Talk:Proton therapy

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Is this an advertisement or what?

Under History of Proton Therapy, "... announced its intent to enter a joint venture with ProCure Treatment Centers Inc. and Radiation Oncology Consultants, Ltd. to bring the future of cancer treatment to Illinois."

That sounds like a corporate PR advertisement to me, and not encyclopedic content. But more specifically, it does not mention that they are bringing proton therapy. For all we know, they could be bringing microwave tissue heating to Illinois.--Bodybagger 09:01, 31 August 2007 (UTC)

Information or promotion

When the footprints of promotion could be tracked in an encyclopedic context like Wikipedia, I start doubting where the exact boundary between information and promotion is. —Preceding unsigned comment added by 212.123.218.194 (talk) 08:49, 22 April 2008 (UTC)

List of treatment centers, list of equipment suppliers

wikipedia:Wikipedia is not the yellow pages or a directory of services. I think these lists are entirely a distraction from the real content. Lists should be included as prose, very generally.- sinneed (talk) 18:24, 3 September 2009 (UTC)

Expanding a bit: I understand how the lists are useful to readers (yellow pages). I don't understand how they help Wikipedia... how do the lists increase the knowledge about Proton therapy contained in Wikipedia. Not where to go to get it or how to buy a machine... but knowledge of "Proton therapy" itself.- sinneed (talk) 18:38, 3 September 2009 (UTC)

I won't revert if these are readded, but I oppose that. This seems to be straight advertisement:

• IBA Equipment supplier - (Belgium)
• Optivus Proton Therapy Equipment supplier - (USA)
• Hitachi Equipment supplier - (Japan)
• Sumitomo Heavy Industries Equipment supplier - (Japan)
• ACCEL Equipment supplier - (Germany)
• Varian Equipment supplier - (USA)
• Mitsubishi Electric Equipment supplier - (Japan)
• Siemens Equipment supplier - (Germany)
• Still River Systems Equipment supplier - (USA)
• ProTom International Equipment supplier - (USA/Russia)\

- sinneed (talk) 21:49, 3 September 2009 (UTC)

Any objection to removing the center list as well? wp:NOT seems to apply... WP is not the yellow pages. Perhaps, if there is a need, an article "List of proton therapy treatment centers" but I would oppose it.- sinneed (talk) 04:20, 8 September 2009 (UTC)

No objections. hatchet falling. - Sinneed (talk) 19:13, 17 September 2009 (UTC)

Well. That hurt. I lost an edit summary and removed my edits, then reapplied them with 1 edit summary for all of it. I left the list of current centers in, since these seem to have become home to other information. Please check it out. - Sinneed (talk) 19:27, 17 September 2009 (UTC)

Hmmm. In later edits I succeeded in integrating the miscellaneous information that was mixed with the list into the body of the article.- Sinneed 02:34, 21 September 2009 (UTC)

PTCOG

An editor stated this was a group intended to promote proton therapy. This was added over the citation to the group's site, and was not covered by content there. I included the quote from the site, though I don't think it belongs. I am uncertain it even needs a mention. I think this list would be better served as an EL to that specific page. If we DO need the blurb in the body, then if this is a promotional organization and an wp:RS says they are indeed there to promote, I would probably support inclusion. - Sinneed (talk) 05:41, 18 September 2009 (UTC)

PTCOG (Particle Therapy Oncology Group) is not a promotional organization. It is a the organizing committee for a twice yearly international conference on charged particle therapy, and keeps/publishes a certain amount of cross institution data. As such I think it is a useful inclusion.AE1978 (talk) 16:42, 18 September 2009 (UTC)

I have turned the list of centers into an EL, wp:NOT the yellow pages... I am unsure that either the body listing or the EL need to stay in the article. My thinking at the moment is that both need to go. On the other hand, several of the centers have articles of their own, this might be a valuable encyclopedic resource. *shrug* - Sinneed (talk) 06:04, 18 September 2009 (UTC)

Looking at the body, I just can't justify having it in there... wp:NOT would seem to apply. Cut. I left in the EL, for the moment, but do we need it? - Sinneed (talk) 06:25, 18 September 2009 (UTC)

An editor has serious concerns about the organization, and I dropped the link under wp:NOT the yellow pages. Easily restored if someone disagrees. - Sinneed (talk) 07:12, 20 September 2009 (UTC)

Image layouts, section headings

There was much repetition of higher level headings in the section / sub-section headings. wp:MOS I whacked those down. - Sinneed (talk) 06:23, 18 September 2009 (UTC)

Following the lead of a subsection for prostate cancer I made one for ocular oncology that was buried in the old treatment center content. This is too short, and I seem to remember a good chunk of content about treatment of ocular tumors but I did not spot it on a quick look. But do we need subsections for the various body bits likely to get dosed in treatment? - Sinneed (talk) 06:23, 18 September 2009 (UTC)

I moved the images around, made them the same size. Thoughts? - Sinneed (talk) 06:23, 18 September 2009 (UTC)

I like this very much. I was planning to move the depth dose info higher myself. On another note, I re-integrated the prostate section with the main application section, the logical flow is better (the comparison with pediatric txs works better). Also, prostate is just one of many treatments, where the ocular treatments have the unique distinction of needing lower energy machines to deliver. However, if anyone objects I'm not fully wedded to this.AE1978 (talk) 18:51, 19 September 2009 (UTC)

Main

I have moved the MAIN template to the top of the article, referring to both the "parent" articles.

EL

• Accelerator Physics: The Plasma Revolution, Nature 449 (2007) 133, by Navroz Patel

It is not immediately clear to me how this adds value to the article and is a for-pay site. I don't feel strongly, if anyone thinks it belongs please just restore it and if very kind explain why here. - Sinneed (talk) 07:10, 20 September 2009 (UTC)

SOBP chart - is it good?

I was editing the Bragg peak article, and noted that it had a very different (and uglier) chart. Then I realized that the chart in this both articles shows an Xray dosage that is VERY much lower than the SOBP dosage at the treatment depth. It appears to me this will understate the Xray dosage at all depths for a comparable treatment dose. Am I missing something?- Sinneed 14:27, 21 September 2009 (UTC) edit - - Sinneed 14:32, 21 September 2009 (UTC)

No Sinneed you are not. both curves are normalized to the same maximum dose (as they should be). It is true the the max dose of a single X-ray field occurs proximal to the target, and this is the whole point of the advantage of protons over X-rays. In practice one ususally uses opposed X-ray fields where the two exponentialy dropping curves from opposite sides add up to a constant dose through the entire patient, thus delivering full dose to the regions both distal to (beyond) and proximal to (in front of) the target. A geometric dose advantage is achieved by summming multiple opposed X-ray fields that add up on the target, and not on normal tissue. It is easy to see that you have much more freedom, and can spare much more normal tissue, with the proton SOBP than with the X-ray curve.AE1978 (talk) 19:43, 21 September 2009 (UTC)

Well, except for the surface and shallow depths which get more "burn", which I think is mentioned in the article.

Too, it would seem to me that X-ray lends itself more to spreading the surface/shallow damage over a wider area... but with the problem that the x-rays continue smashing their way through. Not sure that is in there. If not, should it be?- Sinneed 22:49, 21 September 2009 (UTC)

Exponential decay is not a problem. - The use of parallel opposed fields as an example is an illuminating thought experiment in the application of proton therapy. The argument that protons are better because they "stop" is undone in this case. The spread out bragg peak applied in a parallel opposed fashion shows a comparable distribution, though not identical, to the x-ray distribution. Unfortunately it is just painful to wait for someone to catch on to this concept and then wait for them to have the attention span to learn how to use it in a meaningful way.

When this concept is sufficiently understood then the next step in the argument is to compare IMRT, IMPT and brachytherapy. Considering IMRT, IMPT and brachytherapy is where "skin sparing" resurfaces to become the subtle motivator requiring another level of clarity in thought.

From a mathematical point of view choosing a therapy modality is really a matter of choosing different "basis functions" to fit the same ideal dose distribution. Note that the SOBP displays properties similar to the Gibbs Phenomenon in a Fourier Series. This concept is the pinnacle of understanding what 99% of the people in the field just fail to understand. Mdphd2012 (talk) 18:05, 22 September 2009 (UTC)

mdphd2012 is correct about the basis functions in a mathematical sense (as is well appreciated in the field,I myself have used this explanation uncountable times over the years) , but his thought experiment of the opposed proton fields is specious. The point is that while you need more than one X-ray field to achieve a "flat" dose distribution, with protons you can get that using one field. This allows you considerably more freedom to choose your fields with protons, while still sparing normal tissue. The example if IMRT is illustrative, while the ability to construct a nearly arbitrary distribution from the X-ray basis functions afforded in IMRT systems allows one to produce dose distributions with great conformality to the target, this is at expense of a larger amount of normal tissue that is exposed to a fairly low dose (just compare the dose/volume histograms of an IMRT plan with a proton plan and you'll see what I mean). Anyway, to return to the topic at hand, the depth dose graph as displayed is correct.AE1978 (talk) 13:12, 24 September 2009 (UTC)

I have uploaded a vector trace of the plot, without the photon curve, at File:SpreadOutBraggPeak_complete.svg. This probably isn't good enough to make the main image, but may be useful for some... – drw25 (talk) 14:07, 27 May 2010 (UTC)

Quick Assessment against B-class

1. B-Class-1: It is suitably referenced, and all major points have appropriate inline citations.
   • Not quite there. As a very rough guide, each paragraph is likely to contain at least important statement that will require sourcing. Completely uncited paragraphs are a sign that more sources could be added.
2. B-Class-2: It reasonably covers the topic, and does not contain obvious omissions or inaccuracies.
   • You'll need to check this with an expert in the field, but it seems to cover the topic. The length of the discussions on the talk page often indicate the amount of effort that has gone into making an article comprehensive (this talk page is 103 kB and needs archiving).
3. B-Class-3: It has a defined structure, including a lead section and one or more sections of content.
   • The lead is far too short. It should be a description, an introduction, and then a summary of the rest of the article. See WP:LEAD
4. B-Class-4: It is free from major grammatical errors.
   • Looks fine to me.
5. B-Class-5: It contains appropriate supporting materials, such as an infobox, images, or diagrams.
   • Good supporting materials
6. B-Class-6: It presents content in an accessible way.
   • Apart from an image directly under a level-2 heading, it would meet this B-class criterion. Nevertheless I'd encourage the addition of WP:Alternative text for images as one of the simplest ways of improving accessibility.

There's some more work to be done before it reaches B-class, but it easily meets C-class. Re-assessed accordingly. --RexxS (talk) 22:26, 29 October 2009 (UTC)

new procure facility opening announcement

I removed the announcement of the Oklahoma procure facility opening from the History section. If this belongs anywhere, it would be in the Treatment Centers section. Even here, I don't think it is appropriate to list every new facility that opens. Other editors have also expressed concern when the page begins to seem like advertisement rather than information.AE1978 (talk) 14:19, 18 February 2010 (UTC)

I agree.- Sinneed 16:50, 18 February 2010 (UTC)

X-ray/IMRT vs Proton discussion

Hi Bgordski, I deleted your addition of the sentence "The above is a false scare. Would you like a sun tan at the proton skin entrance or secondary cancers from IMRT which not only has a sloppy beam focus but keeps on attacking healthy cells after passing thru the tumor target until it exits the body?" for the following reasons. First the tone is inappropriately casual, second the skin sparing effect of X-Ray radiation is a useful thing (that is one reason that combined proton/x-ray treatment plans exist) and third because the description of IMRT as having a "sloppy focus" is not clear or correct. IMRT achieves high dose conformality close to that of protons, though at the expense of a much larger low dose "bath" to surrounding normal tissue. I agree with your point of view that proton therapy is superior to IMRT (how could I not, having worked in proton therapy for over 25 years), but it needs to be phrased a little more fairly and accurately.AE1978 (talk) 00:42, 23 November 2010 (UTC)

AE1978 will you please write a more accurate statement. IMRT is not playing fair and particle therapy need to correct IMRT misstatements. NIH actually had a critique of PRT stating that it was accurate but not precise! http://www.can. Very wrong!! Especially since DOD$ were used to fund the last proton therapy center in Virginia. Where is fraud, waste and abuse?

There is no reference to the benefits of LET, direct energy vs. indirect and hypoxia issue. Oncologists make 50% of their profits (NYT article) selling drugs. IMRT needs hypoxia mediating drugs because of the low oxygen level of fast growing tumors. See wiki radiation therapy. I would like to move that here but am working on a Dielectric Wall Accelerator article. Where do you fall on this new devise? Bgordski (talk) 06:02, 23 November 2010 (UTC)

I assume that the comment about precision vs accuracy in the NCI report refers to the issue of depth uncertainty. The sharp distal fall off of the Bragg peak is proton therapy's main advantage (reduces dose to normal tissue) and also it's biggest challenge, in that the transformation of CAT scan data (based on x-ray absorption) into proton depth attenuation is not one to one. This means that the high dose conformality achieved by IMRT is unquestioned, but you must be careful with protons to insure that you are not making assumptions about the transport of the protons through an in-homogenous patient that go beyond your knowledge. Many people in the field (myself included) are working on methods to improve the techniques so that we can more fully use the promise inherent in the distal fall off of the Bragg Peak. That being said, I still think that the state of the art of proton therapy is already superior to IMRT for many (most?) tumor sites. So, while the statements in the NCI report are not strictly false, they do betray a certain bias. However, I don't want this entry to "fight bias with bias", and overstate the issue. As to dielectric wall accelerators, I think that they are an interesting concept with great potential that is, as yet, untested.AE1978 (talk) 22:20, 23 November 2010 (UTC)

What we really need is a tiny proton dosimeter that one can insert on the end of a needle, to backstop your proton beam with. There are such things for photons, are their not? I have a couple of cases at Loma Linda where protons proved outstanding in patients with egg-sized tumors in their upper nasopharynx, essentially right between their eyes. Think of the backstop there-- brainstem and optic chiasm. Your only good shot with photons for that is down through the top of the head-- everything else goes through a lot of brain and optic nerve. Anyway, both these grade-four squamous cell tumors are cures, now 10 years out. These were undoubtedly the first two people to do RADPLAT with protons, not photons, as the radiation component. I'm in the middle of writing them up. SBHarris 22:30, 23 November 2010 (UTC)

Hello. The 'Surgery' heading had misleading information. Conformal radiation therapy is not proton therapy. Information pertaining to conformal radiation therapy was used to describe proton therapy. The abstract is here so you can see for yourself -> http://www.ncbi.nlm.nih.gov/pubmed/22511689 I have edited the surgery section to reflect the true information presented. If you have any questions or feedback for me on this edit, I would appreciate it. Thanks. Helper1976 (talk) 18:39, 18 May 2013 (UTC)

Up date to Proton Therapy reference issues

The FDA is the "US Highest Authority on radiation medical Issues". They approve or deny the right to use radiation emmitting devices for use in the US. The FDA 501(k) is that form. It seems that the reference #2 may look like a reference to Varian and not the FDA. I was using Varian's description of how their add-on device adds to the proton machine. http://www.fda.gov/medicaldevices/deviceregulationandguidance/howtomarketyourdevice/premarketsubmissions/premarketnotification510k/default.htm. BTW:a similiar collimator device is also used on IMRT machines. This is new material and you may not find it in a book. —Preceding unsigned comment added by Bgordski (talk • contribs) 22:53, 5 December 2010 (UTC)

Even though this section was sourced from FDA materials, it reads like an add for a new Varian product. Also, this is an encyclopedia article, not a trade journal, and it is not the appropriate forum to report every new device coming to market. Perhaps we should consider adding a section that discusses the various beam delivery and modification methods currently employed in proton therapy (i.e. single and double passive scattering, pencil beam scanning, modulator wheels, energy lamination techniques, milled apertures & compensators, MLCs etc.) in general terms??? Any opinions on this? AE1978 (talk) 22:07, 7 December 2010 (UTC)

Yes. WP:SOFIXIT. You yourself sound like you know more about the nuts and bolts machinery than anybody here, so add what you know. We can't wait for experts who work for commercial proton accelerator makers to show up anytime soon. Don't be afraid of adding "marker" sections that aren't yet filled out, if you know they eventually will be. They serve as targets. Wikipedia is never "done". It's okay if an article doesn't look polished. Just don't leave hanging sentences and bare outlines. SBHarris 22:24, 7 December 2010 (UTC)

I will try and work up a first shot of this section within the next week or two. Actually, I've been involved in the development of Proton Therapy for over 25 years, so my biggest challenge is finding references for information that I have taken as given for so long, while avoiding original research.AE1978 (talk) 17:35, 9 December 2010 (UTC)

Don't even worry about that. Info is unlikely to be challenged even without a cite, so long as it non-controversial (some other person who knows the field says: "huhh?"). Just write it out and find references later. References are best, but unreferenced (good and correct) stuff is better than nothing. Half of WP wouldn't be here if everybody waited to find references for non-controversial technical stuff. SBHarris 20:03, 9 December 2010 (UTC)

Deletion in Treatment Centers section

I feel that the specific references to the Compact Particle Acceleration Corp (CPAC) new product in development was inappropriate. It reads like a press release advertising an upcoming product. There are a number of other companies pursuing the same end (i.e. compact, low cost proton therapy equipment) such as Still River Systems & ProTom international and (in keeping with the encyclopedia format) we shouldn't detail every possible future product, or site specific companies in the body text (as opposed to in the references). If you want to add references to the general statement that ends the section referring to CPAC, or, better yet, to the particular new technology that they are pursuing, feel free. Or even add a new section that discusses and contrasts the various technologies involved in proton therapy (e.g. Synchrotron vs conventional isochronous cyclotron vs superconducting isochronous cyclotron vs superconducting frequency modulated cyclotron vs dielectric wall accelerator...am I missing any?).AE1978 (talk) 23:52, 12 February 2011 (UTC)

Added language referring to new technologies, including CPACs dielectric wall accelerator, to the end of the section.AE1978 (talk) 18:43, 15 February 2011 (UTC)

Removal of reference to Dr. James Slater from History section

My reason for deleting this is as follows. None of the other pioneering doctors and physicists that predated Dr. Slater's involvement in Proton Therapy are specifically referenced in this section, with the exception of R. R. Wilson who first suggested the technique. If we started specifically mentioning all of the pioneers of proton therapy, the history section alone would be quite lengthy. Perhaps we should write a more detailed stand alone article on the history of Proton Therapy that would give credit to all of the pioneers of this treatment method. If any other editors want to weigh in on this, I would be happy to listen to any arguments for undoing this deletion.AE1978 (talk) 15:22, 17 March 2011 (UTC)

Let's not list every new center in History section or elsewhere (deletion of U. Florida reference)

I don't think that it is appropriate to list each new center that opens in each geographical region individually. The two centers named in the history section (Loma Linda and MGH) both have particular and important significance in the history of proton therapy (Loma Linda becuase it was the first hospital based facility, and MGH because of the historical significance of the MGH/HCl collaboration in the laboratory era development of proton therapy). I added language that makes reference to the rapidly growing numbers of regional facilities in the last few years, and I think that is enough. If anyone else wants to weigh in, please do. AE1978 (talk) 20:10, 1 June 2011 (UTC)

We can mention the above two in paragraph from because they were all that there were for a long time. The rest would make a good topic for an embedded list (see WP:EMBED). There will never be as many of these as there are standard photon therapy centers, so it's not as though it's in danger of overcrowding. I think it would be highly useful and encyclopedic to have a list of the centers where one can get proton therapy in the US, and perhaps other countries as well. Far more than (say) a List of Power Rangers (if you want some horror, have a look at that link). Can we please remember the service to humanity that WP was originally conceived to provide? SBHarris 20:23, 1 June 2011 (UTC)

Good point, and that list probably should be embedded in the "Treatment Centers" section at the bottom of the article. I have such a list (I use it in a talk I give about proton therapy periodically), as well as a list of centers presently under construction in the USA. I hate to exclude the rest of the world, but I'm not as directly connected with the community outside of the US. I will see if I can get that up in the next few days. AE1978 (talk) 19:56, 2 June 2011 (UTC)

I decided to create a stand alone list of USA treatment centers & add a link to it in the "See Also" section. I think that does itAE1978 (talk) 16:23, 5 June 2011 (UTC)

List of Centers by manufacture

I think that this is good information (thank you Sylvian), but I removed it from the page for these two reasons: First it does not distinguish between centers currently operating and centers under construction, which I believe is important. Second I think this should be either an embedded list or a linked to page (like the list of USA treatment centers). Let me know what anyone else thinks. AE1978 (talk) 22:53, 21 June 2012 (UTC)

Removal of section titled Market

While I think that it might be interesting to have a discussion of the present status of the proton therapy equipment market,I deleted this one for the following reasons: First of all it is a lengthy direct quote from source and thus violates Wiki guidelines. Second it assumes prior knowledge of the field by referring to Ion Beam Associates (IBA) without introducing context. In fact I think the best way to present information on the market economics of proton therapy might be in a separate article linked to from the main article. PE CSIntell, why don't you take a stab at that, but please include discussion of not just the major players that have established the market for large multi-room centers (IBA, Hitachi, Varion et al), but some discussion of the newer players installing lower cost one room units such as Mevion and ProTom. Also it might be appropriate to include a comparison of the various technologies employed by these companies (conventional isochronous cyclotrons -IBA, superconducting isochronous cyclotrons -Varion, superconducting FM cyclotrons -Mevion, conventional synchrotrons -Hitachi, ultra compact synchrotrons -ProTom...). I could provide the section on accelerator technologies if you want.AE1978 (talk) 18:40, 29 November 2012 (UTC)

Cost of Proton Therapy

I reverted the cost back to $50,000, but added "or more". I think that this is more accurate than the $100,000 figure put in by 195.84.86.130. I work in the field of Proton Therapy and have heard the ~$50,000 figure many times, but I can find no reference to a figure as high as $100,000. If 195.84.86.130 can find a reference for the $100,000 figure I would be happy to put it in. I also added the language "as much as 100M to 200M" for the facility cost as there are now at least 5 facilities under construction using new much lower cost equipment (20M to 30M per), the first of which expect to treat first patients in early 2013 AE1978 (talk) 14:53, 14 February 2013 (UTC)

As written, I still think the cost section is rather one-sided. From a physicist's perspective, the dosimetric advantage of protons is obvious in almost all cases because there will always be a lower entrance dose and no exit dose compared to photons. There's a subtlety to the cost difference as well, since proton costs generally include much more active R&D than photons since photons are a more well-established technology. That can be expected to change over the next decade or so. — Preceding unsigned comment added by 24.61.12.243 (talk) 02:11, 12 April 2013 (UTC)

Some changes have been made to this costs section. Just begun to review this article, and will continue to do so until it is finally accurate. 'extraordinarily' has been removed. Please avoid use of emotive/persuasive language, and stick to the facts. The information concerning 'false claims' might be true, however deserves to be removed in this article due to its biased, emotive style. Stick to the facts. There is now clear evidence that proton therapy in fact DOES benefit men with prostate cancer - so the emotive, biased information concerning prostate cancer has been removed, due to its inaccuracy. Please avoid emotive/charged/persuasive language when writing encyclopedic material. This is not a marketing campaign. Focus on the facts. Actually, even questionable are the figures you added concerning 4 times more expensive etc. I will not remove this information for now, but this information needs to be referenced soon or it will be deleted / modified. Helper1976 (talk) 10:59, 13 May 2013 (UTC)

You have removed information cited to a medical review, which is considered the very best possible source for medical information on Wikipedia; I've therefore put it back. If you have an updated reference to a source of similar quality, feel free to add it. If you have a conflict of interest relating to proton therapy, do not make any significant edits to the article again; just use the talk page to discuss your edits. Graham87 09:21, 16 May 2013 (UTC)

Hello Graham87, thank you for your suggestions. I am concerned that considerable sections of this article are rather outdated. Prostate cancer is naturally a very sensitive issue. The fact remains that many men have been cured by proton therapy. I would like to add at this point that I do not receive any type of compensation, financial or otherwise, nor do I have a 'conflict of interest' - I am simply an avid researcher of physics and cancer technology, as well as their related advancements, and wish to present information in an objective manner concerning the subject. In particular, the benefits of proton therapy are very promising - these words were even stated by an avid critic of proton therapy. Portions of the article are biased against the subject of proton therapy. As an encyclopedia, surely an objective presentation of the facts is in order, and not biased, emotionally charged language, on top of an already highly sensitive subject such as cancer. Do you know much about the advancements being made concerning proton therapy? Many of the studies showing lack of evidence concerning the benefit of proton therapy and prostate cancer are rather outdated now - proton therapy has advanced considerably since those papers were written, and with the advent of a new treatment delivery technology known as 'pencil-beam' scanning or 'spot scanning', the effectiveness of dose delivery has improved dramatically. It would be unfair to make such strong claims against the benefits of proton therapy for men suffering from prostate cancer - there are many men around the world being cured with this treatment modality right now. Many vulnerable men with this disease will read wikipedia and might be steered away from what many reputable individuals regard as a valid treatment option, due to the 'scare-tactic' employed by the person/s who originally wrote the information contained in the costs section of this proton therapy page. I advise that the 'proton therapy and prostate cancer debate' be developed further into a seperate section of the article, and the 'cost' section instead should focus purely on 'costs', without making reference to specific cancers such as prostate cancer - it's not the only type of cancer in the world, why should it be singled out in the costs section of the article? Proton therapy holds tremendous promise. In a Dutch government survey, it was conservatively estimated that at least 7000 people each year in Holland alone would benefit from protons - this did not even include prostate cancer patients. Current USA capacity for proton treatment is only about 12,000 for the whole of USA! I look forward to your reply, or the reply of others. Our debate can form a new, more up to date version of this page Helper1976 (talk) 10:27, 17 May 2013 (UTC)

I know absolutely nothing about this subject. The only reason I'm here is because I was following the edits of 82.17.155.211, who has made a few reasonable edits but plenty of dodgy ones ... according to them, the US did not become the only superpower after the end of the Cold War; knowing their general pattern, they probably think the UK is still the second one. So you can see why I had a jaundiced view of their removal of part of the section (yes, I'm sure it was the same person) and your removal of more attached sentences. Looking more deeply, that section was added in this edit by Drcoop, who has an interesting talk page. Drcoop did make some persuasive arguments in this other edit, but IMHO you can only really fight large-scale studies with ... more large-scale studies with better technology. But yes, the costs section is a bit of a mishmash. I'm staying out of this issue and removing this page from my watchlist, because I have no knowledge (and frankly not much interest) in the subject. I've alerted WikiProject Medicine to this discussion. Graham87 12:14, 17 May 2013 (UTC)

I have amended the costs section, to reflect a more objective view of the issue. I have included relevant references to reflect these changes. I await feedback and suggestions. Thank you. Helper1976 (talk) 14:17, 18 May 2013 (UTC)

Further amendments (including the addition of valid references) have been made to reflect the literature. As always, feedback and suggestions are welcome. Helper1976 (talk) 11:29, 19 May 2013 (UTC)

Thanks helper 1976 for some very good changes, I have been a little reticent to edit the cost section too much as I am both sensitive to the concerns of others to this issue, and I am a bit biased as I have been involved in proton therapy directly for >28 years. There is no question that prostate treatments are a unique issue in the field with respect to cost/benefit analysis as the clinical advantage over conventional therapy is not clear in many cases, yet the represent a far larger pool of potential patients (and thus revenue) than the much more rare cancers for which the superiority of proton treatments is clear. Some institutions respond to this by only using proton therapy for prostate treatment in specific cases where there is likely to be a clear advantage, allowing them to devote the majority of treatment capacity to diseases where the benefit of proton therapy has been proved. On the other hand, some have aggressively marketed proton therapy for prostate treatment, devoting as much as 90% of treatment capacity to this disease (at my institution we devote ~10% of capacity to prostate TX). So there is real controversy here that must be acknowledged, but I think that you are right to remove some of the more incendiary language. AE1978 (talk) 13:47, 30 May 2013 (UTC)

Actually I think that Helper 1976 has a good idea in creating a separate section on the prostate cancer issue, and breaking that out of the Cost section. AE1978 (talk) 15:10, 30 May 2013 (UTC)

Bias

This article seems to be written with a particular point of view, perhaps motivated by economic interests in traditional photon radiation therapy, the biggest competitor to proton therapy. There are numerous scientific studies in peer-reviewed journals showing the efficacy of proton therapy for specific conditions. Several statements are patently inaccurate. For example, the side effects and risks section is wholly inadequate and misleading. The section on comparison with other health risks inaccurately states, "As of 2012 there have been no controlled trials to demonstrate that proton therapy yields improved survival, or other clinical outcomes..." This is flatly untrue. A simple search of any reputable health sciences article database will yield numerous peer-reviewed studies detailing the benefits of proton therapy for specific conditions. There seems to be a bias against the use of proton therapy for prostate cancer, and makes overly-broad statements about proton therapy generally. There are specific aspects to be disputed, but this is all I have time for this evening. :) Bbbozzz (talk) 05:25, 19 April 2013 (UTC)Bbbozzz

Bbbozzz, I have contributed quite a bit to this article, and done more than my share of cleaning up some obvious POV issues. However I must be a little careful as I am (if anything) biased toward proton therapy as I have spent my entire professional career in the field. Let me address a few of your points. First, I'm not sure what your issue is with the side effects and risks section, it seems quite reasonable to me (if rather brief). While proton therapy does reduce the side effects associated with external beam radiotherapy in many cases, it rarely completely eliminates them, so referring to the main article makes sense. As to the comment about lack of full understanding of proton beam and tissue interactions, that is also accurate (if perhaps not as elegantly stated as it could be). In particular there are still issues with the relationship between Cat Scan data and proton depth attenuation that can result in an increase in negative side effects over conventional therapy in some cases (for instance rectal wall morbidity in prostate treatment). Perhaps it could be more detailed (addressing your "inadequate" comment), but I see nothing misleading. Second is the statement about lack of controlled trials. I also kind of hate this statement, but it is an opinion that serious people in the field hold (however one that I disagree with). Their point is that no institution has ever done a fully randomized trial where patients are treated for the same disease with either proton therapy or conventional therapy by the same clinicians, as one would for a new drug trial. The counterpoint to this argument is that if you have a compelling physics based reason to expect one treatment to be superior to another it would be unethical to treat any patients with the inferior treatment. So the statement is technically correct and expresses a position held by some in the field, so I did not feel I could delete it (as much as I might want to). Finally, there is valid reason to be dubious about the widespread application of proton therapy for prostate cancer (see discussion in the cost section), as well as the aggressive marketing of such by some institutions. AE1978 (talk) 14:56, 30 May 2013 (UTC)

I have had no response to my comments regarding Bbbozz's concern about bias. As I feel that I made reasonable responses to the points raised in the comments I will remove the factual accuracy disputed banner in a week or so if no one has gives me any reason not to.AE1978 (talk) 18:36, 17 July 2013 (UTC)

Since no one has responded, I went ahead and removed the disputed accuacy flag as per my comments above AE1978 (talk) 17:45, 27 July 2013 (UTC)

Alternative sources for proton source

In the treatment center paragraph, new technology are despicited for accelerating the protons of the proton beam. Lase driven ion acceleration is a new and very efficient technique to accelerate high brightness, laminar ions beams and at energy always increasing and up to 70 MeV now. So you shall cnsider it as an alternate solution to synchrotrons. 192.77.52.4 (talk) 17:22, 8 May 2013 (UTC)

While laser acceleration of protons is an interesting and exciting prospect, there are still many issues to be resolved before we can consider this a viable alternative to traditional techniques (such as collimation, energy spread and destruction of targets). Thus I would consider this technology much further from any realistic realization than the other ones mentioned. Even the dielectric wall accelerator is not yet ready for real world implementation, but I believe it is much close than laser acceleration. AE1978 (talk) 15:05, 30 May 2013 (UTC)

List of proton treatment centers currently operating in the United States

I see that in Talk:Proton_therapy#List_of_treatment_centers.2C_list_of_equipment_suppliers above, the consensus in 2009 was to remove the list of treatment centers from this article, but in 2011 the article List of proton treatment centers currently operating in the United States was created, just a list of external links with no introduction, context or inclusion criteria. So I've merged it to Proton therapy#Treatment centers. If consensus is still for a list of external links not to be included, then please remove it. Ruby Murray 15:59, 21 October 2013 (UTC)

Error in table at the end of the article.

A note at the top of the article says the list is in order of year of first treatment, yet the first in the list is four years later than the second entry.71.105.108.187 (talk) 20:50, 15 November 2013 (UTC)kvar2

Any RCTs?

Are there any randomized, controlled trials with a clinical outcome of survival or other meaningful endpoint?

Otherwise, it would be fair to say in the summary that the benefits haven't been demonstrated in RCTs. --Nbauman (talk) 00:54, 2 September 2014 (UTC)

Possibly not - see this from 2009 [1] (in the refs) - don't know the current situation, nor have I looked at the paper. The main editor here hasn't edited since May unfortunately. One thing the article doesn't seem to do is distinguish between the low and high energy types, which seem to have different applications. There may well be other variations within the technique, which would really need different RCTs. Another thing the article doesn't say is that one of the anticipated benefits is a reduction in the appearance of 2nd adult cancers in people who had radiotherapy for a chilhood tumour. You'd need to allow some decades for that RCT, I'd imagine. Wiki CRUK John (talk) 10:47, 2 September 2014 (UTC)

More info here - this is a very hot topic in the UK now. Cochrane review is underway. But it looks as though the RCT issue should be covered better in the article. Wiki CRUK John (talk) 13:02, 2 September 2014 (UTC)

I did a PubMed search for Phase III trials and found one -- http://www.ncbi.nlm.nih.gov/pubmed?term=%28proton%20beam%29%20AND%20%22clinical%20trial%2C%20phase%20iii%22[Publication%20Type] from 1995, and that showed no clinical benefit. The Annals of Internal Medicine is pretty good about insisting on randomized, controlled trials, and if my life were at stake, I'd follow their conclusions.

Proton beam therapy had a lot of heavy-handed promotion several years ago. Medical centers were building machines and advertising them on the radio. Some Congressman used his clout to get proton beam therapy for his wife, who had breast cancer. There were articles in business magazines about the investment potential. Desperate people were getting into fights with their insurance companies. The skeptics (in the medical journals, like Annals of Internal Medicine) were pointing out that there were no clinical trials to demonstrate benefit, and it was even more expensive than the new MRIs.

The Ashya King case is the reason the page views for this article jumped up to 7,000. There are 2 issues to the King case: (1) Is proton beam treatment any better (or worse) than the conventional radiation treatment (2) Do the parents have the right to decide for their child that it is better, and take their child for treatment elsewhere, against the recommendation of the NIH doctors?

I think the answer to (1) is that there is no clinical evidence of superiority. I've been waiting for BMJ or Lancet to do a news story on it, but I think now given the interest, and given the Annals of Internal Medicine review, we should put the review in the lead. Because of the interest, I'm going to be bold and summarize the review in the introduction. If somebody disagrees, they're welcome to make any changes they can support with a WP:MEDRS.

As for (2), the issues are patient autonomy and the right of parents to make a substituted judgment for the child. I'm pretty sure that the answer in the U.S. would be that the parents have a legal right to make that decision. Proton beam therapy is a reasonable treatment, even though it hasn't demonstrated superiority. I'm surprised that the UK doctors and police came down on the parents in such a heavy-handed manner. I expect to see articles by medical ethicists in the UK saying that it was handled poorly. I'm not sure where to fit that into this entry. --Nbauman (talk) 14:03, 2 September 2014 (UTC)

So is everyone else (surprized) - but the story is rather more complicated than your summary. The initial charges were child cruelty, and the police hunt on the grounds of child safety, now possibly looking mistaken. On the wider issues, most medical opinion does seem to support use in certain cases - the English NHS would not have paid for 200 cases to be treated abroad last year otherwise. Wiki CRUK John (talk) 14:38, 2 September 2014 (UTC)

Here's the BMJ coverage.

http://www.bmj.com/content/349/bmj.g5495.short
Boy at centre of legal wrangle is expected to be treated in Prague
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g5495 (Published 04 September 2014)
BMJ 2014;349:g5495
Clare Dyer

http://blogs.bmj.com/bmj/2014/09/04/tessa-richards-when-doctors-and-patients-disagree/
Tessa Richards: When doctors and patients disagree
4 Sep, 14

--Nbauman (talk) 07:41, 7 September 2014 (UTC)

Here's a really good overview of the whole problem, with links to technical assessments and reports on the marketing and over-promotion:

Family’s pursuit of proton beam therapy is focus of international controversy

Sep 4 2014

Posted by Gary Schwitzer in Health care journalism, proton beam therapy - IMRT

--Nbauman (talk) 00:41, 8 September 2014 (UTC)

Really just about the particular US situation. Wiki CRUK John (talk) 09:44, 9 September 2014 (UTC)

Here's another BMJ story, directed at the question of when proton beam therapy is appropriate and whether it was appropriate in the Ashya King case.

--Nbauman (talk) 16:51, 11 September 2014 (UTC)

A BMJ editorial which makes the argument that proton beam therapy is appropriate for focal cancers that can be precisely targeted, but Ashya King's cancer was diffuse, so there is no evidence that it would provide benefit in his case.

http://www.bmj.com/content/349/bmj.g5654.short

Editorials: Childhood cancer and proton beam therapy

BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g5654 (Published 16 September 2014) Cite this as: BMJ 2014;349:g5654

Adam Glaser, James Nicholson, Roger Taylor, David Walker

The consensus view of the Proton Overseas Programme is that any potential long term benefits of proton beam therapy in the treatment of medulloblastoma would be offset by the increased risk of recurrence resulting from the delay in starting therapy. Patients with this cancer require the whole brain and spine to be irradiated, and consequently the predicted brain sparing benefits of proton beam therapy in focal tumours are less certain.

--Nbauman (talk) 04:30, 18 September 2014 (UTC)

Another useful summary (US, prostate focused) Is It Too Much To Expect More Balance When Discussing Proton Beam Therapy For Cancer Patients?, Dr. Len's Cancer Blog Wiki CRUK John (talk) 10:07, 3 October 2014 (UTC)

Incongruous introduction section

The introduction contained the following, which I have removed:

A 2009 systematic review found that "No comparative study reported statistically significant or important differences in overall or cancer-specific survival or in total serious adverse events." {{Clarify|reason=Comparing what with what? IMPT vs IMRT?|date=July 2015\}\}

There are two things wrong with it. Firstly, information in support of a topic doesn't belong in the introduction, where the reader should be assumed to know nothing about the topic. Secondly, it's hard to know what it actually means anyway. As with "50% better", the term "important differences" needs more context if it is to be more than a slogan.

(See Edit of this page if you wish to reinsert the content in a more appropriate place). 92.0.230.198 (talk) 13:36, 5 September 2015 (UTC)

External links modified

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Removal of treatment centres section?

I notice that a previous discussion 7 years ago seemed to come to the conclusion that, as wikipedia is not a directory, the list of treatment centres is not appropriate for this article. Given this, and the fact that the number of centres has grown even more in the meantime, would there be a consensus for removing the treatment centres section now? Particularly notable and pioneering centres can be, and are, covered in the history section. Beevil (talk) 15:18, 29 November 2016 (UTC)

Keep (for now) - I found the US and world wide lists useful and not (yet) excessive. Easily split out later (or now). - Rod57 (talk) 09:04, 24 July 2017 (UTC)

Inaccessible source

I clarified a point in the Treatment centers sections that the number of patients treated is a worldwide figure. However, I'm only assuming this from the title of the source. The relevant content of the source is inaccessible, since you need to be a member of a professional body to get at the data. I don't like sources such as these. The average reader cannot use them for verification. Even a book is better than these inaccessible sources. At least with a book you stand half a chance of being able to get to a copy. Are there no accessible sources here? Silas Stoat (talk) 10:39, 23 January 2019 (UTC)

A Commons file used on this page has been nominated for speedy deletion

The following Wikimedia Commons file used on this page has been nominated for speedy deletion:

• Proton Therapy Treatment Room.jpg

You can see the reason for deletion at the file description page linked above. —Community Tech bot (talk) 13:52, 30 July 2019 (UTC)

Is this used for anything other than cancer therapy?

In the opening sentence, which reads "In the field of medical treatment, proton therapy, or proton radiotherapy, is a type of particle therapy that uses a beam of protons to irradiate diseased tissue, most often to treat cancer," it is implied that proton therapy can be used to treat diseases other than cancer. Does anyone know of any other diseases that can be treated with proton therapy, or should "most often" be eliminated? Jne2021 (talk) 01:09, 5 March 2021 (UTC)

Cancer cells have diminished ability to repair DNA?

"Cancerous cells are particularly vulnerable to attacks on DNA because of their high rate of division and their limited abilities to repair DNA damage"

Is this true? Which cancer cells are being referred to here? As far as i am aware, the jury is still out on this. Breast cancer cells have increased DNA repair mechanisms over their associated healthy tissue counterparts for one. The same with gliobastome multiforme [1]. Pancreatic cancer cells also show increased DNA repair systems compared to normal healthy tissue [2].Unladenswallowcoconut (talk) 17:07, 31 October 2021 (UTC)

Promotional tone

The promotional tone of much of the article made me think that "proton therapy" is a quack product. It took quite a bit of reading and checking for me to (mostly) overcome this view. I still have doubts. If it's a real therapy, there's a lot of tedious work to be done to make the article appear honest and neutral. Maproom (talk) 23:26, 27 March 2024 (UTC)