Does Dayton really need two proton therapy centers?

A promising but expensive and relatively new method of treating cancer called proton beam therapy could be coming to the Dayton area in the next few years — in two locations.

The two separate projects that exist only on the drawing board would make Dayton the nation’s only area to host two proton therapy centers, and have prompted questions about whether the area needs — or can handle — both of the pricey and humongous facilities. There are just eight proton therapy centers operating in the U.S., though many more are in the planning stages. (Plans to build a proton center in Dublin, Ohio, fell apart last year.)

But those questions don’t deter Jon Slater, CEO of Optivus Proton Therapy Inc., a company that’s viewed as a pioneer in the burgeoning field of proton therapy. Slater’s company in October announced plans for a $170 million, 80,000-square foot center that it says will create 400 jobs in Dayton.

Optivus aims to break ground on a 23-acre site in Miami Township by the end of the year and open the center, which is expected to treat about 3,000 patients per year, in 2013. Optivus has agreed to work with Wright State University on research and development at the proposed center.

But Slater isn’t the only one dreaming of a proton therapy center in Dayton. In May, Kettering Medical Center announced planned to collaborate with a California company on an $80 million center that it also hoped to open in 2013. Kettering is deciding between two locations for the project, one of which would be in the same general area as Optivus’ proposal. (A Kettering spokesman didn’t respond to requests for comment on plans for her organization’s proton center.)

What is proton therapy?
Proton therapy was first proposed in the 1950s, but it didn’t start generating much attention until the last decade as plans for centers providing the service began to ramp up. Slater’s family was behind the first hospital-based proton center in the United States, which opened in Southern California in 1990 and is named for Slater’s father, a physician who was an early advocate of proton therapy. Slater’s brother, Jerry, is the center’s director. For 13 years, it was the only proton center operating at a hospital in the country.

Now, as the U.S. population ages and investors sense its profit-making potential, proton therapy is drawing increased attention from advocates and skeptics, alike.

Precision and intensity are the chief benefits of proton therapy, compared with the alternative treatment, traditional X-ray radiation therapy. Proton therapy allows for more exact targeting of a tumor, which reduces the damage to surrounding tissue.

Protons do the bulk of their work beneath the skin where a tumor is located, unlike X-rays, which tend to lose power and cause collateral damage as they penetrate the body’s tissues. Proton therapy is especially useful for sensitive locations, such as the eye or spinal cord, in which misplaced radiation can cause lots of damage. It’s used to fight a wide variety of cancers including prostate, breast and lung.

Many who have undergone proton therapy swear by it, saying it provided the hope of a cure without the pain and side-effects associated with X-ray treatment. One support group of prostate cancer patients who’ve undergone proton therapy boasts about 4,000 members and is dedicated to spreading awareness of the treatment option. Someday, though it’s likely many decades off, proton therapy could replace X-ray treatment for cancer, Slater said.

Irrational exuberance?
Few argue that proton therapy is ineffective, though many would like to see it subjected to rigorous testing. The National Cancer Institute (NCI) last year expressed concern that “enthusiasm for this promising therapy may be getting ahead of the research.” NCI experts worry about a lack of published randomized, controlled trials that show proton therapy works better than standard radiation therapy, increasing survival or improving quality of life for patients.

And then there’s the cost. Medicare reimburses proton therapy at about twice the rate of standard radiation therapy, prompting concerns that patients (or their insurers) could pay twice the price for a treatment that may be no more effective than the cheaper alternative. Part of the cost is driven by the enormity of the facilities needed to house a proton therapy center and its football field-sized particle accelerator, as well as multistory machinery that surrounds each treatment chamber and heavy concrete walls that act as radiation shields. Each center holds about 600 tons of machinery and equipment, Slater said.

So while the two Dayton projects may be welcome news for cancer-stricken Ohioans, is it reasonable to construct two proton centers in the same mid-sized Midwestern city when there are only eight across the whole country? Leonard Arzt,  executive director of National Association for Proton Therapy, diplomatically said he’d be “pleasantly surprised” if there’s adequate financing to support two proton centers in the same community. Similar plans for competing centers in suburban Chicago were advanced in recent years, but one of the projects has stalled, due to financing problems.

A stronger warning comes from Allan Thornton, former medical director at the Midwest Proton Radiotherapy Institute in Bloomington, Indiana. Thornton told U.S. News and World Report, “To roll out multiple facilities competing against each other is illogical and a waste of resources.”

Slater of Optivus rejects such statements. He says it’d be impossible for two proton centers to compete against each other because demand for the treatment overwhelmingly outweighs supply. And Optivus isn’t stopping at Dayton to test his belief. Though the company has just one operating proton center today, it hopes to have 15 U.S. centers in a decade, and a whopping 100 within 20 years, according to Slater. Five would be in Ohio.

Slater estimates that 350,000 Americans per year could benefit from proton therapy, yet only about 3,000 per year receive the treatment. (Arzt of the National Association for Proton Therapy said he couldn’t confirm Slater’s numbers, but he didn’t dispute them, either.) If those numbers are accurate, that means the future is likely to hold enough patients — and cash — to be shared among several proton therapy center operators.

“I don’t think two proton centers can compete against each other anywhere in the U.S. today,” Slater said. “If you build a proton center in the U.S., there will be more demand than there’s capacity to treat.”