Proton Progress

It’s been just over a year since University Hospitals opened its new $30 million Proton Therapy Center, conveniently located at UH Cleveland Medical Center. Based around a compact Mevion S250 system, UH’s Proton Therapy Center is one of the only centers in the world that is immediately attached to a full-service, nationally ranked children’s hospital – UH Rainbow Babies & Children’s Hospital, whose patients in the Angie Fowler Adolescent & Young Adult Cancer Institute benefit from the close proximity. The UH Proton Therapy Center is also less than 500 feet from UH Seidman Cancer Center, where adult patients with cancer can access treatment.

David Mansur, MD

How are things going so far?

“Patient ramp-up for our center was relatively steady, and that continues,” says radiation oncologist David Mansur, MD, Director, UH Proton Therapy Center, Division Chief, Radiation Oncology, UH Rainbow Babies & Children’s Hospital; Associate Professor of Pediatrics and Radiation Oncology, Case Western Reserve University School of Medicine.

During the first 14 months of operation, Dr. Mansur says, 149 patients completed proton therapy treatment at UH – 22 percent being pediatric, adolescent or young adult. The most common cancers treated were brain tumors (37 percent). Others sites treated included cancers of the head and neck, lung, esophagus and prostate. Dr. Mansur presented these data at the recent meeting of the Particle Therapy Cooperative Group – North America, held in Chicago in October.

Preliminary results also indicate favorable approval rates by Medicare/Medicaid and most commercial payers in the region. Of all patients for whom their attending physician considered proton therapy the treatment of choice, 15 percent were denied by insurance after appeals were exhausted.

“We’ve had some refusals, but overall it’s been a bit better than we expected,” Dr. Mansur says. “There can be issues, so we have a dedicated pre-certification specialist to help families determine whether insurance in going to cover the treatment course. It can ease some of the anxiety.”

The Proton Therapy Center also employs a patient concierge to coordinate retrieval of outside medical records and help patients arrange housing for the course of their treatment, Dr. Mansur says.

New developments since the UH Proton Therapy Center opened include implementation of a technique to treat technically challenging breast cancer patients and the credentialing required for the center to participate in National Cooperative Group clinical trials. The first of these trials at UH will enroll patients with cancer of the brain, breast or prostate, Dr. Mansur says. These studies will compare outcomes from proton therapy with traditional photon therapy, enrolling patients with non-metastatic breast cancer or low- or intermediate-risk prostate cancer.

Another planned enhancement is in the area of image guidance.

“We’re planning to implement additional image guidance utilizing CT-based imaging to complement our current image guidance system,” Dr. Mansur says. “The advantage is better delineation of soft tissues for targeting the treatment.”

As always, Dr. Mansur emphasizes that proton therapy is just one of the radiation oncology modalities available to UH patients.

“Everyone is not a candidate for proton therapy,” he says. “Patients with widely metastatic disease are not suitable candidates. The first step is for the patient to be seen by a faculty member here for a radiation oncology consultation to determine the best modality for a given cancer, whether it’s Gamma Knife, conventional radiation therapy or proton beam.”

For more information about the UH Proton Therapy Center or to refer a patient, please email Cancer.Innovations@UHhospitals.org.