Proton Therapy is Here

Johns Hopkins Excellence Setting a New Standard of Care

Published in Promise & Progress - Fall 2020/2021

Technology without advanced and compassionate care is science alone. But technology in an environment of compassionate care, discovery and multispecialty collaboration focused on improving the lives of patients is cancer medicine. This is the hallmark of Johns Hopkins and the Kimmel Cancer Center, where innovation that exceeds the standard is the norm. The result is an unsurpassed level of expertise in radiation oncology, molecular radiation sciences, physics, surgical oncology, medical oncology, cancer biology, engineering, quantitative sciences and more that Johns Hopkins Medicine brings to proton therapy. This level of knowledge and multispecialty collaboration is fundamentally what set the Johns Hopkins Proton Therapy Center apart from most other proton centers across the U.S. Expertise matters because the real value of proton therapy is in the specialists who develop it and use it.  

Proton therapy may be a rare commodity, with less than 40 centers in the U.S., but this level of expertise is even rarer. The Kimmel Cancer Center is among the very few that will combine cancer treatment excellence across all disciplines with proton therapy excellence. 

William Nelson, MD William George Nelson, M.D., Ph.D.

“Patients and families need the team that knows the most about the tumor.  You need to know cancer, not just proton therapy. That is a differentiator for us,” says William Nelson, Director of the Kimmel Cancer Center. “We bring the full complement of Johns Hopkins expertise, spanning programs and departments, and nearly a half-century of cancer discovery and clinical progress to proton therapy.” 

Although this technology provides new opportunity to move cancer science and medicine forward, not all proton therapy is created equal. We are not simply users and deliverers of proton therapy. Our scientists are also inventors, driving, testing and improving the technology to create a proton therapy facility unlike any other. Building upon a lengthy history and strong foundation of pioneering discoveries in radiation therapy, this center has the technology to deliver the most advanced and patient-centered care. 

The translational ingenuity that merges laboratory discovery with clinical care thrives in the Kimmel Cancer Center. It was engaged throughout the planning and construction of our proton therapy center. As a result, it is one of the most comprehensive in the world, one of the very few with separate, dedicated rooms for research, pediatric patient care and adult patient care. Proton therapy has raised many questions about for whom and how it is best used. Our experts are answering those questions. They are providing the “why” and “when” of proton therapy. 

Despite commercial advertising to the contrary, proton therapy is not new, and the science is far from settled. “Although it has been around for a long time, it is very much in its infancy in terms of exploration and potential,” says Akila Viswanathan, interim director of the Department of Radiation Oncology and Molecular Radiation Sciences.  

As a result, what truly is new in proton therapy is what the Johns Hopkins Proton  Therapy Center brings: the laboratory and clinical research to make it better and to advance its use as a tool of precision medicine. Our proton center is among a select few academic centers in the country—and the only in the region—doing research to determine in which situations this type of radiation treatment is the best option.  

Proton therapy does not replace other forms of radiation therapy.

Akila Viswanathan, M.D., M.P.H., M.Sc.

We do well with all forms of radiation therapy, and that’s something most other proton centers do not offer. That’s important because not every patient will need proton therapy.

- Akila Viswanathan, M.D., M.P.H., Interim Director of Radiation Oncologyand Molecular Radiation Sciences

Too much information is marketing driven and not fact driven. Claims of clinical benefit are made with no scientific evidence to back them up. There is a lot we still do not know biologically,” says John Wong, director of medical physics. “At Johns Hopkins, we do it right."

Radiation treatment, in all of its forms, is essentially a form of minimally invasive surgery that replaces scalpels with precisely targeted radiation to get to cancers, Wong explains. “The main reason there is no scientific evidence to support many of the claims of benefit is that there was no way to do research. There was no laboratory counterpart for what we do in the clinic,” he says. To solve that problem Wong invented the Small Animal Radiation Research Platform (SARRP), a miniaturized version of the machines used to treat humans but for animal research and potentially other laboratory models. “SARRP provides a realistic model to study in the laboratory the radiation treatment we give to patients, and this is critical to quantifying the benefits of one type of radiation therapy over another and to finding the safest and most effective way to treat patients,” he says. 

Lack of research has been one of the most common criticisms of proton therapy. Although most experts agree that its ability to spare healthy cells by zeroing directly in on and stopping at the end tumors makes proton therapy the radiation treatment of choice for pediatric and adult patients with tumors in the brain or on or near the spinal cord, definitive research studies are lacking. Wong and collaborators are currently adapting SARRP to study proton therapy. One room in the proton therapy center is outfitted specifically for research and will be dedicated to the cellular, physics and animal studies needed to refine and define who is best treated with proton therapy.  

“What Johns Hopkins does so well is research to improve patient care,” says Theodore DeWeese, Vice Dean for Clinical Affairs and former director of the Department of Radiation Oncology and Molecular Radiation Sciences.  “We are one of the only proton centers that has a whole room dedicated to this kind of research.” 

Curtiland Deville, M.D.

I was drawn to the Kimmel Cancer Center because of its clinical and research expertise and patient-centered approach. The goal is always to leverage this wealth of experience, bring this expertise to the community, and improve the treatment of patients.

- Curtiland Deville Jr., M.D., Associate Director of the Johns Hopkins National Proton Center

Proton therapy expert Curtiland Deville says it is the reason he came to Johns Hopkins. “I wanted to be in an academic center to be at the forefront of solving issues and questions about proton therapy: What are the best indications for proton? Where can we increase benefit and where can we reduce toxicity? Where can we increase benefit, and where can we reduce toxicity? Where are we not getting such benefit and can let go? This is an area that is lacking, and our center can begin to get to the answers.” The Johns Hopkins Proton Therapy Center will be solving these unknowns and leading future progress, says Deville. 

Jeffrey John Meyer, M.D., M.S. Jeffrey John Meyer, M.D., M.S.

Radiation oncologist and gastrointestinal cancer expert Jeffrey Meyer was drawn to Johns Hopkins for the same reason. Meyer completed a fellowship in proton therapy before coming to the Kimmel Cancer Center and says that the Johns Hopkins Proton Therapy Center is one of the few addressing complications associated with proton therapy, such as organ movement and sensitivity to density in organs. All of these questions and concerns can be mitigated with research, he says. 

“There are always going to be new technologies. Expertise and the willingness to do research to know how to use it is critical,” Meyer says. “It’s a great technology we want to take advantage of, but we have to be smart about how we use it.” 

Other proton experts, including Matthew Ladra, a pediatric cancer specialist who directed a proton center in Tennessee, and Jen Holt, a nurse from the same center, came to the Johns Hopkins and the Kimmel Cancer Center because of the combined excellence in research and patient care. 

Marikki Laiho, MD, PhD Marikki Laiho, M.D., Ph.D.

“There are many aspects we still don’t know and a lot of research opportunities. That’s something we bring to the table, with the goal to figure it all out and bridge these gaps in knowledge,” says Marikki Laiho, director of  the Division of Molecular Radiation Sciences. 

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