What to expect when having proton beam therapy

At Proton International London, our dedicated patient services and clinical team will do their utmost to ensure your time with us is as comfortable and worry-free as possible.

Proton International London uses a state-of-the-art proton beam therapy system to treat a variety of cancers, including some paediatric cancers, prostate cancer, head and neck cancers, brain tumours, spinal tumours, breast cancer, and lung cancer. Proton beam therapy works as an exact form of radiation therapy that uses high-energy protons to target and destroy tumour cells, while minimising the radiation dose to surrounding normal healthy tissue.

The treatment usually takes no more than around an hour of your time, five days a week. Depending on the type of cancer you are being treated for, your proton beam therapy treatment may last for several weeks – often between four and six or more.

Before Your Treatment

When you choose to undergo proton beam therapy at Proton International London, you will have an initial consultation with one of our specialist proton beam therapy radiation oncologists. During this consultation, we will discuss your diagnosis, the benefits of proton beam over traditional radiation therapy and, if applicable, your current treatment plan if you are seeking a second opinion.

Before your initial consultation, our team will discuss the costs of proton beam therapy and payment options.

Consultation and Planning

In your initial consultation with your radiation oncologist, they will cover the potential side effects and outcomes of the treatment specific to your case. We will present a personalised treatment management plan designed specifically for you. Our consultant will explain what to expect before, during and after the treatment and answer any questions you may have.

You may need to undergo some additional diagnostic scans to provide additional information about your tumour. These will be done at University College London Hospital where Proton International London is based, or at other closely located private hospitals. These may include MRI, PET CT and/or CT scans.

Preparation For Treatment

Careful and precise treatment planning is crucial for the success of proton beam therapy. Our highly experienced radiotherapy team of radiographers, radiotherapy physicists and radiation oncologists will create a proton beam therapy plan tailored to your tumour.

This plan determines the directions and intensity of the proton beams used to target the tumour area. This complex process typically takes about three to four weeks to finalise before treatment can begin.

Proton beam therapy involves careful planning to make sure the proton beam hits its target and the proton beam delivers the right dose of radiation.

Planning for proton beam therapy includes the following steps:

• Immobilisation: Depending on your tumour type and location, you may also require a specialist immobilisation mould (also called a ‘shell’), to keep the treatment area still during planning or treatment. For example, this could be of the head and neck area, or a leg. If your head and/or neck is being treated, the team will create a custom-fitted mesh mask to keep your head still. You will be able to see and breathe normally whilst wearing the mask.
• Treatment simulation and set-up: It is important to position your body accurately in preparation for treatment. The clinical team may mark areas on your body to indicate how to re-create your position on a daily basis through treatment. These marks are usually small and temporary, though some might be permanent.
• Imaging: You will undergo diagnostic imaging tests, with a CT scan, and possibly also an  MRI scan, to confirm the location and size of the cancer/tumour. Using these scans, the radiation oncologist will determine the tumour’s exact shape and size, as well as identify important surrounding normal tissue structures.
• Dose Planning: The radiation oncologist will determine the target area where radiation needs to be delivered to treat the tumour, by drawing target areas on the planning CT scan. Physicists and dosimetrists use specialised computer planning software programmes to plan the optimal delivery of the radiation dose, including the positioning of the proton beams and how deeply they should penetrate the body.
• Quality Assurance: Physicists conduct a daily quality assurance check to ensure that the proton beam is generated with the precise dose, depth, and angles required for effective and safe treatment.

Many different healthcare specialists are involved in the planning and delivery of proton beam therapy, including:

• Radiation oncologists
• Dosimetrists
• Radiotherapy physicists
• Radiation therapists/ therapy radiographers
• Radiotherapy nurses
• Specialist radiographers
• Play therapists (for children)

During Your Treatment

You will receive proton beam therapy as an outpatient. Treatment is conducted at our state-of-the-art centre at UCLH, and you will also have regular check-ups during treatment at the centre.

Proton beam therapy is typically administered Monday to Friday, although treatment may happen at weekends if treatment days are missed due to public holidays or patient illness. Treatment appointments last about 60 minutes. The actual proton beam treatment takes about 20 – 40 minutes, with additional time for setting you up in the treatment position and doing imaging to check your position.

Before each proton beam therapy session, we carefully check your position using X-ray images and/or limited CT scans done in the PBT treatment room, and perform other necessary checks before starting the treatment. At least once a week, you will have check-ups in the PBT department with a member of our treatment review team (this could be a radiotherapy nurse, specialist radiographer, or PBT clinical fellow doctor), who will review your treatment progress and assess your condition. You will also be reviewed by your radiation oncologist during treatment.

It is important that PBT is delivered continuously without treatment breaks if at all possible. Treatment should only be interrupted for serious health reasons, or if there is a breakdown of the PBT machine. If there is a machine breakdown for more than a day, our clinical team will assess the impact on individual patients.

Sometimes if it is judged that a longer treatment break might be harmful, it may be best for a patient to have a small number of treatments delivered with photon radiotherapy, with a ‘backup’ photon radiotherapy plan which will be prepared. This possibility will be discussed with you if relevant at the time that you sign consent for PBT at the consultation with your radiation oncologist.

During a proton therapy treatment session:

• Our therapy radiographers will place you on the treatment table in the position determined during the simulation planning stage, putting you in your immobilisation shell/mask if this has been necessary for you.
• The therapy radiographers will position the gantry so the proton beam is aligned with the treatment set-up marks on your skin. The gantry is open, rather than a confined space like an MRI machine, so you should not feel claustrophobic, although you will need to remain very still. For younger patients, they may require a general anaesthetic for the delivery of proton beam therapy.
• An X-ray or a limited CT scan will be taken in the treatment room to confirm your position and set-up.
• The therapy radiographers will leave the room to operate the proton beam therapy machine. A video camera allows them to see, hear and talk to you during treatment, so you will not be alone.
• Once the machine is on, protons are accelerated in a separate room and directed to the proton beam gantry in the treatment room that you are in, which focuses them into a thin beam and aims them at the tumour treatment area. The gantry will move around your body to treat the tumour from different angles.
• The proton beam may turn on and off several times during treatment as it moves or needs to realign with the tumour if it shifts as you breathe. You will not feel the proton beam entering your body or treating the tumour, but you might hear clicking noises as the machine moves around you.

After Treatment

At Proton International London, our consultant radiation oncologists and patient services team are dedicated to supporting your recovery after treatment. We will maintain regular communication with you and your medical team to monitor your progress and address any late side effects you may experience.

At Proton International London, we will support you through your cancer treatment journey

At Proton International London, we recognise the benefits that proton beam therapy can offer. Our experience in proton therapy centres spans across the globe, and Proton International is a global leader in proton beam therapy, with over 30 years of experience treating cancer patients.

Our highly respected radiation oncologists work in conjunction with the first-class clinical team at University College Hospital (part of University College London Hospitals NHS Foundation Trust). Working together, they have a strong interest in clinical research and provide a comprehensive and high-quality service to patients diagnosed with a wide range of cancers. We are proud to offer PBT as a unique treatment option to treat cancer here in the UK.