Proton therapy

Overview: 

Proton therapy is a kind of radiation therapy used to treat cancers. Instead of the traditional X-rays used to treat cancers, proton therapy uses energy from proton beams to treat cancers. Protons are positively charged particles that when excited release energy. 

About PT: 

Proton therapy uses protons that pass through the tissues and stop abruptly to deposit their energy at a particular depth. This depth is called the Bragg peak where they deliver the highest dose of their energy. This causes minimal damage to the tissues and precisely targets the tumors. Proton beam was spread by passive scattering previously and now uses magnetic scattering. Magnetic scattering delivers the proton beam more accurately and matches the tumor shape. This reduces the damage to the adjacent tissues.  

The machinery of PT:

The machines used for proton therapy are called cyclotrons and synchrotrons. Using advanced software treatment planning is done and proton doses are optimized. The protons used in PT are accelerated at 70-250 MeV by using cyclotrons or synchrotrons. These accelerated protons are used to treat cancer. Cyclotrons and synchrotrons differ in the way they release the protons. Typically cyclotrons are compact and release a continuous stream of high-energy protons. Synchrotrons are energy-flexible machines that generate protons with different energy levels in batches. 

Techniques of PT:

The generated proton beams are made to match the tumor shape by two techniques. They are by passive scattering and magnetic scanning. 

• Passive scattering spreads the proton beam with rotating wheels and scatterers. Using brass apertures and range compensators, the beam matches the tumor’s shape and size. 
• Magnetic scanning is an advanced and precise technique in PT. It has greater accuracy and control as it uses magnets to direct the narrow beam of protons into the tumor. 

Using any of the techniques, the beam is directed to the tumor through a nozzle. This is mounted on a rotating gantry. This setup targets the tumor from different angles in a pattern with precise dose control. The beamlets produced during the therapy are monoenergetic and are delivered as layers. Each layer has protons with a specific energy to deliver them precisely to the target area. 

PT delivery: 

PT is delivered by a method called Intensity-modulated proton therapy (IMPT). IMPT delivers the protons to the target area as layers using computer algorithms. This painting of the target by layers of protons enables to receive the proton therapy precisely. Simultaneously it spares the healthy tissue from the proton therapy. Complex dose patterns are uniformly delivered to the target area with minimal exposure to the surrounding tissues. 

Indications: 

Proton therapy is indicated for a variety of cancerous and non-cancerous tumors. It can be used alone or as a combination therapy. It can also be used for recurrent tumors which cannot be cured by traditional radiation therapy. 

PT is indicated in tumors that are located close to the vital organs. They are also used for tumors that have not spread to other areas of the body. 

Advantages of PT: 

• They have the following advantages: 
• They cause dense ionization than traditional radiation
• They are effective for treating cancers as they can penetrate deeper tissues
• They have a precise dose of distribution
• They can protect the body’s immune system 

Before PT: 

Before undergoing PT, an individual will undergo radiation simulation. Simulation is the process where the healthcare professionals determine the most comfortable position to receive the radiation. An individual is made to lie on the table and using some restraints or immobilizing devices, the best comfortable position to receive the PT will be determined. The area on the body to receive the treatment will be marked using temporary or permanent markers. 

Advanced imaging like the MRI or CT will be used to determine the extent, size, and shape of the tumors and the area of the skin to be treated. Then they calculate the dosage and determine the direction of the beam to the target area. Sometimes tight-fitting masks may be customized to prevent radiation exposure to the vital organs of the body. 

During the procedure:

An individual will undergo PT for five days in a row in a week. The number of days and dosage will be decided on the extent of the tumor and the response. After positioning the individual on the table and based on the previous markings PT is administered through a nozzle present in the gantry. The individual's position on the table is confirmed through an X-ray, a CT scan, or a laser to deliver the PT at the same location as planned. The gantry directs the protons to the exact locations of the tumor. The HCP team will be in a console room from which they will be viewing as the PT goes on. 

After the procedure:

The entire procedure of PT takes a few minutes but the preparation for the PT takes about 30-45 minutes. After the treatment, an individual is subjected to multiple CT or MRI scans to analyze the response of the tumor to the treatment. One can continue their daily activities after the PT. 

Side effects:

Fatigue and redness are the main side effects of the proton therapy that are seen over a series of exposures. 

Risks and complications:

Long-term weakness, hair loss over the irradiated area, pain and tenderness, redness of the exposed areas, difficulty in swallowing, nausea, vomiting, and headaches are some of the risks associated with the procedure. Long-term complications include infertility and changes in the vital structures. 

Conclusion: 

Proton therapy is an advanced radiation therapy used to treat cancers and noncancerous tumors. It is more effective than traditional radiation therapy as it uses protons for the treatment. Using high-energy particles, cancer is treated to increase the survival rate. 

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