Proton Beam Therapy in India

Proton Beam Therapy, referred to as Proton Therapy, is a radiation-based treatment that accurately administers a stream of protons to interrupt and eliminate cancerous cells. Unlike conventional radiation, protons possess distinct attributes enabling medical professionals to more precisely direct radiation according to the tumour’s dimensions and contours. This proton beam eradicates tumour cells while safeguarding a larger portion of the neighbouring healthy tissue.

Proton Beams have the capacity to address tumours consisting of diverse cell types and situated in various regions of the body. Instances encompass:

• Brain tumours, including those located at the Skull's base
• Tumours of the Spinal Cord
• Cancer affecting the Head and Neck
• Breast Cancer
• Lung Cancer, as well as other Thoracic Cancers like Thymoma, Mesothelioma, and Lymphoma
• Liver Cancer and Metastatic Liver Tumours
• Pancreatic Cancer
• Rectal Cancer
• Prostate Cancer
• Recurrent Tumours requiring additional rounds of radiation (reirradiation)
• Sarcomas, including rhabdomyosarcoma
• Ocular melanoma and other eye cancers

Investigative research is still ongoing to explore the potential advantages of proton beam therapy for diverse Cancer types.

Proton beam therapy necessitates meticulous preparation to ensure accurate targeting of the proton beam and precise delivery of the intended radiation dose. Numerous distinct experts contribute to the planning and execution of proton therapy, such as radiation oncologists, nurses, dosimetrists, physicians, and radiation therapists.

The pre-evaluation process typically spans several weeks and encompasses the following steps:

• Imaging: Diagnostic tests like CT scans or MRIs are conducted to validate the tumour's location and dimensions. Using these scans, the radiation oncologist pinpoints the tumour's precise shape and size, along with crucial adjacent organs and tissues. This data is then fed into a computer to create a detailed map.
• Simulation: The imaging data assists in positioning your body accurately for the treatment. The medical team might mark your body to guide the proton beam's direction. These markings are usually temporary, though some could be permanent. Once the optimal position is established, a team member will design immobilization tools to help you maintain this position during each treatment session. If the head or neck area is under treatment, a custom-fitted mesh mask is created to secure your head in place. This mask allows you to see and breathe comfortably.
• Dose Planning: The radiation oncologist determines the precise radiation dosage to administer to the target area. Dosimetrists utilize specialized computer software to strategize the optimal way to deliver this dosage, decide on the beam's alignment, and calculate how deeply within the body the beam should penetrate.
• Quality Assurance: Physicists conduct a thorough quality assurance assessment to ensure that the Proton Beam can be generated with exact precision regarding the dosage, penetration depth, and angles required for the treatment.

Proton Beam Therapy is an outpatient procedure conducted within a specialized facility. Most patients undergo treatment across multiple sessions, with varying durations. The proton therapy occurs within a dedicated room outfitted with a sizable mechanical arm, referred to as a gantry. This gantry is responsible for manoeuvring the proton beam around you while you remain positioned on a table. Throughout a proton therapy session:

• Your medical team will position you on the treatment table according to the established position from the simulation phase. They will utilize positioning aids like a body mold or a mask to keep your body and head stable.
• The Radiation Oncologist will align the gantry so that the Proton Beam coincides with the markings on your skin indicating the tumour's location. Unlike an MRI machine, the gantry is not a confined space, alleviating any claustrophobic feelings during treatment, though you will need to remain very still.
• An X-ray or another imaging scan will be taken to verify your accurate positioning and alignment.
• Radiation therapists will exit the room to operate the Proton Beam apparatus. A video camera allows the therapist to observe and hear you, ensuring you are not alone.
• Once the apparatus is activated, a particle accelerator in a separate room accelerates protons and directs them to the gantry within the treatment room. The gantry focuses these protons into a fine beam and directs them toward the Tumour. It might move around your body to target the tumour from different angles.
• The Proton Beam may be turned on and off intermittently during treatment, adjusting its position as it shifts due to your breathing. While you won't feel the proton beam entering your body or treating the tumour, you might hear clicking sounds as the machine repositions around you.

The complications of Proton Therapy resemble those associated with conventional radiation therapy. These effects may manifest gradually after treatment and encompass:

•  Sensitivity and redness of the skin at the point of entry for the proton beam, akin to sunburn in appearance and sensation
•  Hair loss within the treated region
•  Fatigue or reduced energy levels
•  Depending on the treated area, further side effects might emerge, including headaches and difficulties with eating and digestion

After your treatment session is finished, you can resume your regular daily activities without emitting radiation or being radioactive. The complications of proton beam therapy (PBT) typically manifest gradually. Initially, you might encounter only minor side effects. However, as you undergo multiple treatments, you might start experiencing fatigue. This fatigue might give you the sensation that your usual activities require more energy or that you have reduced energy for your everyday tasks.

Additionally, you might observe skin redness similar to a sunburn in the specific area where the proton beams are targeted. Your doctor may advice you to restrain exposing yourself to direct sunlight and protect the treated area. Use sunblock, clothing, or other measures recommended by your medical team to prevent further skin irritation. Around four to six weeks after you finish your entire course of proton therapy sessions, you'll have your initial post-treatment meeting with your doctor. During this appointment, the doctor will conduct a physical examination, assess your advancements, go over any test outcomes, and address any inquiries you might have.

Life after Proton Beam Therapy can vary depending on the individual, the type of cancer being treated, the overall health of the patient, and the specifics of the treatment. Proton Therapy had a comparatively lesser impact on individuals' capacity to carry out everyday tasks such as household chores when compared to conventional radiation. However, in few cases there can be delayed complications that may emerge months or even years after the completion of treatment. Depending on the treated region, delayed side effects might encompass:

• Impaired fertility.
• Lymphedema.
• Alterations in the brain and spinal cord.

The success rate of Proton Beam Therapy (PBT) can vary depending on several factors. However, the benefits of proton therapy for paediatric patients seems to minimize the probability of delayed negative effects and can also mitigate the risk of secondary cancers. This is supported by comparisons of the radiation dose distribution between PBT and photon radiotherapy, which demonstrate a reduced exposure of normal tissue to radiation in PBT. A recent study revealed that survivors of retinoblastoma (a kind of eye cancer) treated with PBT had notably lower 10-year cumulative rates of secondary tumours compared to those treated with photon therapy, both for tumours within the treated area (0% vs. 14%) and for all secondary malignancies (5% vs. 14%).

Proton Beam Therapy stands as a viable treatment option for older patients also dealing with lung cancer. A study indicates that the 3-year survival rate encompassed 67.2% (90.0% for patients with Lung Cancer amenable to surgery, and 58.2% for those with inoperable Lung Cancer) with PBT. Additionally, the 3-year rate of maintaining local control with PBT reached 86.5%.

The cost of Proton Beam Therapy in India is notably more budget-friendly when contrasted with rates in other nations. Furthermore, the medical care and services provided are on par with those furnished by some of the world's most renowned medical institutions. Even when accounting for accommodations, meals, and travel costs, the cost of proton beam therapy in India varies between approximately $33,000 and $65,000. In comparison, a series of radiosurgery treatments typically amounts to around $8,000 to $12,000, while intensity-modulated radiation therapy (IMRT) comes to about $15,000.

The cost of Proton Beam Therapy in India can fluctuate based on various factors, including:

• Pre-surgery costs including diagnostic cost
• Treatment type
• Location and severity of cancer
• Approach utilized
• Qualifications of the medical practitioner
• Procedure cost that includes fees of the specialists, Anaesthesia, and Hospital room charges
• Preferred hospital and location
• Availability of specialized facilities and equipment
• Rehabilitation

The expenses associated with diagnosing proton beam therapy might encompass several preliminary assessments and examinations performed prior to the primary treatment. These supplementary costs cover diagnostic procedures like X-rays, CT (computed tomography) scans, MRI (magnetic resonance imaging) scans, PET (positron emission tomography) scan, biopsies, and other diagnostic evaluations. The overall costs for these tests can range from INR 50,000 to INR 10,00,000.

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