Proton beam facility groundbreaking set

University of Florida officials are heralding the Jacksonville City Council’s recent approval of a $19 million bond issue to help establish Florida’s first proton beam cancer treatment facility at Shands Jacksonville Medical Center.

Groundbreaking ceremonies for the long-anticipated project have been scheduled for 10 a.m. Jan. 29.

“The current schedule calls for us to move forward with actual construction beginning approximately April 1,” said C. Craig Tisher, M.D., dean of UF’s College of Medicine and the project’s director. “We’ve been working to put all our funding in place by mid-March.” City Council officials approved the bond issue with a 17-1 vote Aug. 14. Another bond issue will finance technology and start-up costs totaling about $62 million. The funding will supplement $11 million in legislative appropriations earmarked for construction.

“I personally have been very appreciative of the tremendous support we’ve received from the Jacksonville community—the leadership in the Jacksonville city government as well as the many individuals within the community who’ve supported the project from its inception,” Tisher said.

Proton beam therapy involves the delivery of tightly focused doses of electrically charged particles called protons to destroy tumors, with little or no damage to adjacent healthy tissues. The treatment is an effective way to target tumors in children and cancers of the prostate, brain, eyes, and head and neck, and has the potential to increase cure rates while reducing complications, experts say. It also is used on patients who have certain eye diseases, including a form of age-related macular degeneration.

The facility is expected to become a centerpiece of the UF Shands Cancer Center, which encompasses advanced patient-care, education and research programs at the Gainesville and Jacksonville campuses. It will be staffed by UF radiation oncologists and a 115-member support team.

“While this is a very specific radiation technology, we anticipate its effects will be far-reaching in the cancer center,” said Nancy Mendenhall, M.D., chairwoman of UF’s department of radiation oncology and the Rodney R. Million, M.D., professor of radiation oncology. “We believe it will attract patients with many different diagnoses who will need other forms of cancer treatment as well, such as chemotherapy, surgery and conventional radiation, so our hope is that it will be a cornerstone of an overall cancer program and enhance growth throughout the clinical cancer services.

“We’re going to have a unique radiation oncology facility, with both conventional radiation therapy and proton beam therapy in the same building,” she added. “We think this will enable us to offer the best treatment to patients with any kind of cancer treatable with radiation. We think it will enable us to participate better in combined modality therapy programs where chemotherapy is being used because many times the radiation side effects limit what can be done with chemotherapy. For example, the rates of esophagitis in patients treated for head and neck or lung cancer are likely to drop significantly, permitting physicians to deliver more intense chemotherapy.”

Proton beam therapy requires a complex array of machinery that must be run by a highly trained team of medical, engineering and computer scientists.

“Computerization and the quality of imaging that’s now available makes this technology applicable to an increasing population of patients with various forms of cancer,” Tisher said. “It’s an excellent treatment for the wet form of age-related macular degeneration, the most common cause of blindness in the elderly.”

Tsoi/Kobus & Associates, a Boston-based architectural and engineering firm, has designed the three-story facility. Perry-McCall Construction Co., of Jacksonville, first will build the portions of the building that will contain the proton beam generator, and the treatment area. The facility will be situated on a 3.7-acre site on UF’s Shands Jacksonville campus. The top floor will be dedicated to research.

Belgium-based Ion Beam Applications Co. will then install the proton beam equipment while the remainder of the building is finished. Officials estimate that most of the construction will end by November 2004, with all equipment to be installed by December 2005.

More than 2,000 cancer patients a year are expected to undergo proton beam therapy at the Shands Jacksonville site once the facility is fully operational.

Two proton beam facilities are in operation elsewhere in the United States, at the Loma Linda University Medical Center in Loma Linda, Calif., and at Massachusetts General Hospital in Boston.

“We’ve known for years about the superior dose distribution of protons—but until you can precisely delineate the borders of the tumor, you don’t want to make your radiation dose conform too tightly because you’ll miss the cancer,” said Mendenhall, who will serve as the facility’s first medical director. “Protons would have been useful for only a few tumors in the 1970s and 1980s because we just couldn’t define them well enough with the imaging tools of those days. By the mid-90s, with high-resolution CT scans and MR imaging, enhanced by functional imaging, it began to make sense to precisely conform our radiation dose distribution around these better-defined tumor targets. We also have the ability now to localize these cancers when a patient is on a radiation treatment table and to immobilize the patient so that there’s little or no body motion.”

Respiration moves the diaphragm up and down several centimeters, enough to potentially move a lung tumor in and out of the treatment field, requiring physicians to target radiation to a wide margin of healthy tissue around the tumor to compensate.

“We are working on radiation beam gaiting now,” Mendenhall said. “If you can gait the radiation beam to only turn on when the patient is breathing in or exhaling, and you don’t have to account for organ motion, you can use much tighter margins. We think that most localized cancers are curable with radiation if you can get a high enough radiation dose. In many malignancies we’ve already documented better cure rates with higher doses. What prevents us from giving very high doses to all cancers is the surrounding normal tissues because they’re also damaged by radiation. If we have a way of avoiding normal tissues we can give higher doses and get higher cure rates. The proton beam reduces the inadvertent normal tissue exposure quite significantly. We therefore expect both higher cure rates and less radiation toxicity with proton beam therapy.”

UF scientists also are planning a variety of proton beam-related research projects, some cancer-related, and others focused on innovative uses of protons in the treatment of other, nonmalignant disorders, Tisher said. In addition, NASA has expressed interested in studying the impact of protons on certain inert materials. Other biomedical researchers will examine the impact of radiation on cell death and cell recovery, and the effect of low doses of protons on living materials such as plants.

Tisher and Mendenhall spent the past four years planning the project in collaboration with a steering committee that included Louis Russo, M.D., former senior associate dean for Jacksonville programs of the UF Health Science Center; and Greg Miller, vice president for operations at Shands Jacksonville.