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"Proton therapy allows patients to live a higher quality life." MUDr. Pavel Vítek
Proton radiotherapy has a special application in primary liver tumors.
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The Highest Chance Of Being Cured

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The Highest Chance Of Being Cured

Liver cancer 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.

Radiotherapy of primary liver tumors is a relatively new method which has thus far not been used frequently. In case of hepatocellular carcinoma, and regarding the location and extent of involvement, an effective radiation dose often cannot be applied via any other means but protons. Proton therapy considerably reduces exposure of the tumor surroundings to radiation; therefore, it gives patients a greater chance of recovery. 

Benefits Of Proton Therapy

  • Reduced number of fractions and shortened period of irradiation, which leads to further mitigation of the risk of various complications.
  • Possibility to administer a higher radiation dose, thus increasing the chance of tumour destruction.
  • Minimized unwanted exposure of healthy tissues and organs to radiation and thus reduces the risk of adverse effects.
  • Use of radiotherapy also for diseases (conditions) which so far could not be treated by conventional radiotherapy.
How To Choose The Optimal Treatment

How To Choose The Most Suitable Treatment For Liver Cancer

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.

 

 

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.

 

Léčba rakoviny jater

 

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.

 

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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:

  • minimizes exposure of the bladder and kidneys, small intestine and other abdominal organs;
  • minimizes radiation doses to the spinal cord.

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.

 

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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 liver cancer 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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The treatment is outpatient and, in most cases, takes about 15 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

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 Liver Cancer

Primary liver tumors (not the secondary lesions of other liver tumours) are quite a rare type of disease in Europe. The treatment process is therefore unique and special. In this case liver transplantation represents the most effective treatment method. Less effective treatments include partial liver resection, radiotherapy, chemotherapy administered via the hepatic artery, and many specific methods, such as RF heating of tumorous lesions and biological therapy.

Approximately 400 people suffer from primary liver tumours in the Czech Republic annually. The statistics, however, are not exact in this area. Infectious hepatitis, cirrhosis, and alcoholism are unequivocally considered as the risk factors. The symptoms of primary liver tumours usually appear at advanced stages of the illness. Early signs and symptoms are often missing – therefore, the illness is often diagnosed as advanced. The symptoms include undefined aches in the upper right part of the abdomen, undefined indigestion complications, jaundice (only as a symptom, not hepatitis proper), or deteriorated blood coagulation.

Primary liver tumors, i.e. those that are not secondary lesions of other tumors (metastases), are treated with different methods than other types of tumors. The most effective treatment is liver transplantation. Less effective treatments include partial liver resection, radiotherapy, chemotherapy administered via the hepatic artery, and many specific methods, e.g., RF heating of tumorous lesions, and biological therapy.

 

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Liver transplantation (in accordance with very specific criteria) and the possibility of a surgical solution (partial liver resection):

  • The options are evaluated by one of the two transplant centres in the Czech Republic – IKEM Prague, or University Hospital Brno (FN Brno). The health care system in the Czech Republic provides one of the best transplant programmes in the world.
  • If either liver transplantation or resection is ruled out, the options of radiation and targeted chemotherapy administered to the liver artery are considered.
  • Radiation represents a technically demanding method. Regarding the localisation and extent of damage, an effective dose often cannot be applied by any other means but protons.

 

Surgical treatment, transplantation, partial resection:

  • The surgical methods are the most effective. Only when the surgeon definitely rejects transplantation or resection other treatment modalities can beindicated. Naturally, in conditions of well progressed illness, e.g., with multiple metastases, the viewpoint is given beforehand so to speak and it is not necessary to burden the top-ranking facilities with non-essential consultation requests.

 

Radiotherapy:

Radiotherapy of primary liver tumors is a relatively new method which has thus far not been used frequently. This follows from the fact that it has thus far not been feasible to apply prevalent radiation methods using photon (gamma) radiation for liver tumour radiation in effective and at the same time safe doses.

Only with the advent of advanced radiotherapy methods, for instance, proton radiotherapy, has it become possible to radiate a primary liver tumor with high efficiency. A tumorous lesion designated by the surgeon as unsuitable for resection or transplantation and that does not affect any tissues outside the liver is subjected to radiation. The lesion also must not be larger than half of the liver itself.

 

Chemotherapy, biological therapy, and other methods:

Effective primary liver tumour chemotherapy has so far not been developed. Only a special type of chemotherapy called TACE, administered directly into the liver artery, has shown any efficiency. Some primary liver tumors can be treated with direct intervention, usually via a needle inserted into the tumour under CT supervision – generally called “ablation methods”. These include radiofrequency ablation (RFA), percutaneous ethanol injection (PEI), irreversible electroporation (IRE), etc. Biological treatment is used in advanced conditions in the form of tablets (sorafenib in these cases being the active substance).