First on the beam

Tufts-New England Medical Center has asked the state for permission to use proton beams to zap cancerous tumors, betting on new technology that could lower costs and increase the availability of the most advanced form of radiation treatment.

The new type of proton beam unit would cost $19 million, according to the hospital's application, compared to the $150 million or more it costs to install conventional proton therapy systems.

But the system is unlikely to be installed before 2008. It is still in development by scientists at the Massachusetts Institute of Technology and a licensee, Still River Systems Inc., of Littleton.

And once it's ready, the manufacturers will need to seek Food and Drug Administration approval.

Still, Tufts-New England's request, made last month to the state Department of Public Health, guarantees it will be first in line among Massachusetts hospitals as the state considers how many of the new proton units to allow.

Reduced overhead costs for hospitals would increase the availability of such treatments nationwide for patients with a variety of cancers. The lower cost of the new technology also would allow smaller hospitals like Tufts-New England to compete in an arena that has been restricted to just a few big medical centers in the country.

``It has been the dream of every radiation oncologist to have access to a proton beam, but this has been limited because of the enormous expense associated with these facilities," said Dr. David E. Wazer , radiation oncologist in chief at 238-bed Tufts-New England Medical Center.

Proton beams are more desirable than traditional cancer radiation treatments because they deliver a tightly focused, intense treatment directly to a tumor, preventing damage to healthy tissues. That can be especially important for children with partially developed organs, and for patients with spinal and brain tumors.

In addition to the cost, the enormous size and weight of proton beam systems (they fill four or five rooms and include a huge piece of equipment called a cyclotron) make them rare. There are currently only four in the country: at Massachusetts General Hospital , Loma Linda University Medical Center in California, the Midwest Proton Radiotherapy Institute in Bloomington, Ind., and the MD Anderson Cancer Center in Houston. The University of Florida in Jacksonville is opening a unit this year.

The more economical machine being developed is still in pieces at MIT, Still River Systems, and various subcontractors. Its builders say the technology is based on engineering breakthroughs that permit creation of a much smaller cyclotron that can be built into the same unit that fires the beam, instead of being housed in a separate room.

``It's a single-room system, which makes it much more feasible for hospitals to get involved," said Marc Buntaine , chief executive of Still River Systems.

Buntaine and an MIT fusion scientist, Timothy Antaya, declined to describe the engineering innovations that led to its development, describing them as proprietary. But they said they are confident the machine will work. The FDA will only require that it is capable of firing a proton beam, because the effectiveness of proton therapy has already been proven, they said. The new unit is ``going to lead to widespread adoption" of proton therapy, Antaya said.

Tufts-New England is only the second smaller hospital in the country to say it wants the new proton beam technology. The first was Barnes-Jewish Hospital, in St. Louis.

Larger medical centers, which are forced to turn away many patients for proton beam therapy because of long waiting lists, hope the new technology will help reduce the backup.

``If this technology comes to fruition, it will be great for a lot of smaller centers who don't have the capital or space to do what we have done," said Dr. Jay S. Loeffler, chairman of the Mass. General department of radiation oncology.

The $150 million systems do have advantages over the version being developed. They can focus beams into four treatment rooms, allowing doctors to treat a greater number of patients per day. They also can vary the intensity of the beam, said Loeffler, a feature not available on the new systems. That means a small percentage of patients will have to continue seeking treatment at traditional proton centers.

In its application to the state ``determination of need" program, which regulates expensive technologies and hospital improvements, Tufts-New England said it would treat 253 patients in 2009, and 356 by 2012. Patients require an average of 30 treatments.

The federal Medicare insurance reimbursement rate ranges from $950 to $1,100 for each treatment, about $33,000 for the average course of treatment. The hospital could generate more than $11 million a year by 2012 from proton beam therapy, if the reimbursement rate remains the same.

That's significantly less than the existing centers. According to the Tufts-New England analysis of the market, the Indiana site treats 1,000 patients a year, M.D. Anderson in Houston expects to treat 3,300 patients a year, and the Florida unit is expected to handle about 2,200.

Christopher Rowland can be reached at crowland@globe.com.