Radiotherapy is an integral part of comprehensive cancer treatment. The objective of modern oncological treatment is to ensure patients the maximum chance of recovery while minimising adverse effects related to the treatment.
The essential component of proton radiotherapy is the proton beam. It is formed from protons that are obtained from hydrogen; these are the nuclei of hydrogen atoms. Protons are accelerated to about half the speed of light in a special device known as a cyclotron. They thus gain energy allowing for the destruction of tumours. Subsequently, they are directed by a strong magnetic field into a narrow beam and “sent” into the tumour.
At PTC, we use Pencil Beam Scanning (PBS) to target tumours, and we are among the world leaders in this field. In this type of radiation, a thin (pencil) beam is directed at a given point of target volume using the magnetic field. If we were to compare this method to something, imagine how concentrated and meticulous you are when tasked with using a crayon to colour something in on a piece of paper, such as a circle. You will always try to keep the crayon within the perimeter of the circle. This is how our PBS method works.
When using protons, we can therefore protect healthy tissues from unwanted radiation and thereby significantly reduce the risk of complications and preserve the patient’s quality of life during and after treatment.
Proton radiotherapy is a highly effective, precise, and gentle cancer treatment with minimal side effects. By precisely targeting the proton beam at the tumour, the occurrence of undesirable side effects is greatly reduced. This means that proton therapy gives patients a chance to live a good life after cancer treatment.
Currently, photon or proton radiotherapy can be used for radiation. The difference rests with the physical properties of individual types of radiation and related behaviour in tissues. The objective of modern cancer treatment is to ensure patients the maximum chance of recovery while minimising adverse effects related to the treatment. Proton therapy now achieves this objective to a maximum degree.
Photon radiation (also known as bremsstrahlung X-rays or braking radiation), the source of which is linear accelerators, passes through the body, gives off most of its energy at the surface of the body, and continues and delivers a significant part of its energy behind the tumour.
However, protons have a physical property called the Bragg peak. Thanks to this property, protons transmit a very small part of the radiation dose to the surface of the body, and the intensity of the transmission increases with depth, reaching a maximum in the target area (in the area of the so-called Bragg peak), which we will precisely determine, and beyond which energy transmission no longer occurs.
When protons are used, a smaller volume of healthy tissue is irradiated, thereby significantly reducing the risk of side effects associated with radiation.
The technology installed underground at the Proton Center commands respect and few patients are aware of the complexity of this system. The protons are positively-charged elemental particles of hydrogen atom nuclei that are accelerated in the cyclotron to approximately half the speed of light. They thus gain energy allowing for the destruction of tumours as deep as 30 centimetres. They are then compressed with a strong magnetic field into a very narrow beam and delivered to the tumour with a high level of precision During their deceleration in the tumorous tissue, energy is emitted, ionisation takes place, and the DNA of affected cells is damaged. If a cancer cell suffers multiple damage, it stops dividing or dies.
Pencil Beam Scanning (PBS) indicates the precise distribution of the proton beam dose. In this type of radiation, a thin (pencil) beam is directed at a given point of target volume using the magnetic field. Thanks to highly precise control of changes in this magnetic field, gradual irradiation of the entire target volume (tumour lesion) is achieved.
To illustrate the principle of PBS, imagine how concentrated and meticulous you are when assigned a task to colour in a certain object, for example a circle, on a sheet of paper with coloured pencils. You will always try to remain within the perimeter. This, in principle, is how PBS works. Moreover, you can be one hundred percent sure that it will “colour in” only what is needed. Thanks to this precision, surrounding healthy tissues and organs are not unnecessarily irradiated.
Based on this initial examination, the doctor will decide if proton therapy is right for you. Your personal coordinator will plan all the necessary examinations (especially the planning CT scan) needed to start the treatment and will also take care of the necessary administration.
However, precise planning of the treatment is key to its success. Therefore, a team of doctors and clinical physicists will prepare a radiation plan tailored to each patient, according to which the proton therapy will be performed. The irradiation plan also determines from which directions and with what intensity the proton beam will deliver radiation to the tumour.
You will come to the Proton Center on precisely determined days and times that will be reserved solely for you. The radiation treatment itself takes only a few minutes.
We provide this information at the request of our patients who have been misinformed. Even after 12 years of proton radiotherapy being fully available to Czech patients, there are still numerous discussions and, unfortunately, our patients continue to hear or read these misconceptions. Therefore, we would like to clarify the falsehoods that we encounter most often.
We continuously publish the results of proton therapy in journals that are fully accessible online or in scientific research databases. In general, the outcomes are very good, and in terms of treatment efficacy, we have excellent success not only in treating prostate tumors but also in patients with head and neck tumors or malignant lymphomas. There is a significant difference between radiation therapy and surgical treatment, particularly in the case of prostate cancer. For this diagnosis, we see better treatment outcomes with protons in terms of both side effects and post-treatment survival. Operated patients more frequently experience what is known as treatment-related toxicity, which can lead to incontinence or impotence. The difference is also quite noticeable over a five-year period when assessing whether the disease recurs or not. It is not uncommon for us to irradiate patients who have had a recurrence of the disease after surgery.
Yes, our results are indeed very good, comparable to the world leaders in proton therapy. Thanks to our outcomes, we are ranked among the top 5 centers globally. All our data is processed by an independent company certified for healthcare research, which guarantees its authenticity and accuracy. Have you asked your treating doctors what results they have with the treatment method they are offering you? We would be happy to show you ours.
Proton therapy is legally covered by health insurance and is therefore available to all citizens of the Czech Republic. We have long-term contracts with all Czech health insurance companies.
Pacemakers, also known as ICDs, are sensitive electronic devices that are generally harmed by any radiation. In the case of proton radiotherapy, secondary high-energy particles are generated, which pose an increased risk of damaging the electronics, potentially leading to subsequent malfunction of the pacemaker. CT scans are crucial for planning radiotherapy. Metal materials (implants, dental fillings, etc.) create so-called artifacts in the CT image (structures that do not exist in the body). These can affect the dose calculation in the given area, potentially causing inaccuracies in radiation dosing. At the Proton Center, we strive to eliminate all risks, which is why we do not treat patients with implants in the irradiated area. Of course, metal in the pelvic area does not interfere if we are irradiating tumors, for example, in the head and neck region.
Even during treatment, you can stay with your loved ones. You don’t have to stay in the hospital; you can continue working, and we can adjust your radiation schedule according to your needs.
Tumors that rapidly change their position or shape over time are considered unsuitable for proton therapy. This applies to tumors of the eye, larynx, pharynx, vocal cords, skin (e.g., melanoma), stomach, small and large intestines, bladder, testicles, and generalized diseases with multiple metastases.
Clinical trials are conducted to evaluate the overall effectiveness of proton therapy. They are carried out according to a predetermined scheme on a selected group of patients and help determine whether the treatment method is safe and effective. As of May 24, 2024, the international clinical trial registry ClinicalTrials.gov lists 157 closed studies when searching for the keywords "cancer" and "proton radiotherapy." The registry lists 191 open studies recruiting patients as of the same date. These numbers are not small. Therefore, we can say that proton radiotherapy is not an experimental treatment and has been sufficiently tested. The increasing number of ongoing studies, on the other hand, indicates that it is a promising method that will be able to treat a broader spectrum of cancer diagnoses in the future.
When using the most modern techniques of proton radiotherapy, the skin is marked as a so-called risk organ that needs to be protected. The skin dose is precisely determined according to the doctor’s and clinical physicist’s requirements and is increased only in patients with advanced tumors that initially penetrated the skin. Skin reactions (known as radiation dermatitis) that appear during treatment are the same or even less severe than with conventional radiation therapy and subside within 2–3 weeks after the completion of radiotherapy. We have treated hundreds of women with breast cancer to date. We continue to monitor the vast majority of these patients. The management of radiation dermatitis and its development is documented for each of these patients, including through photographs. However, we have not encountered any extensive or deep tissue damage in any of the patients we have followed up with. Therefore, the information that proton radiotherapy will cause skin burns, scarring, and make breast reconstruction impossible is absolutely false.
Chief Physicist at PTC: If the beam encounters fluid, air, bones, or another material or their combination, this is accounted for in the calculation and does not affect the accuracy of the irradiation. For example, if the patient has a metal implant, the proton beam is not directed through it. This means that the dose distribution always corresponds to the relevant anatomical situation, which is considered in the calculation.
Photon radiation passes through the body and delivers a significant amount of energy beyond the tumor. As a result, not only the tumor but also healthy tissues and organs in front of and behind the tumor are irradiated. This can lead to many complications for the patient during and after treatment. However, protons have a physical property that allows them to deliver minimal energy on their way to the tumor, stop there, release maximum energy, and not continue further. By using protons, we can protect healthy tissues from unnecessary radiation. This significantly reduces the risk of side effects from treatment.
Biologically and technically, it doesn’t matter whether protons are used to treat a person who is 10, 20, or 80 years old. The reason why younger patients are sometimes preferred is due to the likelihood of side effects that arise with any cancer treatment, and the risk increases with life expectancy. However, with protons, the probability of side effects is reduced. The younger a person is, the more carefully they need to be irradiated. But this does not mean that we cannot treat older patients; age discrimination is out of the question.
Consider the options available to you. You don’t need to decide immediately. The treatment you choose will have a significant impact on your quality of life, both during and after the treatment. The side effects can vary greatly depending on the type of prostate cancer treatment.
Contact usWe provide this information at the request of our patients who have been misinformed. Even after 12 years of proton radiotherapy being fully available to Czech patients, there are still numerous discussions and, unfortunately, our patients continue to hear or read these misconceptions. Therefore, we would like to clarify the falsehoods that we encounter most often.
Clinical trials are conducted to evaluate the overall effectiveness of proton therapy. They are carried out according to a predetermined scheme on a selected group of patients and help determine whether the treatment method is safe and effective. As of May 24, 2024, the international clinical trial registry ClinicalTrials.gov lists 157 closed studies when searching for the keywords "cancer" and "proton radiotherapy." The registry lists 191 open studies recruiting patients as of the same date. These numbers are not small. Therefore, we can say that proton radiotherapy is not an experimental treatment and has been sufficiently tested. The increasing number of ongoing studies, on the other hand, indicates that it is a promising method that will be able to treat a broader spectrum of cancer diagnoses in the future.
We continuously publish the results of proton therapy in journals that are fully accessible online or in scientific research databases. In general, the outcomes are very good, and in terms of treatment efficacy, we have excellent success not only in treating prostate tumors but also in patients with head and neck tumors or malignant lymphomas. There is a significant difference between radiation therapy and surgical treatment, particularly in the case of prostate cancer. For this diagnosis, we see better treatment outcomes with protons in terms of both side effects and post-treatment survival. Operated patients more frequently experience what is known as treatment-related toxicity, which can lead to incontinence or impotence. The difference is also quite noticeable over a five-year period when assessing whether the disease recurs or not. It is not uncommon for us to irradiate patients who have had a recurrence of the disease after surgery.
When using the most modern techniques of proton radiotherapy, the skin is marked as a so-called risk organ that needs to be protected. The skin dose is precisely determined according to the doctor’s and clinical physicist’s requirements and is increased only in patients with advanced tumors that initially penetrated the skin. Skin reactions (known as radiation dermatitis) that appear during treatment are the same or even less severe than with conventional radiation therapy and subside within 2–3 weeks after the completion of radiotherapy. We have treated hundreds of women with breast cancer to date. We continue to monitor the vast majority of these patients. The management of radiation dermatitis and its development is documented for each of these patients, including through photographs. However, we have not encountered any extensive or deep tissue damage in any of the patients we have followed up with. Therefore, the information that proton radiotherapy will cause skin burns, scarring, and make breast reconstruction impossible is absolutely false.
Yes, our results are indeed very good, comparable to the world leaders in proton therapy. Thanks to our outcomes, we are ranked among the top 5 centers globally. All our data is processed by an independent company certified for healthcare research, which guarantees its authenticity and accuracy. Have you asked your treating doctors what results they have with the treatment method they are offering you? We would be happy to show you ours.
Chief Physicist at PTC: If the beam encounters fluid, air, bones, or another material or their combination, this is accounted for in the calculation and does not affect the accuracy of the irradiation. For example, if the patient has a metal implant, the proton beam is not directed through it. This means that the dose distribution always corresponds to the relevant anatomical situation, which is considered in the calculation.
Proton therapy is legally covered by health insurance and is therefore available to all citizens of the Czech Republic. We have long-term contracts with all Czech health insurance companies.
Photon radiation passes through the body and delivers a significant amount of energy beyond the tumor. As a result, not only the tumor but also healthy tissues and organs in front of and behind the tumor are irradiated. This can lead to many complications for the patient during and after treatment. However, protons have a physical property that allows them to deliver minimal energy on their way to the tumor, stop there, release maximum energy, and not continue further. By using protons, we can protect healthy tissues from unnecessary radiation. This significantly reduces the risk of side effects from treatment.
Pacemakers, also known as ICDs, are sensitive electronic devices that are generally harmed by any radiation. In the case of proton radiotherapy, secondary high-energy particles are generated, which pose an increased risk of damaging the electronics, potentially leading to subsequent malfunction of the pacemaker. CT scans are crucial for planning radiotherapy. Metal materials (implants, dental fillings, etc.) create so-called artifacts in the CT image (structures that do not exist in the body). These can affect the dose calculation in the given area, potentially causing inaccuracies in radiation dosing. At the Proton Center, we strive to eliminate all risks, which is why we do not treat patients with implants in the irradiated area. Of course, metal in the pelvic area does not interfere if we are irradiating tumors, for example, in the head and neck region.
Biologically and technically, it doesn’t matter whether protons are used to treat a person who is 10, 20, or 80 years old. The reason why younger patients are sometimes preferred is due to the likelihood of side effects that arise with any cancer treatment, and the risk increases with life expectancy. However, with protons, the probability of side effects is reduced. The younger a person is, the more carefully they need to be irradiated. But this does not mean that we cannot treat older patients; age discrimination is out of the question.
Even during treatment, you can stay with your loved ones. You don’t have to stay in the hospital; you can continue working, and we can adjust your radiation schedule according to your needs.
Tumors that rapidly change their position or shape over time are considered unsuitable for proton therapy. This applies to tumors of the eye, larynx, pharynx, vocal cords, skin (e.g., melanoma), stomach, small and large intestines, bladder, testicles, and generalized diseases with multiple metastases.
Consider the options available to you. You don’t need to decide immediately. The treatment you choose will have a significant impact on your quality of life, both during and after the treatment. The side effects can vary greatly depending on the type of prostate cancer treatment.
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