Spreading the word on proton therapy
When we think of radiation therapy, we think of the standard treatment that uses X-ray technology. But in recent years, proton therapy has become more accessible, offering a more targeted approach to radiation as well as fewer side effects and thus less downtime for the patient.
Among its most articulate advocates is Stamford resident Arpit Chhabra, M.D., an attending radiation oncologist at the three-year-old New York Proton Center in Harlem. The first facility of its kind in New York state ”“ and indeed the tristate region ”“ the center is one of the anchoring projects of the New York City Economic Development Corp.”™s plan to create an innovation corridor around East 125th Street. It is operated by a consortium that includes Memorial Sloan Kettering Cancer Center (MSK), Montefiore Health System and Mount Sinai Health System, serving more than 100 patients daily. (Chhabra is also an assistant clinical professor in the Department of Radiation Oncology at Mount Sinai Health System.)
What makes proton therapy special, he said, is the way it attacks malignant tumors, including even some metastatic ones, using a beam of protons, which are particles in the nuclei of atoms.
“To make a comparison, standard X-ray radiation is like a flashlight, reaching its target but continuing onward, spreading radiation to surrounding normal tissues,” Chhabra said. “Proton therapy, on the contrary, reaches its intended target ”“ and stops.
“This allows the possibility to reduce the risk of side effects and for certain situations when you need a higher dose, proton therapy enables you to deliver that dosage to the tumor.”
The result is better for the patient as well as society as a whole, he added, because that patient can get back to everyday life sooner.
Yet proton therapy is not for every cancer sufferer, said Chhabra, who specializes in the treatment of central nervous system (CNS) tumors and head and neck cancers, as well as malignancies of the gastrointestinal (GI) and genitourinary (GU) tracts. Age, the type of cancer and whether the treatment is curative or palliative are among the factors in determining its use. For example, a case of early-stage breast cancer in which a low dose of radiation on a small, superficial area is indicated, he said, would call for conventional radiation therapy.
Still, he noted, “A subset of radiation patients benefit from proton therapy. Determining that is the art.”
It”™s an art that has long captivated Chhabra, who was born in the Punjab region of northern India and raised in New York City amid a medical family. His parents are doctors, with him and his sister joining his father in oncology.
“It runs in the family,” he said.
What helps distinguish Chhabra ”“ who received his Bachelor of Science degree in the biological sciences and economics from Cornell University and earned his M.D. from New York University Grossman School of Medicine ”“ is his passion for proton therapy. It”™s a passion that was fired during his residency and a dedicated fellowship at the University of Maryland Medical Center, which was building its proton center at the time he was there (2017-18). In 2018, he became a radiation oncologist with Hartford HealthCare, moving over in March 2020 to the New York Proton Center, where he is a practitioner of the cutting-edge technique, which has actually been around since the 1950s but didn”™t come into use until the 1990s. Cost is a factor. Proton therapy ”“ requiring large equipment and thus big centers, with the New York Proton Center being 140,000 square feet ”“ is more expensive than X-ray therapy. And even though it”™s covered by Medicare, Medicaid and many insurers, other carriers and even some physicians have said the jury is still out on its cost-effectiveness. To date, there are only 40 proton centers nationwide.
Yet Chhabra speaks enthusiastically of a 2020 study involving esophageal cancer patients ”“ the first randomized control trial showing the benefit of proton therapy in this population ”“ in which half received proton therapy and half X-ray radiation.
““The X-ray radiation was associated with a two-to-seven times higher rate of side effects”¯”””¯possible heart, lung and gastrointestinal issues, among them”¯”””¯which proton therapy was able to reduce,” he said. “Many other studies since have further supported the ability of proton therapy to reduce side effects, not only in esophageal cancer but in many other tumor types.”
As with other technology, such as smartphones, the size of the equipment and the cost will decrease over time, he added: “The upfront cost of proton therapy is offset by the reduction in side effects.”
As for the future of proton therapy, it will be decided by two things ”“ access/affordability and education, which go hand in hand, said Chhabra, who sits on the American Society for Radiation Oncology (ASTRO) Payor Relations and Government Relations Subcommittee and the American College of Radiation Oncology (ACRO) Education Committee, among others:
“As more data and clinical trials show the effectiveness of proton therapy, it will be up to everyone ”“ providers and patients alike ”“ to advocate for its utilization.”
For more, visit nyproton.com.