Children’s bodies are still growing and developing, which makes it challenging to treat pediatric tumors with conventional radiation. Proton therapy can help minimize the risk of side effects.
Radiation therapy is quite effective at shrinking or eliminating tumors. But doctors sometimes shy away from using radiation in children with cancer. Conventional radiation treatment with X-rays carries a risk of long-term side effects in children, whose developing bodies are very sensitive.
Proton therapy is a powerful, safer alternative. It could allow more children to benefit from radiation treatment. This sophisticated therapy uses charged particles called protons to deliver high doses of radiation directly to tumors. With proton therapy, there is a reduced impact on surrounding tissues. It also has a lower risk of side effects related to the treatment.
The unique physical properties of protons allow them to deliver the radiation dose at a specific depth in the body. X-rays release their energy both before and after they hit their target. With proton therapy, all energy is released when the protons reach the tumor.
Suzanne Wolden
Memorial Sloan Kettering has offered proton therapy for adults and children since 2013. MSK Kids radiation oncologist Suzanne Wolden has treated a growing number of children with a variety of pediatric brain tumors, sarcomas, and other cancers using this technique. In 2018 alone, she used proton therapy to treat approximately 100 children.
“I’m very excited that we have proton therapy as an option. It’s really a game changer for a lot of people and enables us to provide the best care for our patients,” she says. “We are able to treat kids more effectively with less worry about impairing growth and development.”
Another critical factor is being able to reduce the risk that a child will develop another cancer at some point. Radiation treatment can increase the risk of a second type of cancer years or even decades later.
A striking example of the advantage of proton therapy is in the treatment of pediatric brain and spine tumors. Radiation for these cancers must cover the whole brain and spine.
“We deliver radiation treatment for these cancers from the back side of the head and body,” Dr. Wolden says. “With conventional radiation, the X-rays keep going past the tumor, and other tissues get unnecessary exposure. With protons, it stops completely where the tumor is. You’re not getting any radiation to the throat, heart, stomach, or other organs.”
More Convenient Care for Children in the New York City Area
For the last six years, MSK doctors have delivered proton therapy at ProCure Proton Therapy Center in Somerset, New Jersey. Beginning in the fall of 2019, adults and children receiving care at MSK will be treated at the New York Proton Center in upper Manhattan. This new facility is a partnership between Memorial Sloan Kettering, Montefiore Health System, and Mount Sinai Health System.
Dr. Wolden says that the new proton center will likely make proton therapy accessible to even more children. For some young MSK patients, going to New Jersey was often burdensome. And sometimes, MSK Kids patients need to stay in Memorial Hospital, so it is not always feasible to send them to New Jersey for treatment.
“Now we can transfer them up the street for treatment every day if needed,” she adds. “Making proton therapy an option for children staying in the hospital is a major benefit.”
A State-of-the-Art Facility
Apart from its location, the New York Proton Center offers other unique advantages. It delivers highly precise treatments using these advanced technologies:
- Pencil beam scanning employs an extremely narrow beam to deliver the protons. The process is repeated throughout the tumor, layer by layer, like paint applied with the tip of a very fine brush. Pencil beam scanning is highly effective at treating even the most challenging tumors, including those that are irregularly shaped or wrapped around vital tissues.
- Advanced imaging technology is used for both planning and delivering treatment. This includes CT scanning that guides the treatment with great precision in real time, as well as MR-PET, which is used during simulations (treatment planning).
- Intensity-modulated proton therapy can target different parts of a tumor with varying dose levels based on the exact location and the amount of radiation prescribed.
“The technology is far superior to what almost anyone else has,” Dr. Wolden says. “It’s really incredible — one of the most sophisticated centers in the world.”
The New York Proton Center also has child-friendly spaces, including a playroom, and a child-life specialist who can help young patients and their families develop strategies for coping with and adjusting to treatment.
“Nothing More Meaningful”
As the tristate area’s only dedicated pediatric radiation oncologist, Dr. Wolden is enthusiastic about the potential of proton therapy. “Ever since medical school and medical residency, my favorite thing has been taking care of kids,” she says. “I love my job. There is nothing more meaningful than helping them get past a scary situation and get on with their lives.”
