Treating Cancer with Pinpoint Accuracy
Growing up in communist Romania under Nicolae Ceausescu's repressive regime, Cornel Butuceanu didn't have any big plans or dreams.
A good student, he imagined he might one day become a teacher.
But in a world where bread and milk were often hard to come by, Butuceanu's focus tended to be on the simple day-to-day act of living, not the distant, uncertain future.
Now a medical physicist, Butuceanu says his life still doesn't follow a predetermined path.
"I do not plan much," he said. "I basically don't believe in plans. I just live life like it will be the last day. I really do."
It's an outlook that probably helps him in his job, where every day he talks to patients whose plans have been derailed by a cancer diagnosis.
Butuceanu, part of the staff at the Hampton University Proton Therapy Institute (HUPTI), discussed treating cancer patients with proton therapy in the February Colloquium at NASA's Langley Research Center.
Less well known than traditional radiation therapy, proton therapy is slowly gaining a foothold the U.S. It was first mentioned as a potential treatment method by scientist Robert Wilson in 1946, and first used to treat patients in the 1960s. According to the HUPTI website, approximately 52,000 patients around the world have been treated with proton therapy.
The primary advantage of treating cancerous tumors with proton beams, says Butuceanu, is that it's highly targeted. With traditional therapy, high doses of radiation are delivered not only to the tumor, but also to the tissues surrounding it.
"Basically you blast it with radiation," he said. "What's the consequence of that? If you live long enough, you will develop secondary cancer."
Proton therapy, on the other hand, is highly conformed to the size and shape of the tumor. Brass plates machined to match the exact shape of a patient's tumor help guide the proton beam, which deposits most of its energy directly into the tumor.
"This is what protons actually are doing today — allowing the physicians to deliver a higher dose to a tumor, at the same time sparing the tissue around it," Butuceanu said. "Using a higher dose means you can shrink the tumor at a faster pace without harming the patient."
That, of course, raises a question: why aren't more cancer patients being treated with proton therapy?
The simple answer is economics.
Proton therapy facilities can cost over $200 million to build — HUPTI cost $225 million — and the treatment itself is expensive as well.
"Proton therapy is not new. The first patients were treated 60 years ago, but still the price has driven this technology," Butuceanu said.
HUPTI, which opened in August 2010, is the eight and largest proton therapy facility in the U.S., and the only one in Virginia. It houses a cyclotron particle accelerator that can deliver proton beams to five treatment rooms. In four of those rooms, enormous gantries capable of rotating around patients at multiple angles allow Butuceanu and his colleagues to target tumors with almost pinpoint precision.
Appointments take anywhere from 15 to 30 minutes a day over a five- to 10-week period. The treatment itself only takes between one and two minutes. Positioning the patient is the most time consuming thing, Butuceanu says. That takes about 10 minutes in most cases, usually a little more for patients with brain tumors.
And patients really are the focus at HUPTI. In addition to receiving cutting-edge treatment there, they're also welcomed into an environment Butuceanu describes as looking more like a nice hotel than a medical facility.
"Already the people who open the door have heavy hearts," he said. "We don’t want to put anymore pressure on them than is needed."
He estimates that currently, between 60 and 70 patients walk through HUPTI's doors every day. As those patients come and go, Butuceanu, perhaps still clinging to his one-time desire to teach, does his best to educate them about the treatment they're undergoing.
"I try to put myself in my patients' skin," he said. "I want them to know everything, and they're entitled to know everything. They should not take it for granted that, 'Oh, somebody just does something to me.' And personally, I stress that."
He also stresses that his job can come with big rewards — namely, seeing patients who come back to visit after being declared cancer free.
"When you see a human coming after several years and radiating life and being happy — yeah, that's good. That is really good," he said.
By: Joe Atkinson
The Researcher News
NASA Langley Research Center
Editor & Curator: Denise Lineberry
Executive Editor & Responsible NASA Official: Rob Wyman