Jacksonville - the epicenter of the Radonc Arms Race - to have carbon ions

[Tigerstang]

Mayo Clinic in Jacksonville plans North America’s first carbon ion therapy center to fight cancer

It’s still a few years away, but Mayo Clinic plans to add a “promising” cancer treatment to its Jacksonville campus, the first of its kind in North America.

www.jacksonville.com

---

Members don't see this ad.

 

[medgator]

Well when you have a metro with 2 proton facilities already (UF and Ackerman), if you are going to be the 3rd, better have something fancier. Im guessing mayo jax thought planning protons wasn't enough.

 

[scarbrtj]

Guys, Jacksonville and carbon ions go together like cocaine and waffles. Like radiation oncology and residency expansion. Maybe.

 

[KHE88]

Because of course they are.

Guys (and, excuse me, #womenwhocurie as well), the real problem are the criminal greedy private practice rad oncs out there still giving 200 cGy fractions to the breast (the horror!) to make an extra thousand bucks here or there.

As a rural rad onc, I'm concerned about the lack of particle therapy in flyover country. My patients are really suffering now that that second proton center in rural Oklahoma shut down. No Biryanis or carbon ions. Can we at least get a proton center with sushi in the cafeteria? It's basically unlivable.

 

[medgator]

Then again, Jax is the largest city in the US*











*-by area

 

[thecarbonionangle]

I applaud anybody trying to address our field’s difficult challenges. Carbon ions should absolutely be studied.

 

[evilbooyaa]

Nothing wrong with a carbon ion facility. There are zero in the US currently, I don't care where it ends up.

When protons existed at MGH, MDACC, MSKCC, and a few other regional places, I didn't mind. It's only when they started popping up like crazy with for profit centers that it was a big issue to me.

Carbon ions need to be studied. This will almost guaranteed lose money but it is a worthwhile task to do it.

 

[SneakyBooger]

Nothing wrong with a carbon ion facility. There are zero in the US currently, I don't care where it ends up.

When protons existed at MGH, MDACC, MSKCC, and a few other regional places, I didn't mind. It's only when they started popping up like crazy with for profit centers that it was a big issue to me.

Carbon ions need to be studied. This will almost guaranteed lose money but it is a worthwhile task to do it.

Possibly being funded by NASA as my understanding is that NASA will be wanting the beam during the night to conduct research in which they are very much interested.

 

[KHE88]

When protons existed at MGH, MDACC, MSKCC, and a few other regional places, I didn't mind. It's only when they started popping up like crazy with for profit centers that it was a big issue to me.

Huh?

MGH was the original offering proton therapy since the 70s.

Loma Linda was the other original.

MD Anderson in 2006.
MSKCC was offering since 2013.

I was personally in college when proton centers began popping up. I guess I really wasn't thinking about it as I didn't even really know what rad onc was until 2012 or so. Guess I should have been paying more attention.

The academic centers are a big part of the problem, and a huge portion of why they are doing it is marketing, even as a loss leader. I find it extremely difficult to believe the carbon ion facility in Florida is all about academics and advancing the field forward and not profit-driven marketing. But I don't pretend to know.

 

[medgator]

The academic centers are a big part of the problem, and a huge portion of why they are doing it is marketing, even as a loss leader. I find it extremely difficult to believe the carbon ion facility in Florida is all about academics and advancing the field forward and not profit-driven marketing. But I don't pretend to know.

NASA does have a big presence in the space coast/Cape Canaveral which is about 2 hours south of there. I still find it interesting they decided to put it with the "third" proton facility in the area. Seems like a way to draw pts from their competitors across the street.

 

[KHE88]

NASA does have a big presence in the space coast/Cape Canaveral which is about 2 hours south of there. I still find it interesting they decided to put it with the "third" proton facility in the area. Seems like a way to draw pts from their competitors across the street.

The Hampton University proton facility in eastern Virginia has also done research with NASA and creates neat headlines like this...

Hampton University Proton Therapy Institute Helps Virginia Students Prepare for Space Flight

www.space.vt.edu

However, I don't see these centers as crucial for the mission of NASA or other agencies given the national laboratories and their facilities and resources including large particle accelerators. That's not what's going on here.

 

[RickyScott]

Had a pt who went to one of the other proton centers in jacksonville. T1C NO ER/PR+ right breast elderly lady told she needed protons!

 

[KHE88]

Had a pt who went to one of the other proton centers in jacksonville. T1C NO ER/PR+ right breast elderly lady told she needed protons!

It's about the research, bro. This kinda thing is not gonna happen with carbon ion therapy.

 

[medgator]

Had a pt who went to one of the other proton centers in jacksonville. T1C NO ER/PR+ right breast elderly lady told she needed protons!

Choosing wisely as I say, not as I do

 

[Mandelin Rain]

Protons/Carbon Ion is just to get people through the door. "No, what you really need are highly targeted photons rather than protons. They are only one letter different so worth coming here."

 

[RadOncDoc21]

Protons/Carbon Ion is just to get people through the door. "No, what you really need are highly targeted photons rather than protons. They are only one letter different so worth coming here."

well we’ll run your insurance just to be safe first.

 

[mheat3]

well we’ll run your insurance just to be safe first.

I believe the professional term is a "wallet biopsy." This is a standard part of the workup in FL.

 

[RickyScott]

I find it very narcisti

The Hampton University proton facility in eastern Virginia has also done research with NASA and creates neat headlines like this...

Hampton University Proton Therapy Institute Helps Virginia Students Prepare for Space Flight

www.space.vt.edu

However, I don't see these centers as crucial for the mission of NASA or other agencies given the national laboratories and their facilities and resources including large particle accelerators. That's not what's going on here.

Instantly you are so high tech cutting edge when you mention nasa.

 

[BobbyHeenan]

Had a pt who went to one of the other proton centers in jacksonville. T1C NO ER/PR+ right breast elderly lady told she needed protons!

It's fine, they were on trial*

* a registry trial which answers zero clinical questions and is a trojan horse to get insurance coverage.

 

[thecarbonionangle]

It makes complete sense for a wealthy institution like Mayo to work together with the feds to bring a carbon facility to the USA. The first patients ever treated with heavy ions were in Cali in a government funded lab. Other countries are investing in this very expensive technology through government grants. The MGH proton facility building costs was also done with the government’s help, with Dr. Suit.
It is most certainly going to lose money just like initially going to the moon was going to be funded by the government. Now you have SPACEX.

i don’t know if carbon is a game changer. interesting angle nonetheless but i would love to see more research in it and learn more about it.

 

[seper]

Fast heavy ion effects are now believed to a limiting factor for human interplanetary spaceflight... makes total sense to extract some money from NASA for such facility

 

[Palex80]

Two carbon ion facilities were built and shut down in Germany.
Here's an old article on the story:

The curious tale of abandoned plans and dismantled hopes

A prototype for proton and ion therapy has been used clinically in Heidelberg since 2009. Built jointly by Siemens and GSI (Helmholtz Centre for Heavy Ion Research) in Darmstadt.

healthcare-in-europe.com

Kiel was dismantled completely by Siemens. Marburg was taken over by Heidelberg and now running after several issues were encountered.


It was quite a shame. The main problem was the expectation of how many patients could be treated with carbon ions vs. the reality of how little we understand carbon ions.

Surely you can treat peripheral NSCLC (SBRT-like), liver tumors, localized prostate cancer, chordomas, chondrosarcomas, but the main problem with carbon ions is the unknown radiobiology behind them. Trying to treat fast repopulating tumors (for example head&neck cancer) with carbon ions may actually be counterproductive. You may be dealing more damage to healthy tissues than tumor itself.

 

[Lamount]

FWIW, NASA has been interested in this for decades. They have a facility in NY called the NSRL that uses high energy particle accelerators at BNL to conduct biology and space material sciences research (if you're interested, they rent out beam time). As of now, this is the only US facility I am of aware of actively investigating heavy ion therapy... but only on cell cultures and small animals.

A US clinical carbon ion center is long over due so we can run high quality randomized trials. I applaud whomever manages to get it done.

 

[Chartreuse Wombat]

Two carbon ion facilities were built and shut down in Germany.
Here's an old article on the story:

The curious tale of abandoned plans and dismantled hopes

A prototype for proton and ion therapy has been used clinically in Heidelberg since 2009. Built jointly by Siemens and GSI (Helmholtz Centre for Heavy Ion Research) in Darmstadt.

healthcare-in-europe.com

Kiel was dismantled completely by Siemens. Marburg was taken over by Heidelberg and now running after several issues were encountered.


It was quite a shame. The main problem was the expectation of how many patients could be treated with carbon ions vs. the reality of how little we understand carbon ions.

Surely you can treat peripheral NSCLC (SBRT-like), liver tumors, localized prostate cancer, chordomas, chondrosarcomas, but the main problem with carbon ions is the unknown radiobiology behind them. Trying to treat fast repopulating tumors (for example head&neck cancer) with carbon ions may actually be counterproductive. You may be dealing more damage to healthy tissues than tumor itself.

We found that carbon ions were three times as potent as X-rays in this aggressive tumor model and identified unanticipated differences in radiation response that may have clinical implications.

Characterizing the Potency and Impact of Carbon Ion Therapy in a Primary Mouse Model of Soft Tissue Sarcoma. - PubMed - NCBI

 

[scarbrtj]

The main problem was the expectation of how many patients could be treated with carbon ions vs. the reality of how little we understand carbon ions... carbon ions may actually be counterproductive. You may be dealing more damage to healthy tissues than tumor itself.

Carbon ions show more radiobiologic effectiveness on paper/in the lab I am sure...

 

[thecarbonionangle]

Fast heavy ion effects are now believed to a limiting factor for human interplanetary spaceflight... makes total sense to extract some money from NASA for such facility

absolutely. Say you get to Mars. After a few years you would have received the total whole body max xrt dose with modern medicine (6-7 gy), mostly from heavy Ions. It is essentially a suicide mission and we have no good radioprotectants

 

[RadOncDoc21]

Do they need general supervision for these carbon ions or can my dog oversee the treatments? I just want to make sure I’m compliant.

 

[scarbrtj]

Do they need general supervision for these carbon ions or can my dog oversee the treatments? I just want to make sure I’m compliant.

only if it's .... Atomic Dog

 

[ramsesthenice]

Guys, Jacksonville and carbon ions go together like cocaine and waffles. Like radiation oncology and residency expansion. Maybe.

i grew up in Jax. Sounds like you have been to a north side Waffle House

 

[PhotonBomb]

It makes complete sense for a wealthy institution like Mayo to work together with the feds to bring a carbon facility to the USA. The first patients ever treated with heavy ions were in Cali in a government funded lab. Other countries are investing in this very expensive technology through government grants. The MGH proton facility building costs was also done with the government’s help, with Dr. Suit.
It is most certainly going to lose money just like initially going to the moon was going to be funded by the government. Now you have SPACEX.

i don’t know if carbon is a game changer. interesting angle nonetheless but i would love to see more research in it and learn more about it.

absolutely

you won't see much support for something like this in sdn crowd tho

they simply dgaf

 

[medgator]

absolutely

you won't see much support for something like this in sdn crowd tho

they simply dgaf

As palex alluded to, even Germany couldn't swing it

 

[Mandelin Rain]

I’m not adverse to there being a carbon ion machine in the USA. If furthering cancer science is a priority, it Probably should be at a high powered research institute. If patient care is a priority, it probably should be centrally located to allow for greater access for all. It also should be in an area without existing particle options, again related to access.

Mayo Jacksonville is none of these things.

If it’s understood that this is nasa’s machine and mayo Jax can use it as a marketing gimmick/treat A few recurrent gbm or something patients per day, meh.

 

[OTN]

absolutely

you won't see much support for something like this in sdn crowd tho

they simply dgaf

There are plenty of people on here arguing both sides of this issue.

 

[PhotonBomb]

There are plenty of people on here arguing both sides of this issue.

fair, def some people care (including me, of SDN fame)

 

[medgator]

Orlando is looking at potentially 3 as well. Reminds me of the days of a shady cyberknife on every corner.

Protons are just as bad, but a whole different level in terms of financial toxicity

Horizon West will soon get proton therapy center to treat cancer — Lake Nona might be next

Central Florida is one step closer to having two centers that offer proton therapy, an advanced form of radiation therapy for cancer treatment. Since January, the Tennessee-based company Provision …

www.orlandosentinel.com

 

[RadOncMegatron]

I’m not adverse to there being a carbon ion machine in the USA. If furthering cancer science is a priority, it Probably should be at a high powered research institute. If patient care is a priority, it probably should be centrally located to allow for greater access for all. It also should be in an area without existing particle options, again related to access.

Mayo Jacksonville is none of these things.

If it’s understood that this is nasa’s machine and mayo Jax can use it as a marketing gimmick/treat A few recurrent gbm or something patients per day, meh.

I agree with this right here. I think we are already looking bad with protons centers popping up everywhere sans data and now a carbon ion facility?! Yet, I am torn b/c I think there may be some promise in these new technologies and it is something worthy of study. We can't move the field if we don't do the research, but how to accomplish this I have no idea.

 

[FrostyHammer]

I agree with this right here. I think we are already looking bad with protons centers popping up everywhere sans data and now a carbon ion facility?! Yet, I am torn b/c I think there may be some promise in these new technologies and it is something worthy of study. We can't move the field if we don't do the research, but how to accomplish this I have no idea.

We can't hold ourselves to a double standard. Surgeons operate without good data/evidence all the time, and med oncs throw immunotherapy for off label reasons all the time... Much more expensive than protons will ever be. Yet we're the only ones that (sometimes) care about costs.

 

[medgator]

We can't hold ourselves to a double standard. Surgeons operate without good data/evidence all the time, and med oncs throw immunotherapy for off label reasons all the time... Much more expensive than protons will ever be. Yet we're the only ones that (sometimes) care about costs.

Fine. Drop the "choosing wisely"/fraction shaming nonsense in that case which comes across as hypocritical.

Ignoring the cost of davinci machines or immunotherapy, carbon/proton centers are orders of more magnitude expensive than an igrt/sbrt capable linac without much to show for it

 

[RadOncDoc21]

We can't hold ourselves to a double standard. Surgeons operate without good data/evidence all the time, and med oncs throw immunotherapy for off label reasons all the time... Much more expensive than protons will ever be. Yet we're the only ones that (sometimes) care about costs.

We’re also the ones convincing patients that protons are better than photons and encouraging patients to seek treatments in another location at a much higher cost.

 

[RadOncDoc21]

Fine. Drop the "choosing wisely"/fraction shaming nonsense in that case which comes across as hypocritical.

Ignoring the cost of davinci machines or immunotherapy, carbon/proton centers are orders of more magnitude expensive than an igrt/sbrt capable linac without much to show for it

Damn, beat me to it!

 

[FrostyHammer]

Fine. Drop the "choosing wisely"/fraction shaming nonsense in that case which comes across as hypocritical.

Ignoring the cost of davinci machines or immunotherapy, carbon/proton centers are orders of more magnitude expensive than an igrt/sbrt capable linac without much to show for it

Fraction shaming will soon be taken care of at most places by the APM.
Also, I'm sure protons have more to show than TORS or last-ditch off-label immunotherapy for a patients at death's door. Big picture.
Fully support what RadOncDoc21 says about biased patient counseling. Taking a page out of the surgeons' book, clearly.

 

[scarbrtj]

Orlando is looking at potentially 3 as well. Reminds me of the days of a shady cyberknife on every corner.

Protons are just as bad, but a whole different level in terms of financial toxicity

Horizon West will soon get proton therapy center to treat cancer — Lake Nona might be next

Central Florida is one step closer to having two centers that offer proton therapy, an advanced form of radiation therapy for cancer treatment. Since January, the Tennessee-based company Provision …

www.orlandosentinel.com

This ProVision thing sits funny with me. "We will see" as Trump says/as I say. It's (the company, and protons themselves IMHO) being held aloft by some powerful people/financing, not powerful science. The CEO is one of the guys who invented PET scanning. He's got real gotohell money.

 

[RickyScott]

Jacksonville isn’t that far from orlando

 

[Mandelin Rain]

Lots of pediatric cases, chordomas, and ocular melanomas in Florida I guess.

 

[medgator]

Lots of pediatric cases, chordomas, and ocular melanomas in Florida I guess.

Fake news. More like lots of prostate cancer and heavy marketing.

UF would have been enough for all the peds cases, but that doesn't pay the bills....

 

[deleted941485]

Fake news. More like lots of prostate cancer and heavy marketing.

UF would have been enough for all the peds cases, but that doesn't pay the bills....

Unless those poor kids are heirs to the house of Saud.

 

[medgator]

Unless those poor kids are heirs to the house of Saud.

Lore when I rotated as a med student was that CCF and the original Mayo both had dedicated wings for their cash-paying patients from the ME who came for whatever specialized treatment was needed at those facilities.

 

[PhotonBomb]

Lore when I rotated as a med student was that CCF and the original Mayo both had dedicated wings for their cash-paying patients from the ME.

Idk about CCF (I don't think they have Proton) or Mayo but MDACC has many Saudis who pay straight cash for proton.

 

[medgator]

Idk about CCF (I don't think they have Proton) or Mayo but MDACC has many Saudis who pay straight cash for proton.

I meant for specialized care in the US in general, surgical, proton or otherwise. I wouldn't be surprised about mdacc either