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Proton Therapy

Last updated April 25, 2018

Approved by: Krish Tangella MD, MBA, FCAP


Proton Therapy is a type of radiation therapy used to treat tumors, both benign and malignant.

Background Information:

What are the other Names for the Procedure?

  • Proton Beam Therapy
  • Radiation Therapy

What is Proton Therapy radiology procedure? (General Explanation)

  • Proton Therapy is a type of radiation therapy used to treat tumors, both benign and malignant
  • Protons are the atoms that carry positive charges. They are produced after removing the negatively charged electrons
  • There are several properties of protons that make them better than X-rays or photons.
    • Protons are positively-charged, they release most of their energy at the destination site, and do not travel pass the destination site unlike X-rays
    • Thus, using proton therapy, it is much easier to provide radiation doses at the specific site without damaging normal surrounding tissues

What part of the Body does the Procedure involve?

Proton Therapy may involve various parts of the body being targeted for the treatment depending upon the site of cancer.

Why is the Proton Therapy radiology procedure Performed?

Proton Therapy is used treat tumors such as:

  • Prostate cancer
  • Liver tumor
  • Melanoma of the eye
  • Skull base sarcoma
  • Tumors in the rectum
  • Tumors at esophagus
  • Brain tumors
  • Head and neck tumors
  • Lung cancers

What is the Equipment used? (Description of Equipment)

The following equipment is used in Proton therapy:

  • Cyclotron or synchrotron and magnet:
    • These machines are used to produce and accelerate positively-charged proton particles and steer them toward specific body parts
    • It looks like a big rectangular box with examination table on one side       
  • Immobilization devices as necessary

What are the Recent Advances in the Procedure?

There have been no recent advances to the Proton Therapy procedure.

What is the Cost of performing the Proton Therapy Procedure?

The cost of the Proton Therapy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Proton Therapy procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/?term=proton+therapy (assessed on 3/7/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25657176 (assessed on 3/7/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25653863 (assessed on 3/7/2015)

Prior to Proton Therapy radiology procedure:

How does the Proton Therapy radiology procedure work?

The Proton Therapy procedure works in the following manner:

  • Cyclotron or synchrotrons are special machines that are used to produce positively-charged protons. These machines also accelerate protons at very fast speeds so they can penetrate into the body tissues
  • These positively charged and accelerated protons are directed toward the patient using magnet that attracts the protons toward them. These magnets then steer the proton to the specific part of the body being treated
  • Once protons reach their target organs and gives-off their energy to those tissues. This high energy makes changes at molecular levels of tumor cells being targeted and eventually destroys them

How is the Proton Therapy radiology procedure Performed?

Proton Therapy is an outpatient procedure and is performed in the following manner:

  • The patient is taken to the treatment room and positioned on the examination table
  • An immobilization device specifically made for the patient is used to properly position the patient
  • A specific imaging process is used to position the patient in order to achieve the maximum precision
  • After the treatment parameters and positioning are properly confirmed, the radiation oncologist starts the treatment from an adjacent room
  • Video cameras and microphones are used to observe the patient during the procedure
  • Once the required dose of Proton Therapy is delivered, the technologist removes the immobilization device from the patient

Where is the Procedure Performed?

The Proton Therapy is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

Radiation therapist under the supervision of a radiation oncologist performs the Proton Therapy procedure.

How long will the Procedure take?

  • Generally, the standard treatment period for most Proton Therapy procedures is about 7 weeks
  • During this 7 week period, treatment is delivered five days a week
  • The tumor type and stage is used to determine how long the procedure will take
  • The delivery of proton beam only takes a few minutes, but position and imaging takes about 15-20 minutes

Who interprets the Result?

A radiation oncologist interprets the results of Proton Therapy procedure.

What Preparations are needed, prior to the Procedure?

Following preparations are needed prior to Proton Therapy:

  • Achieving precise position is very important in Proton Therapy, thus specific immobilization devices are required and must be individually fitted for the specific patients. This step of the treatment is called simulation
  • In certain cases, it is required to mark the treatment site with a marker. This procedure is performed a few days before the actual procedure
  • Once the immobilization device is constructed, a CT scan is used to create a 3-dimensional reconstruction of the tumor and adjacent tissues
  • Using this 3-d model, the site of treatment is planned so that damage to the normal tissues can be minimized
  • A radiation oncologist works with the physician to determine the most effective radiation technique for that particular patient
  • Additional examinations, such as MRI or PET scans, may be needed in certain cases

What is the Consent Process before the Procedure?

A physician will request your consent for Proton Therapy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent. 

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of Proton Therapy:

  • It is an outpatient, painless, and noninvasive procedure
  • It can treat many cancers effectively
  • High precision used during the procedure minimizes damage to the nearby tissues

Following are the risks of Proton Therapy:

  • In rare cases, excessive radiation used during the procedure may cause cancer
  • Patient may experience many side effects depending upon the site of the treatment. The side effects may include hair loss, nausea, vomiting, diarrhea, headaches, urinary or bladder changes, secondary cancers, organ changes, and infertility

What are the Limitations of the Proton Therapy radiology procedure?

Proton Therapy is mostly used for tumors that are localized; the treatment may not be as effective with metastatic cancers.

What are some Questions for your Physician?

Some of the basic questions you might ask your healthcare provider or physicians are as follows:

  • What is a Proton Therapy procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • What are the possible side effects from the procedure? How can I minimize these side effects?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Proton Therapy radiology procedure:

What is to be expected during the Proton Therapy radiology procedure?

  • Proton Therapy is a completely painless procedure. Patient does not feel any pain during the procedure
  • Most of the side effects caused by the procedure depend upon how large the dose of radiation is and what part of the body is involved
  • Side effects observed during or immediately after the therapy are usually gone in a few weeks’ time
  • Some of the most common side effects are fatigue, tiredness, and skin changes, such as redness, dryness, itching, and peeling
  • Patient may experience nausea or vomiting, which may be treated during the procedure

What kind of Anesthesia is given, during the Procedure?

Anesthesia is rarely used during the Proton Therapy procedure.

How much Blood will you lose, during the Procedure?

Since the procedure is noninvasive, the blood loss involved during the procedure is minimal. 

What are the possible Risks and Complications during the Proton Therapy radiology procedure?

Proton Therapy may damage the healthy tissues around the tumor site.

What Post-Operative Care is needed at the Healthcare Facility after the Proton Therapy radiology procedure?

Regular follow-up sessions may be required after the Proton Therapy procedure, to assess effectiveness of the treatment and to diagnose if any secondary cancers have developed.

After the Proton Therapy radiology procedure:

What is to be expected after the Proton Therapy radiology procedure?

There may be several side effects depending upon the area of body being treated and radiation dose used after the Proton Therapy procedure. Following are some of the side effects that the patient may experience after the procedure:

  • Soreness
  • Swelling
  • Hair loss
  • Nausea and vomiting
  • Headaches
  • Difficulty swallowing
  • Digestion problems
  • Urinary retention
  • Diarrhea
  • Infertility
  • Brain or spinal cord changes
  • Lymphedema

When do you need to call your Physician?

Patients may need to call their physician in the following situations after a Proton Therapy:

  • If the side effects during or immediately after the procedure do not resolve in a few weeks
  • There is severe nausea and vomiting

What Post-Operative Care is needed at Home after the Proton Therapy radiology procedure?

Patient may need several follow-up appointments after the Proton Therapy procedure, to check for effectiveness of the treatment and for any signs of cancer recurrence.

How long does it normally take to fully recover, from the Procedure?

  • One may resume their normal activities immediately after the Proton Therapy procedure
  • Most of the early side effects are resolved in few weeks following the procedure

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Proton Therapy procedure does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the Proton Therapy procedure, a pathologist does not get involved in the care of the patient 

Who will you receive a Bill from, after the Proton Therapy radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital, where the procedure is performed
  • Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Proton Therapy procedure is performed.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: March 24, 2015
Last updated: April 25, 2018