Friday, April 24, 2009

Proton Therapy

Section 16.11.3 in the 4th edition of Intermediate Physics for Medicine and Biology discusses proton therapy.
Protons are also used to treat tumors. Their advantage is the increase of stopping power at low energies. It is possible to make them come to rest in the tissue to be destroyed, with an enhanced dose relative to intervening tissue and almost no dose distally (“downstream”) as shown by the Bragg peak.
Proton therapy has become popular recently: see articles in US News and World Report and on MSNBC. There even exists a National Association for Proton Therapy. Their website explains the main advantage of protons over X-rays.
Both standard x-ray therapy and proton beams work on the principle of selective cell destruction. The major advantage of proton treatment over conventional radiation, however, is that the energy distribution of protons can be directed and deposited in tissue volumes designated by the physicians in a three-dimensional pattern from each beam used. This capability provides greater control and precision and, therefore, superior management of treatment. Radiation therapy requires that conventional x-rays be delivered into the body in total doses sufficient to assure that enough ionization events occur to damage all the cancer cells. The conventional x-rays lack of charge and mass, however, results in most of their energy from a single conventional x-ray beam being deposited in normal tissues near the body’s surface, as well as undesirable energy deposition beyond the cancer site. This undesirable pattern of energy placement can result in unnecessary damage to healthy tissues, often preventing physicians from using sufficient radiation to control the cancer.

Protons, on the other hand, are energized to specific velocities. These energies determine how deeply in the body protons will deposit their maximum energy. As the protons move through the body, they slow down, causing increased interaction with orbiting electrons.
Figure 16.51 of the 4th edition of Intermediate Physics for Medicine and Biology shows the dose versus depth from a 150 MeV proton beam, including the all-important Bragg peak located many centimeters below the tissue surface. If you want to understand better why proton energy is deposited in the Bragg peak rather than being spread throughout the tissue, solve Problem 31 in Chapter 16.

To learn more about the pros and cons of proton therapy, I suggest several
point/counterpoint articles from the journal Medical Physics: Within the Next Decade Conventional Cyclotrons for Proton Radiotherapy will Become Obsolete and Replaced by Far Less Expensive Machines using Compact Laser Systems for the Acceleration of the Protons, Chang-Ming Ma and Richard Maughan (Medical Physics, Volume 33, Pages 571–573, 2006), Proton Therapy is the Best Radiation Treatment Modality for Prostate Cancer, Michael Moyers and Jean Pouliot (Medical Physics, Volume 34, Pages 375378, 2007), and Proton Therapy is Too Expensive for the Minimal Potential Improvements in Outcome Claimed, Robert Schulz and Alfred Smith (Medical Physics, Volume 34, Pages 1135–1138, 2007).

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