professionals are still of the opinion that the higher radiation doses used in standard (photon) radiotherapy to which healthy tissues are exposed do not justify the use of proton beam therapy.

New clinical data is available from extensive studies suggesting that the frequency of acute toxicity (complications monitored for 90 days after initiation of treatment) is significantly lower in proton irradiation than in a comparable group of patients treated with photon radiotherapy.

A team of physicians from the University of Washington monitored almost 1,500 patients with various types of cancer, of whom about 400 underwent proton beam therapy while the rest were irradiated with state-of-the-art photon radiotherapy techniques. All the patients from this group were irradiated and at the same time were administered concomitant chemoradiotherapy. The study researchers focused on the emergence of toxicity at grade III and higher, which already requires hospitalisation and intensive medical treatment and care.

The study has shown that the observed toxicity (the complications associated with irradiation) in patients treated with protons is two-thirds lower than in the group treated with photon radiotherapy.

Specifically, serious adverse complications were reported by 11.5% of patients irradiated with protons as compared with 27.6% of patients irradiated with photons.

*Link: medicalnewstoday.com...

About Tumors Of The Digestive Tract

Pancreatic Tumors

Pancreatic tumors occur mainly in the gland's duct system. They rarely occur in the endocrine portion of the pancreas (which produces a number of hormones, e.g. insulin, among others). Those that do, however, are called PNETs, have a better prognosis, and their treatment entails special rules and procedures.

Pancreatic cancer is a very serious disease that is typically quite severe. It has a strong tendency to produce further lesions (metastases) especially in the liver and the peritoneum. The treatment of pancreatic tumors is very difficult and often unsuccessful.

Over 2,000 people are diagnosed with pancreatic cancer in the Czech Republic each year. The incidence increases in people over the age of 50. Risk factors for the development of pancreatic cancer are not clearly defined. They certainly include smoking, alcoholism, and recurring inflammations of the pancreas (pancreatitis).

The disease lacks early symptoms. It is usually diagnosed at an advanced stage. The very first symptom is often yellowing (jaundice, not to be confused with infectious hepatitis, i.e. a viral inflammation of the liver). Other symptoms include intense pain in the upper part of the abdomen, loss of appetite (with a particular aversion to meat) and significant weight loss. The symptoms of advanced stage include persistent nausea and recurrent vomiting.

Various methods are used in the treatment of pancreatic tumours (in medical terminology: modalities), the choice and progression of which are strictly established.

In the treatment of pancreatic tumours, surgery (pancreatic resection, full or partial), including the resection of the duodenum, as well as surgery of the small intestine are of paramount importance. If it is not possible (for any reason), the disease is treated principally by chemotherapy, which can be followed by radiation (radiotherapy). The irradiation makes sense solely in the context of chemotherapy, i.e. in relation to chemotherapy. Successful resection is followed by postoperative chemotherapy, also supplemented by irradiation. Special rules apply to postoperative irradiation.

 

Surgical treatment:

For pancreatic tumours, radical surgical treatment always comes first, if feasible. In other words, if the surgeon is able to perform radical surgery, it is best to do so as soon as possible. (Options are determined by the extent of pancreatic involvement and the health of the patient. Radical surgery means complete removal of the section of the organ.) If a radical procedure is not possible, the may perform surgery to bring the patient relief, depending on the situation (e.g. interconnection of the stomach and small intestine, which relieves from gastrointestinal issues).

If a radical procedure is not possible but the surgeon believes that the objective may be achieved through chemotherapy or irradiation, they will still plan the surgery, but will also request pre-surgical chemotherapy or radiotherapy. If the possibility of radical surgery can be achieved through pre-surgical treatment, it should be performed immediately.

 

Radiotherapy can be performed performed:

  • Postoperatively, following radical surgery. Aimed at the eradication of any residual microscopic cancerous tissue.
  • Independently, if surgery is not possible, in order to destroy the tumor.
  • Pre-surgically. If the surgeon believes in the possibility of performing radical surgery for tumor reduction.
  • In particular cases of recurrent cancer following radical surgery.

 

The irradiation follows several strict rules:

  • Proper efficacy is achieved only if irradiation is applied in the context of chemotherapy. This means that chemotherapy is administered first, and after a certain period, irradiation follows.
  • From a technical and biological standpoint, irradiation of the pancreas is extremely difficult. This is because the pancreas is surrounded by a number of organs which may be damaged by irradiation (liver, duodenum, kidneys, stomach, etc.). Proton therapy can solve this problem, making it the perfect tool for the job.

 

Chemotherapy is a fundamental method in the treatment of pancreatic tumours. Indications:

  • Post-surgical – following radical surgery (aimed at the eradication of residual microscopic cancerous tissue).
  • Pre-surgical – as with radiotherapy, aimed to achieve the possibility of a radical procedure.
  • Independently – if radical surgery is not possible, and there is chance of its feasibility in the future.
  • For these indications, irradiation procedures follow after a specific number of chemotherapy cycles.

 

 

Esophageal Tumors

Esophageal tumors are a very serious conditions generating from the inner esophageal layer, the treatment of which is extremely difficult, but can be highly successful in that it can lead to a complete recovery.

Treatment consists of various sequences of chemotherapy, irradiation, and surgery. Typically, the process principally comprises of concurrent chemo- and radiation therapies, which is then followed by a surgical procedures.

Over 500 people are diagnosed with esophageal tumors in the Czech Republic each year. It is most frequently diagnosed in patients between 50 and 70 years of age.

The risk factors include smoking, the consumption of hard liquor, alcoholism, and low-residue unbalanced diet.

Esophageal tumor symptoms manifest early on, and include difficulties swallowing, painful swallowing, rapid weight loss, vomiting, bleeding and/or the vomiting of partly digested blood, persistent chest pain.

Various methods are used to treat esophageal tumors (in medical terminology: modalities), the choice and progression of which are strictly established. The treatment is always determined after a thorough medical consultation between the surgeons and oncologists.

 

Surgical treatment:

Tumors are treated surgically, with resection, either initially (in case of small initial findings), or following the preparatory phase of irradiating the site, or the application of chemotherapy (in progressed tumours). The resection is a very complex and complicated procedure , which will be described in greater detail by the surgeon. The choice between irradiation and chemotherapy is made on the basis of the site of the tumor.

Chemotherapy is preferred in tumors originating in the passage between the esophagus and the stomach.

In tumours originating in the cervical section of the oesophagus, it is impossible to perform surgeries.

 

Radiotherapy:

The radiotherapy of oesophageal tumours is applied as:

  • pre-surgical, which means that the tumour is irradiated in relation to the subsequent surgical procedure, in a precise succession of time;
  • independent – irradiation is carried out without the prospect of the surgery, either for tumours in the cervical section of the oesophagus, or in situations where surgery is out of the question for any reason;
  • radiotherapy is sometimes also indicated as post-surgical treatment, usually in cases where the cancerous tissue was discovered during resection to be larger than originally estimated. The anatomic placement of esophagus – between two lungs and close to the heart – requires application to a geometrically complex area in the midst of organs to which irradiation needs to be minimised. That is why proton radiotherapy is used with great benefit.

 

Chemotherapy:

Chemotherapy in esophageal tumors is predominantly applied concurrently with of irradiation. The goal of this type of chemotherapy treatment is to make the tumor more sensitive to irradiation. This type of chemotherapy is applied in lower doses and using a decreased concurrent number of substances - two at the most. It is therefore well-tolerated by the patients. Chemotherapy as an independent form of treatment is used in tumours originating in the passage between the esophagus and the stomach.

 

 

Anal Tumors

Anal tumors are a highly specific type of condition originating in the sphincter area, or even in the area of the transition between the sphincter and the skin. Currently, radiotherapy in anal tumours treatment is predominantly preferred over a surgical procedure, which requires the introduction of a permanent (lifelong) colostomy.

For a treatment that is extremely difficult and high-risk, 90% of cases can be cured using radiotherapy alone. Treatment using proton radiotherapy is less difficult.

170 to 190 people are diagnosed with anal tumours in the Czech Republic each year. The incidence increases after 40 years of age. Anal tumour incidence risk factors include HPV infection (vaccination available), smoking, and unusual sexual practices.

Although the anal tumour symptoms are early, they are often mistakenly diagnosed as mere haemorrhoids.

The main symptom is bleeding, as well as undefined pain in the sphincter, painful defecation, or sometimes finding of enlarged inguinal lymph-nodes.

The progression of anal tumours follows specific rules. The choice of therapeutic modalities is completely different from tumours of the adjacent anatomical site – rectum. It is thus necessary to quite clearly (and accurately, of course) establish the diagnosis: Anal tumour vs. rectal tumour.

The choice of therapeutic modalities is completely different from tumours of the adjacent anatomical site – rectum. It is thus necessary to quite clearly (and accurately, of course) establish the diagnosis: Anal tumour vs rectal tumour.

The treatment process is always chosen in consultation with the patient who has the choice between a surgical procedure and irradiation. Irradiation is always complemented with concurrent chemotherapy. Radiotherapy is very complicated and demanding, accompanied by a number of adverse effects not only in the areas of the sphincter skin and epithelium and surroundings, but also those adverse effects manifesting themselves in the blood count. For this reason, proton radiotherapy techniques have been developed to limit the adverse effects, typically allowing for the application of irradiation without needing to perform a temporary (relief) colostomy.

 

Surgical treatment:

Surgical treatment of anal tumours has not been used as a first course of action since the 1980s. This is because a distinct radiation effect has been discovered leading in a high proportion of affected patients (depending on the disease stage between 80 % and 95 %) to a complete cure without surgery.

Nonetheless, the surgical procedure is still available as a standard procedure as an alternative modality to radiation treatment. It consists in the complete removal of the sphincter, i.e. it requires the introduction of permanent colostomy.

Currently, the main indication factor for surgery is a so called “life-saving treatment,” in situations when there is a relapse of the disease, or the disease is not completely cured with irradiation (depending on the disease stage the risk is between 5 % and 15 %).

The realm of surgical treatment also includes the question of a temporary colostomy for the period of radiotherapy application, facilitating better tolerance in post-radiation skin and epithelium response.

 

Radiotherapy:

Radiotherapy is considered to be the primary treatment modality in anal tumours, unless the patient decides to undergo surgery.

Radiotherapy in anal tumours is an extremely complicated form of treatment. Standard application of chemotherapy concurrently with irradiation forms its integral part. It is accompanied by an array of adverse effects to the skin, epithelia, urogenital system, and the blood count as well.


This is why proton radiotherapy is used, applying a more favourable dose distribution than conventional photon radiotherapy with the reduction (but not elimination, of course) of adverse effects.

In the majority of cases, proton radiotherapy can be performed without introducing a temporary colostomy, however, not in all cases. The anticancer efficacy of both proton and photon radiotherapy is identical.

 

Chemotherapy:

Chemotherapy is customarily administered concurrently with irradiation, while as a standalone modality it is considered as a secondary option only. It is indicated in cases of large tumorous masses prior to radiotherapy with the goal of reducing the size of the radiated mass. It is also indicated for relapses in the form of distant metastases (local relapse can be resolved with life-saving surgery).