For the past five years Denmark has facilitated the opening of a new cancer treatment center that treats cancer patients with a new and advanced type of treatment called particle therapy. Cancer treatment in Denmark is especially important since Denmark has the highest rates of cancer cases in the world.

 

By Amy Melki & Hyebin Yoo

Since the release of the World Cancer Research Fund International’s data on cancer frequency by country that put Denmark in the number one spot, the Danish government has invested in the development of a new form of cancer treatment in Denmark.

The World Cancer Research Fund International, which is a not-for-profit organization that leads and unifies a network of cancer prevention charities with a global reach, held out a study back in 2012 concerning the highest cancer rates by country. This data reveals that Denmark, which is the smallest of the three Scandinavian countries with a population of 5.5 million people, has the highest cancer rates worldwide. Although the results showed that the age-standardized rate was at least 300 people per every 100,000 for nine countries — including Denmark, France, Australia, Belgium, Norway, United States of America, Ireland, Republic of Korea and The Netherlands — Denmark still ranked the highest with 338 people per every 100,000 that were diagnosed in 2012.

The data that resulted from this study has led the Danish government to invest and develop in the research of a new type of cancer treatment known as particle therapy, or in other terms, proton therapy.

The Danish Government’s response

In May of 2011 the Danish parliament agreed to start the process that will establish a national center for particle therapy in Denmark. Soon after this announcement was made, the Danish government gave the opportunity to all Danish hospitals that were interested in hosting this center to submit applications to the Danish medicines agency. Two applications were submitted; the first application was that of Aarhus University Hospital and the second was that of Rigshospitalet hospital in Copenhagen.

The decision making process that determined the host for Denmark’s very first national particle therapy center was determined by a committee of international experts. After evaluating these applications, the international committee of experts concluded on December of 2012 that only one hospital should be the host of this center and Aarhus University Hospital was the one selected.

According to the 2012 document on the Danish National Center for Particle Therapy, Aarhus University Hospital has the largest radiation oncology research department in Scandinavia as well as accelerator expertise and specific expertise in particle therapy. These, along with other factors, placed Aarhus University Hospital at an advantage when it came down to decision making.

Doctor Morten Høyer, a doctor-professor of clinical oncology at Aarhus University Hospital talks about the Danish government’s decision to build Denmark’s particle therapy center at Aarhus University Hospital.

“It was decided that it should be here in Aarhus and that the center should have a public and private granting behind it,” Dr. Høyer said, “The Danish government actually provided the buildings and Maersk, the shipping company, delivers the protons and all the technical stuff we need for the treatment of these cancer patients,” Dr. Høyer said.

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Dr. Morten Høyer, who is a Doctor-Professor of clinical oncology at Aarhus University Hospital, stands near the construction site for Denmark’s first Particle Therapy Center. Photo by, Hyebin Yoo

 

What is particle therapy?

Over the years, particle therapy has gradually picked up popularity among leading countries in the fields of medicine, such as Sweden, France and Japan, due to its non-invasive procedure. Particle therapy uses protons or charged light ions in order to target and kill cancer cells.

Dr. Høyer, whose research interests include, cancer tumor treatments, clinical trials and particle therapy, explains how particle therapy works to kill cancer. Dr. Høyer also talks about the differences between traditional radiotherapy, which is widely used to treat cancer patients, and the new upcoming treatment known as particle therapy.

“Particle therapy is a new kind of radiation therapy, it is actually particles or protons,” said Dr. Høyer, “The difference between traditional radiotherapy and particle therapy is the physical property of the radiation,” Dr. Høyer said.

As a specialist on several types of cancers and cancer treatment, Dr. Høyer goes on to explain how radiotherapy uses special machinery to send high doses of radiation to cancer cells. This radiation is sent in the form of lasers or beams targeting the tumor from different directions.

“If we are talking about traditional radiations, or photons as we call it, then it penetrates the body and you can only treat a tumor if you direct beams from different angles into the body of the patient and direct it to the tumor,” said Dr. Høyer.

Although radiotherapy may seem like a less invasive cancer treatment than other types of cancer treatments, it still has its side effects. When a cancer patient undergoes radiotherapy, not only are the cancer cells exposed to a strong dose of radiation, but surrounding healthy tissue is also exposed. On the other hand, when a cancer patient undergoes particle therapy this therapy distinctly avoids such side effects and only targets specific cancer tissue.

“Particle therapy is different because when it is entering the body it slows a bit down,” said Dr. Høyer, “When it comes to a certain velocity, it explodes and delivers all the energy in one single point, which means that there is not so much exposure to the surrounding tissue,” said Dr. Høyer.

Benefits and limitations of Denmark’s particle therapy center

Since particle therapy works to kill cancer cells by targeting specific points in the body, it is often used to treat children who have cancer as well as adults with cancers in the brain, neck, central nervous system and prostate.

According to the Proton Therapy Center’s website, the process of particle therapy makes sure to protect healthy tissue from unnecessary toxicity as well as has a high probability of eradicating tumor cells.

“A proton beam transfers a minimal dose of radiation to the front of the tumor, a maximal dose to the tumor area itself and no dose behind the tumor. Therefore, proton therapy is safer for healthy tissue surrounding the tumor,” stated the Proton Therapy Center’s website.

Despite the fact that one of the most common types of cancer in Denmark is found in lung cancer, particle therapy is not fit for the treatment of lung cancers.

“The problem with lung cancer is that it actually moves with respiration,” explained Dr. Høyer, “Particle therapy is a very precise treatment that delivers the radiation to a very precisely defined spot in the body, so if the cancer is moving there is a risk that we might actually deliver the radiation very precisely but to the wrong place,” said Dr. Høyer.

However, since particle therapy specifically targets certain precise areas in the body, the treatment has proven successful on cancer tumors in other areas of the body.

“The indications right now are more in the brain so it might be brain tumors, it might be tumors in the skull of the brain right underneath the brain and close to a very radiosensitive organ,” said Dr. Høyer.

Hans Storm, a medical director from the Danish Cancer Society, agrees with Dr. Høyer from Aarhus University concerning the success of particle therapy.

“So far this targeted radiation therapy has proven superior for certain cancers,” said M.D. Storm referring to cancers found in the brain and nervous system.

Other than the known limitations of particle therapy when it comes down to certain types of cancer, such as lung cancer, the particle therapy center in Aarhus is facing other obstacles. According to Aarhus University Hospital’s original plan published in an article on the University’s website, the center was planned to start treating cancer patients in 2017. However, 2017 is just around the corner and the construction of the new centre is not completed yet. According to a document published by Dr. Høyer in 2016, the first cancer patient to receive particle therapy in Denmark is now scheduled to take place in October 2018.

In the mean time, cancer patients in Denmark who are in need of particle therapy are often sent to other countries who offer this treatment, such as Sweden and the United States of America.

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Construction site of the new center for particle therapy at Aarhus University Hospital. Photo by, Hyebin Yoo

According to Dr. Høyer, the implementation of this new cancer treatment will pose new obstacles to the doctors handling particle therapy.

“We have to find out which patients should be treated with protons,” said Dr. Høyer, “Some of them are patients that we know will already benefit from protons or particles but they will only account for approximately 20% of patients that we are going to treat with particle therapy,” said Dr. Høyer.

Dr. Høyer continued to explain that 80% of cancer patients that will undergo particle therapy will be patients on trial where the aim of the trial is to find new indications for proton therapy.

Hans Storm from the Danish Cancer Society who himself was a cancer patient talks about the attitude of cancer patients towards particle therapy.

“Nobody knows before it has been studied,” said M.D. Storm about the attitude of cancer patients towards particle therapy, “As a patient and a patient advocate organization living in a society where we care for each other and where health care is free and supposed to be of the highest possible standard, those that are offered this treatment are likely happy,” said M.D. Storm.

Where is particle therapy in the world today?

Due to its growing popularity, particle therapy centers have opened in many countries around the world. Today, there are 58 particle therapy centers worldwide with 21 in Europe, 19 in North America, 17 in Asia and 1 in Africa.

Along with the current functioning particle therapy centers, there are 52 centers worldwide that are currently under construction or planning. North America is expected to open an additional 19 particle therapy centers, Europe and Asia each have 16 centers underway and Australia is planning to open 1 center.

According to The National Association for Particle Therapy, at least 70,000 cancer patients have been treated at particle therapy centers in the United Stated, Europe and Asia.

The future of particle therapy

Although the opening of Denmark’s first particle therapy center will come with various obstacles and learning opportunities to all those involved, including doctors and engineers, the center holds a promising future. With three main treatment rooms that will be equipped with the best technology, Aarhus University Hospital’s particle therapy center will be able to treat up to 1,200 cancer patients per year.

“To some extent we will reach the limit and the limit is 1200 patients per year,” said Dr. Høyer, “After that, and that may be 10 years after we open our center, there might be a need for more particle therapy centers in Denmark,” said Dr. Høyer.

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