Two UK hospitals are to launch a procurement competition for particle beam cancer therapy technology after securing £250m of funding from the Department of Health.
By 2017 it is hoped that around 1,500 cancer patients — many of them children — will benefit from the cutting-edge treatment at University College London Hospitals (UCLH) NHS Foundation Trust and the Christie NHS Foundation Trust hospital in Manchester.
Particle beam therapy, which uses protons or other ions, is a highly targeted modality of cancer treatment that can precisely irradiate tumours while preserving healthy tissue — especially valuable in brain tumours.
Although the basic technology has been in place since the mid-1980s, its application in cancer medicine has only really come of age in the past decade. However, the UK presently lacks any full-scale facilities and NHS patients have previously been sent abroad for treatment.
With the latest funding, the two centres will launch a procurement phase considering technological offerings from seven potential suppliers including Hitachi, IBA, Varian and Sumitomo.
‘Ideally we’d get one supplier for both sites because there would be economies of scale and, given the engineering support we need for this, there would hopefully be a tranche of engineers situated somewhere between ourselves and Manchester,’ Derek D’Souza, head of radiotherapy physics at UCLH, told The Engineer.
For the facilities to be economically viable, they will also have to have a high throughput of patients, with somewhere in the region of 1,500 cases a year.
‘One accelerator would supply three to four gantries; however, it can only supply to one gantry at a time because there’s only one beam line. So the accelerator emits the protons, which go to one gantry, and the other patients in the line are waiting. There’s a switching and auto-tuning of the beam to the required clinical parameters for the next patient — what we’re trying to do is minimise the time that you have to switch between gantries,’ D’Souza said.
The procurement team will consider synchrotron accelerators, which synchronise the magnetic and electric field, and possibly the newer cyclotron technology, which uses a constant magnetic and electric field. However, the team will almost certainly opt for beams of protons rather than other ions and more exotic mediums.
‘The issue is the DoH is adverse to risky, unproven technology, and protons have some track record; other particles such as carbonides or hadron particles haven’t really been tested in terms of clinical effectiveness,’ D’Souza said.
Given the central London location of the facility, the available space is also a major consideration during planning.
‘What we’re looking at is a more compact solution. If you look at most facilities, they’re elongated, single-level facilities where the accelerator is on the same floor as the treatment end with the patients. What we’re aiming to do is have the accelerator at the bottom and bend the protons upward and round rather than sideways. We’re looking into all of this with manufacturers.’
Despite the fact that the two centres have been muted for some time now, the decision errs from general DoH policy on new technologies and treatments given that there has been no appraisal by the National Institute for Health and Clinical Excellence (NICE) for cost-benefit ratio.
In fact, a trial published last week found that men with prostate cancer treated with proton beam therapy had more complications than patients given conventional radiotherapy.
In the US, where 10 new proton beam facilities are being built, former government health adviser Prof Ezekiel Emanuel recently described the treatment as ‘crazy medicine and unsustainable public policy’.
Nevertheless, D’Souza predicts the UK facilities will quickly reach capacity and only deal with ‘complex workloads’.
‘Most of the world is now looking towards the UK because we have a track record for clinical trials in assessing the efficacy of treatments.’