FAQ

BELOW YOU WILL FIND THE ANSWERS TO the most frequently asked questions

 

INFORMATION

What are protons?

Everything around us is made of atoms, which consist of protons (positively charged), electrons (negatively charged) and neutrons (neutral). A hydrogen atom is composed of one proton and one electron. When the electron is removed (ionization) from the hydrogen atom, a positively charged proton remains. This proton is accelerated by means of electric and magnetic fields, so it will be suitable for therapy.

 

WHY A NEW THERAPY?

Studies show that more than half of all cancer patients require treatment by irradiation. Conventional irradiation therapy is sufficiently effective for many patients, but sometimes the tumors are located to close to critical organs (such as the brain), or they are relatively insensitive to the irradiation. In that case proton therapy may be a solution. This therapy causes less damage to healthy organs near the tumor, thus preventing drastic side effects which severely reduce the quality of life for a patient. In some cases, proton therapy may lead to a more effective way to destroy tumor cells. 
 

IS PROTON THERAPY BOTH SAFE AND PROVEN?

Proton therapy is new in the Netherlands, but has already been proven internationally. In several treatment centers, some 100,000 patients have been treated worldwide. The therapy is not experimental, but the result of years of scientific research showing the irrefutable usefulness of the treatment.

WHEN AND HOW CAN I BE TREATED AT HOLLANDPTC?

The treatment in HollandPTC will take place through the affiliated medical centers (Erasmus MC Rotterdam and Leiden LUMC). Patients will only visit the facility in Delft for the actual treatment. The first treatments will be launched in the first half of 2018. Until then, Proton therapy will only be available abroad. In order to qualify for this, patients should consult with their doctor.

WHY IS HOLLANDPTC LOCATED IN DELFT?

For proton therapy, complex and large-scale equipment is required in a specially designed facility. This requires a lot of space and specialist expertise. Both are available in Delft. The Technical University of Delft (TU Delft) is one of the few institutions in the Netherlands having many years of experience in irradiation technology and safety. Moreover, Delft is located at a short distance from the participating medical centers in Leiden (28 km) and Rotterdam (15 km). HollandPTC will also cooperate with the “Reinier de Graaf” Hospital, which is located in Delft.

WHO IS BEHIND HOLLANDPTC?

HollandPTC is a collaboration between the Erasmus University Medical Center Rotterdam, the Leiden University Medical Center and the technical university of Delft (TU Delft). Together they wish to introduce a new treatment  for cancer in the Netherlands.

HOW  CAN I CONTACT hollandptc?

For press contacts, or for information how companies can contribute to the realization of HollandPTC, please click on the contact page in the menu above and fill in the form.

WHAT DOES HOLLANDPTC STAND FOR?

HollandPTC is an abbreviation of Holland Proton Therapy Centre. Proton therapy is an innovative way to fight tumors by irradiating them with tiny charged particles. Protons are such particles.

IS HOLLANDPTC A HOSPITAL?

No. HollandPTC is a specialized clinic for proton treatments only. The treatment in HollandPTC is performed by physicians of Erasmus MC and LUMC. As part of their treatment, patients come to Delft for proton radiotherapy. All necessary medical facilities will be available. The Reinier de Graaf Hospital is located near HollandPTC.

WHO WILL BE CARRYING OUT THE TREATMENT?

HollandPTC will have a team of physicians and medical physicists specialized and trained in the use of protons. This team is currently being assembled and will consist of experienced radiotherapists of the medical partners and specialists elsewhere. This team will be responsible for the entire treatment, from planning to follow-up.

Has Proton therapy been authorized?

Proton therapy is a therapy approved by the Dutch government. For years, patients have been referred to abroad if they qualify for proton therapy. For the therapy to be available in the Netherlands, a so called WBMV Act (Special Medical Operations) permit is required. In December 2013 the Ministry of Health has granted this license to HollandPTC.

WHAT TYPES OF CANCER CAN BE TREATED WITH PROTON THERAPY?

Proton therapy is only used in the treatment of indications in which we know that proton therapy may have a significant advantage over conventional therapy. In November 2011, The Health Care Insurance Board has recommended the government to initially make the following indications qualify for proton therapy: intraocular tumors (eye), lung tumors, chordomas / chondrosarcomas (skull base), pediatric malignancies (children), Head neck tumors, breast cancer, lung cancer and prostate cancer. Except for tumors in children, all these indications will be treated in HollandPTC. With each patient, it is closely examined whether proton therapy offers an advantage over conventional therapy: This is not necessarily the case. The group of indications can be expanded over time.

WHY ARE PROTONS BETTER THAN HIGH ENERGY X-rays?

That depends on the precise location of the tumor and the type of cancer. In general, proton therapy will cause fewer side effects than conventional radiotherapy.

WHat ARE THE SIDE EFFECTS OF PROTON THERAPY?

X-rays consist of small packets of energy, called photons. Protons and photons have different physical properties. For example, protons, in contrast to photons, have a mass and electric charge. As a result, protons have a very specific depth of penetration in the body. Precisely there, where they come to a standstill in the body, they will release most of their energy. Physicists call this the "Bragg peak”. By fine tuning the energy of the protons, the destructive energy can be precisely focused in the tumor. Photons do not have this capacity; they evenly release their energy, also to healthy tissue both in front of and behind the tumor.

IS PROTON THERAPY SUITABLE FOR THE TREATMENT OF CHILDREN?

Because children are extra sensitive to the side effects of radiotherapy, proton therapy does offer advantages to treat cancer in children. Because the treatment of children in some cases must be given under general anesthesia, the Dutch Minister of Health has determined that the treatment of children with proton therapy may only take place in or in the near vicinity of a hospital (the ‘on campus’ or ‘hospital based’ situation).Therefore, HollandPTC will not treat children yet. Once a proton therapy center will be operational in a Dutch hospital, children can be referred hereto. Until then children will have to be treated abroad.

WILL THE TREATMENT TAKE LONG OR BE PAINFUL?

The irradiation with protons does not last longer than conventional irradiation treatments. The irradiation itself is painless and has to be repeated a number of times, depending on the type of cancer. The number of irradiations with protons is comparable to or less than that of conventional irradiation treatments.

HAS THERE BEEN COMPARATIVE RESEARCH BETWEEN PROTON THERAPY AND CONVENTIONAL RADIOTHERAPY?

Worldwide, all kinds of research on the benefits of proton therapy have been carried out for some diseases, but there is also an urgent need for large-scale comparative research for many more types of cancer. Erasmus MC and LUMC have unique experience in such research. They will develop a joint clinical research programme at HollandPTC.

IS PROTON THERAPY MORE EXPENSIVE THAN conventional THERAPY?

Yes. This is due to the complex equipment needed to make proton beams. Therefore, proton therapy will never completely replace the conventional radiotherapy. It will only be used when it provides a measurable higher chance on cure and lower risk of complications. HollandPTC will investigate these opportunities. Besides cost, the improved quality of life (fewer side effects immediately after treatment and in the long term), are an important reason to switch to protons. HollandPTC will research ways to make the therapy more efficient and thus less expensive.

DOES HOLLANDPTC HAVE THE REQUIRED EXPERIENCE WITH PROTON THERAPY?

When HollandPTC will launch treatments in 2017, all the necessary expertise will be available. Currently the partners of HollandPTC are the leading experts in both the field of conventional radiotherapy and modern irradiation techniques as well as medical technology. In the next few years and in conjunction with proton centers abroad, they will be training physicians, scientists and technicians to become experts in the field of proton therapy. Several experts from abroad have already been involved in the preparations regarding HollandPTC.

WILL ONE PROTON FACILITY BE ENOUGH FOR ALL PATIENTS IN THE NETHERLANDS?

HollandPTC will be treating 600 patients per year. The Health Council estimates that currently, there are about 7,000 patients each year that will benefit from proton therapy. By 2015 that expectation will be for some 9,400. So, more proton facilities are likely to be needed in order to provide all Dutch patients with adequate care. On 1st August 2013, the Minister of Health has determined that initially up to four proton therapy centers may be built in the Netherlands for a total of 2,200 patients per year.

WILL HOLLANDPTC BE PREPARED FOR ANY MEDICAL COMPLICATIONS, CONSIDERING IT IS NOT A HOSPITAL?

HollandPTC includes all necessary medical facilities in order make the entire treatment (radiotherapy plus any chemotherapy) for every patient as easy and safe as possible, even for non-ambulatory patients. Acute medical complications during radiotherapy treatment are very rare. Nevertheless, HollandPTC will make solid arrangements with both the university medical centers in Rotterdam and Leiden, and with Reinier de Graaf hospital which is in the vicinity of HollandPTC.

CAN PROTON THERAPY BE COMBINED WITH CHEMOTHERAPY?

Yes, combined therapy is possible, as is with conventional radiotherapy.

WHAT IS PROTON THERAPY?

More than half of all cancer patients need treatment by means of ionizing irradiation in order to stop the growth of the tumor. At present, standard irradiation with X-rays (photons) takes place. However, for several years, an increasing number of patients world-wide have been irradiated with tiny charged particles, such as protons.

WHAT ARE THE MAIN BENEFITS OF PROTON THERAPY?

The main advantage of irradiation with protons compared to the present techniques is a very accurately defined dose delivery. This allows for a higher dose to be given to relatively insensitive or unfavorable located tumors. In addition, a lower dose will be delivered in the surrounding healthy tissue. These are important advantages for the treatment of tumors in critical areas of the body, such as the brains. Worldwide, already 100,000 cancer patients have been irradiated with protons. At present, there is a considerable increase in the number of irradiation facilities for this technology, particularly in Germany, the US and Japan.

FOR WHOM WILL PROTON THERAPY BE SUITED?

The Dutch Health Counsel earlier estimated that about 9,400 Dutch patients could have benefitted from proton therapy in 2015. That is almost 10% of all cancer patients in the Netherlands. The Health Care Insurance Board estimates that the first group of patients will be about 3,500 per year. The Minister of Health has determined in 2013 that initially more than 2,200 patients in up to 4 Dutch proton centers may be treated.

IN WHICH COUNTRIES IS PROTON THERAPY ALREADY AVAILABLE?

In the map below all existing peer centers are shown, indicating the starting year and the number of patients that have been treated until 2011.

HOW DO I GET ACCESS TO TREATMENT AT HOLLANDPTC?

When you are eligible for proton therapy, you will be referred to Erasmus MC or LUMC. Several hospitals in the South of Holland, Brabant and Zeeland have indicated that they want to cooperate closely with HollandPTC, to allow patients to be referred easily. The multidisciplinary treatment teams at Erasmus MC and LUMC will determine whether irradiation therapy by using protons is the best treatment strategy. If this is the case, irradiation will take place in HollandPTC in Delft under the supervision of Erasmus MC and LUMC.

WILL I BE ABLE TO HAVE ACCESS TO HOLLANDPTC FROM MY REGULAR HOSPITAL?

A number of hospitals and irradiation therapy centers that already closely cooperate with Erasmus MC and LUMC have indicated that they want to cooperate with HollandPTC. These hospitals have radiotherapy departments where patients are now being treated with conventional radiotherapy. In the future, a patient which is under treatment at one of these centers and will possibly benefit from treatment with protons may be referred to a treatment team at Erasmus MC and / or LUMC. If this treatment team decides that proton therapy is indeed the best treatment strategy, the patient can be irradiated at HollandPTC.

WHAT WILL MY FIRST VISIT TO HOLLANDPTC BE LIKE?

Through the glass entrance door you will enter the central reception area of HollandPTC. In this room, which overlooks the water and the forecourt of HollandPTC, you can wait comfortably until one of our staff will come to collect you. At the coffee corner you can take out refreshments.

On your first visit you will be guided from the central reception area to one of our irradiation oncologists for an intake interview, which will take place in the outpatient clinic of HollandPTC. The next step, after the intake, will be the making of a scan in order to create an irradiation treatment plan and to precisely calculate the irradiation dose in the tumor and in the irradiation sensitive organs. This scan is made several days before the start of the treatment and requires high-quality CT, MRI and PET / CT scanners, which are available in HollandPTC.

WHAT IS A TREATMENT AT HOLLANDPTC LIKE?

Specialized oncologists will be ready to closely guide the entire treatment. By means of advanced equipment, the precise location and extent of the tumor is determined, after which the tumor is accurately irradiated by a beam of protons. Here, you can watch the virtual tour through HollandPTC to see how the treatment will take place.

A few days after the preparatory scan, the irradiation phase begins, which will be conducted with the highest possible precision. HollandPTC has three areas where you can be irradiated, including one specifically for the treatment of eye tumors. The irradiation is led by specialist technicians and under the supervision of a doctor and a medical physicist, who are both nearby at all times. During the irradiation, a special alarm system is available that allows you to alert the laboratory to any discomfort.

If case you will need chemotherapy in addition to proton therapy, this may be administered in the daycare area of HollandPTC. In this room, which also gives access to the terrace, there are a number of day treatment chairs.

WILL RESEARCH ALSO BE CONDUCTED AT HOLLANDPTC?

The Netherlands is a world-wide leader in the research on improving the treatment of cancer with radiotherapy. Erasmus MC and LUMC are important participants in this field.

With the TU Delft as a third partner, a strong research partnership has been created to increase the cure rate and reduce the risk of side effects from the irradiation. In the preparation to the arrival of the proton center HollandPTC, a joint research program is launched in Delft, Leiden and Rotterdam.

WHAT ARE THE PRIORITIES OF HOLLANDPTC?

Imaging
One of the priorities of both the clinical program and the research program of HollandPTC is the application of advanced imaging to enable more precise treatment with protons and to spare the surrounding healthy tissue. The strength of proton therapy is that the protons can be precisely directed so that there is no dose delivery behind the tumor – this in contrast to radiotherapy with X-rays. However, this treatment is particularly sensitive to anatomical changes during irradiation. Such changes may occur at different time scales within a few weeks, a few days or even a few seconds. The major lines of research are therefore:

• Online compensation for anatomical changes using high-quality imaging.

• The design of irradiation plans that are solid on anatomical changes.

• The development of detectors during the irradiation which can guarantee the quality of dose delivery.

• The inclusion of biological information in the optimization and adjustment of the irradiation plans, such as, for example, variation in the irradiation sensitivity of the tumor.

Clinical studies
A second priority is conducting clinical trials with the aim to learn more about the effect of the treatment on the tumor and the surrounding healthy tissue. In these trials the quality of life and cost effectivity are important issues.

WILL HOLLANDPTC ALSO INCLUDE EDUCATION ?

HollandPTC will provide education in the field of proton therapy for clinicians (radiotherapists), medical physicists, radiotherapy technicians and technical staff. In addition, students and PhD students will be trained within the research team of HollandPTC.

Each year the course "Particle Therapy" (AP3242) is offered at the TU Delft. Also interesting graduation projects are regularly offered. This annual course is coordinated by dr. Danny Lathouwers (d.lathouwers@tudelft.nl) and dr. Martijn Engelsman (m.engelsman@tudelft.nl)

Course materials: Harald Paganetti, Proton Therapy Physics, CRC Press, 2011

ISBN10: 1439836442, ISBN13: 9781439836446

Download the full program

WHAT DOES HOLLANDPTC LOOK like?

The design of HollandPTC combines a patient-friendly environment with sufficient daylight and greening, with the latest ‘state of the art’ equipment. The compact building provides room for both optimal treatment and research. The design was developed after extensive consultation with the future users of the building, including doctors and nurses. Also, feedback from patients, radiotherapists and assistants has been collected and analyzed in a research project by the TU Delft.

The HollandPTC design team consists of dJGA architects and engineers (design), Sweegers & de Bruijn (engineering consultant), Aronsohn (constructions) and AT Osborne (project management).