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The positively charged particles of proton therapy may kill tumors more effectively with fewer side effects

By Lisa Greene

Dr. Richard Tuli’s patient had already had surgery to remove his pancreatic cancer and radiation therapy to kill any remaining cancer cells.

But when the cancer came back two years later, his local doctors told him that his body couldn’t handle another course of radiation.

That’s when the man returned to Tuli’s treatment team in New York to benefit from the cutting-edge treatment that Tuli is helping bring to Tampa General Hospital: proton therapy.

“His cancer was controlled, and he went into remission,” said Tuli, who now is chief of radiation oncology at Tampa General and the USF Health Morsani College of Medicine. “He did remarkably well.”

Tampa General Hospital aims to create more life-saving success stories like this one by partnering with Florida Cancer Specialists & Research InstituteProton Therapy Partners and Florida Urology Partners to bring proton therapy to Tampa Bay. Construction is slated to start on the freestanding proton therapy center in the second quarter of 2022. It will become one of nearly 40 treatment centers in the U.S.

As the first proton therapy center on the West Coast of Florida, the center will bring new options for patients with difficult-to-treat cancers in Tampa Bay. Proximity is especially important for proton therapy patients, as treatment can range from a single course of radiation to daily sessions that take place over one to two months.

Providing this option for patients is an important piece of providing the comprehensive cancer care that patients expect from a leading academic medical center such as Tampa General, said Tuli, who joined USF Health and Tampa General earlier this year.

“Access to care is critically important, and the onus is on us to be able to provide the best that medical care has to offer right here in Tampa Bay,” Tuli said. “Patients should not have to travel out of state and leave their home and loved ones for six weeks -- or even for one day -- to get a treatment that we know is effective.”

This alternative to traditional radiation can precisely target tumors that are near – or even wrapped around – critical structures, such as the brain stem and spinal cord.

Traditional radiation uses X-rays to kill tumor cells. While this treatment is effective, in some cases it can damage surrounding tissue. In contrast, proton radiation shoots beams of protons – tiny positively charged cell particles – into a tumor, killing it by damaging the molecules inside the tumor cell. The narrowly targeted beams stop at the tumor, making damage to the surrounding tissue much less likely.

For Tuli’s pancreatic cancer patient, that trade-off was important. The pancreas is surrounded by delicate organs: the stomach, liver, kidneys, intestines and spinal cord.

“The concern with a second course of standard radiation is that you will overdose the normal tissues that surround the tumor,” Tuli said. “And that, in and of itself, can be detrimental to the point where it outweighs the potential benefits of treatment.”

While the technology is relatively new, the benefits for treating such cancers this way are already clear. More than 200,000 people have been treated with proton therapy in the U.S., and the technology was first cleared by the federal Food and Drug Administration (FDA) in 1988. Cancers that may be treated with proton therapy include brain, head and neck cancers, oral cancer, lymphomas and other tumors located near the heart and lungs, such as breast and esophageal cancers. Prostate cancer and sarcomas also may be candidates for treatment.

Children also tend to be good candidates for proton therapy because their smaller size makes damaging sensitive tissue with traditional radiation more likely – as is the chance they could face heart, liver, lung diseases or even second cancers related to the radiation years later. It’s important, Tuli said, for physicians to weigh how treatment will affect patients’ quality of life.

“If a sarcoma in the leg, spine or pelvis is radiated, we may cure the cancer, but the bone stops growing on that side, causing significant quality of life issues,” he said. “These kids are in school and are supposed to be playing sports. Even things that are not life-threatening are still important to live normal, healthy lives and need to be considered with every treatment we administer.”

Once completed, the new proton therapy center will be around 20,000 square feet and house a machine that weighs around 50 tons. The treatment costs more than standard radiation, which remains the best choice for some patients.

“We want to be economically appropriate and judicious and treat patients the way that the best standard of care would dictate,” Tuli said. “You want to use the tool that’s appropriate for the job. But I see this as kind of the coolest tool on the tool belt.”

To learn more about proton therapy treatment at Tampa General, contact the TGH Cancer Institute at (813)-844-7585.