Some call it a washing machine, some a spaceship. For Ahinara it is simply “machine”.
This is how the 7-year-old Ecuadorian classifies the apparatus of the Proton Therapy Unit, which the Clínica Universitária de Navarra maintains at its headquarters in Madrid. The “machine” managed to completely eradicate a brain tumor that had been diagnosed months earlier by doctors in his country.
The massive instrument is at the heart of an advanced cancer treatment called proton therapy: radiation therapy that uses protons instead of photons (as in traditional radiation therapy) to destroy tumor tissue.
It is a relatively new, expensive, and highly precise treatment that is only available in a few parts of the world for the treatment of certain types of cancer. Today there are 107 proton therapy units in 20 countries and about 37 under construction.
The big advantage, and the reason this treatment is best suited in certain cases, is that because of their physical properties, this type of radiation is less damaging to the surrounding tissues and therefore has fewer side effects.
“In the case of tumors in the central nervous system, at the base of the skull, in the head area, in the spinal cord or in the immediate vicinity of the tissue to be preserved, as well as in patients who have previously been irradiated, it is particularly important to reduce the radiation dose to the healthy tissue around the tumor.”
This is explained by Pablo Menéndez, Director of Radiation Therapy at the Angel H. Roffo Institute of Oncology at the University of Buenos Aires, in an interview with BBC Mundo (the BBC’s Spanish service).
The behavior of the proton beams as they penetrate the human body makes it possible “to concentrate the maximum radiation dose on the tumor and bring it practically zero to two or three millimeters beyond,” he adds.
Ideal for cancer in children
This makes proton therapy more suitable for most tumors even in pediatric patients.
“In these cases it is important to minimize side effects in normal tissue because if children survive and they survive massively with childhood cancer, they have long-term life-limiting consequences,” said Dr. Felipe Calvo, Director of the Proton Therapy Unit at the University Hospital of Navarre.
“Most childhood tumors are brains, and brains that have been exposed to photons and survive for a long time have neurocognitive problems,” added the doctor who was on the team that treated Ahinara.
In addition, it is a less toxic therapy because it minimizes radiation reaching the vessels, arteries, and circulating blood and protects the patient’s immune system.
The Ahinara girl’s cancer – a type of brain sarcoma rare in Europe but most common in Latin America – was perfectly suited for proton therapy offered by the University of Navarra Clinic, one of two private medical centers that practice the type of therapy offer Spain.
Victoriano Iglesias, the girl’s father, recalls in detail the events that led him to leave his country for the first time with his family in order to find the best possible treatment for his daughter.
Ahinara was joking after school when Victoriano and his wife received a call from their grandmother saying “the girl was vomiting,” he told BBC News Mundo, the BBC’s Spanish service.
“We thought it was a viral or bacterial disease and went to the pediatrician. He thought the same thing, ”he remembers.
However, when they returned to the hospital because Ahinara was no better, a series of analyzes and verbal tests revealed that it was serious.
“The doctor asked her how she was feeling and she said ‘ha’ (she couldn’t pronounce a B in the word ‘good’). It was difficult for her to coordinate movements and words, and the child neurologist saw that there was a slight stain on one side of her little face “.
The tomography confirmed the suspicion and the girl was operated on. Although the operation was successful – most of the tumor was removed – treatment had to be continued, as in the vast majority of cases, with chemotherapy and radiation therapy.
And it was at this point that Victoriano began looking for the best treatment options, which included a trip that, thanks to the collaboration of non-profit organizations – Teleton in Ecuador, Spanish Association Against Cancer and Children Against Cancer in Spain – between others – brought him to the clinic the University of Navarre.
It was a difficult journey through the pandemic, but it changed the girl’s future.
Less than a minute
“There are usually between 5 and 25 days of treatment, depending on the tumor,” explains Calvo. In the case of Ahinara, there were 30 sessions, one a day.
Firing the proton beam takes less than a minute, but positioning the body in its exact position inside the machine can take anywhere from 20 to 25 minutes.
Children under the age of eight are given an anesthetic so that they can remain calm without moving.
“The procedure does not hurt and the anesthesia is gas,” explains Elena Panizo, a specialist in pediatric oncology at the University of Navarre clinic that treated Ahinara.
“In the short term, the tolerance is very good. One of the most intensive treatments that we offer children with brain tumors is craniospinal radiation therapy, which consists of irradiating the entire skull, the entire spine and the entire neuro-axis, and we see that they tolerate it. “Phenomenal,” says the oncologist.
Progress in Argentina
Meanwhile, Argentina began taking the first steps to build a proton therapy center, which would be the first in the entire region.
The building that will house the center began construction in the capital in mid-2019, and teams from Belgium arrived in June of this year to apply the therapy.
This is a joint project of the National Atomic Energy Commission of the University of Buenos Aires, Dr. ngel Roffo Oncology Institute and the technology company Invap and is expected to be operational by the end of 2023 or early 2024.
The challenges in setting up such a center in the country are diverse.
“It’s a very complex technology,” Roffo Institute’s Pablo Menéndez told BBC News Mundo. “You need a team that manages this proton beam and directs it with millimeter precision over a patient who is lying on a stretcher that can be rotated 360 degrees in order to choose the most favorable angle,” he explains with reference to the device, which is much larger than what can normally be seen in radiation rooms.
“In order for the generated radiation to reach this entire cycle, a very large physical structure is required,” he continues. “For example, for the equipment purchased by Argentina – which will have two treatment rooms and a third for research – the physical facility in which it will be installed occupies an appropriate place.”
The area also needs “shields so that no radiation escapes from the generation area, and reinforced concrete structures three or four meters thick must be built for this”.
In short, it is a complicated job that requires large investments and resources for equipment maintenance and everything related to medical assistance.
“The implementation of new technologies in the region is always a bit more difficult because you are not so close to the centers where this technology is created,” adds Menéndez.
The center will of course not be able to cover all the needs of the continent, but perhaps in some cases it could be an alternative to the expensive trips that many patients have to take to the USA or Europe.