- Laura Plitt
- BBC News World
Some say the washing machine, others spaceship. But for Ahinara, it is simply the machine.
This is how this 7-year-old Ecuadorian girl calls the device of the Proton Therapy Unit that the University of Navarra Clinic has at its headquarters in Madrid and that managed to completely eliminate a brain tumor that doctors in her country had diagnosed for a few months before.
This immense instrument is the centerpiece of an advanced cancer treatment known as protonotherapy: a type of radiation therapy that instead of photons (as in traditional radiation therapy) uses protons to destroy the tumor tissues.
It is a relatively new, expensive and highly accurate treatment that is available only in some places in the world – there are currently 107 proton therapy spaces in 20 countries, and about 37 are under construction – and it is especially indicated in some cancers.
Its great advantage, and the reason that makes this treatment the most suitable in certain cases, is that, due to its physical characteristics, this type of beam produces less damage to the surrounding tissues and therefore fewer side effects.
“In tumors located in the central nervous system, at the base of the skull, the area of the head, the spinal cord or that are very close to tissue that needs to be preserved, as well as in patients who received radiation before, it is particularly critical reduce the radiation dose to healthy tissues around the tumor. “
This is how Dr. Pablo Menéndez, director of the Radiant Therapy Area of the Angel H. Roffo Institute of Oncology at the University of Buenos Aires, explains to BBC Mundo.
The way in which the proton beams behave when passing through the human body allows “to concentrate the maximum dose of radiation on the tumor and make two or three millimeters beyond it practically zero”, he adds.
Ideal for cancers in children
This makes proton therapy the most suitable also in most tumors in pediatric patients.
“In these cases it is essential to minimize the side effects in normal tissues because when children survive, and massively survive childhood cancers, they are left with sequelae that limit their long-term life as adults,” the doctor tells BBC Mundo Felipe Calvo, director of the Proton therapy Unit of the Clínica Universidad de Navarra.
“Most of the childhood tumors are brain, and brains that are irradiated with photons and survive in the long term have neurocognitive problems, “adds the doctor who is part of the team that treated Ahinara.
In addition, it is a therapy less toxic, since it minimizes the radiation that reaches the vessels, arteries, and their content (the circulating blood), thus protecting the patient’s immune system.
Ahinara’s cancer – a type of brain sarcoma rare in Europe but seen more frequently in Latin America – was perfectly suited to the proton therapy offered by the clinic at the University of Navarra (one of two private medical centers that provides this type of therapy in Spain).
Victoriano Iglesias, the girl’s father, recalls in detail how the events that led him to leave his country for the first time with his family to seek the best possible treatment for his daughter unfolded.
Ahinara was playing after leaving school, when Victoriano and his wife received a call from their grandmother to tell them “that the girl had vomiting,” he tells BBC Mundo.
“We thought it was a viral or bacterial picture, and we took her to see the pediatrician. He thought the same thing,” she recalls.
But when they returned to the hospital because Ahinara was not improving, a series of analyzes and verbal tests revealed that it was something serious.
“The doctor asked her how she felt and she answered ‘Tien’ (she couldn’t pronounce the b). It was difficult for her to coordinate movements and words, and the pediatric neurologist saw that on one side of her face she had a slight effusion”.
The tomography confirmed the suspicions, and the little girl underwent emergency surgery. Although the surgery was successful – most of the tumor was removed – treatment had to continue, as in the vast majority of cases, with chemotherapy and radiotherapy.
And that’s when Victoriano began to look for the best treatment options, which involved a journey that, thanks to the collaboration of non-profit organizations – Telethon in Ecuador and the Spanish Association against Cancer and Children against Cancer, in Spain, among others— he took him to the Clinic of the University of Navarra.
It was a difficult journey in the midst of the pandemic, but one that changed the girl’s future.
Less than a minute
“Generally, it takes between 5 and 25 days of treatment depending on the tumor,” explains Calvo about the treatment. In Ahinara’s case, there were 30 sessions, one per day.
The proton beam firing is less than a minute, but getting the body in the exact position inside the machine can take between 20 and 25 minutes.
Children under the age of eight are given anesthesia so that they can lie still without moving from position.
“The procedure is not painful, and the anesthesia is done with gases”, explains to BBC Mundo Dr. Elena Panizo, the specialist in Pediatric Oncology at the Clínica Universidad de Navarra who treated Ahinara.
“In the short term the tolerance is very good. One of the most intensive treatments that we give to children with brain tumors are craniospinal radiotherapies, which consist of radiating the entire skull, the entire spine, plus the entire neuroaxis, and we are seeing that children tolerate it phenomenally, “says the oncologist.
“On the other hand, with photons, you saw a lot of affectation, because the radiation dose reached a little to the throat or the gut and they could have diarrhea and more mucositis (inflammation of the mucous membranes of the lining of the gastrointestinal tract).”
“Many of the children hardly know that they are receiving the treatment,” she says, and excitedly recalls how Ahinara came singing and dancing, happy to enter the proton room.
“In the long term, we hope to see something that we have already seen in other countries that use protons for a longer time: that the effects are minor.”
As the first pediatric patient to successfully undergo this treatment at the clinic, Ahinara left a valuable lesson for the entire medical team.
From how to coordinate treatment in international patients (due to the lack of a proton therapy unit in Latin America, the clinic is now receiving patients from Mexico, Ecuador, Chile, among other countries) to thinking, deciding and designing treatments with protons in children’s brains .
“There are many little secrets that you have to face when the first patient with such a profile arrives,” says Calvo.
Back in Ecuador, Ahinara leads a normal life today: she continues to study at school – virtually due to the pandemic – and playing with her older sister, Anael, from whom she is inseparable.
Progress in Argentina
Meanwhile, on the other side of the pond, Argentina began to take the first steps to create a proton therapy center, which would be the first in the entire region.
In mid-2019, the building that will house the center began to be built in the capital and, in June of this year, the teams arrived in the country from Belgium to apply therapy.
It is a joint project of the National Atomic Energy Commission, the University of Buenos Aires, which depends on the Institute of Oncology “Dr. Ángel Roffo” and the high-tech company INVAP, which is estimated to be operational by the end of 2023 , early 2024.
The challenges of setting up such a center in the country are many.
“Is a fairly complex technology“Pablo Menéndez, from the Roffo Institute, tells BBC Mundo BBC Mundo.
“You need a team that generates this beam of protons, you have to direct them with millimeter precision on a patient who is placed on a stretcher that can rotate 360º to choose the most convenient angle,” he explains, referring to the device that is much more large behind what is seen in the radiation room.
And “to make that generated radiation hit all that loop requires a very large physical structure,” he continues.
“For example, for the team that Argentina bought – which will have two treatment rooms (gantry) and a third to do research— the physical plant where it will be installed occupies an important space “.
It must also have “the necessary shielding so that radiation does not escape from the generation area, and for this it is necessary to build reinforced concrete structures three or four meters thick.”
In short, it is a complicated civil work that requires an expensive investment, as well as the training of resources in place to maintain the equipment and everything that has to do with medical assistance.
“Always implementing new technology becomes a little more difficult in the region, because you are not so close to the centers where this technology is generated,” adds Menéndez.
The center, obviously, will not be able to satisfy all the needs of the continent, but perhaps it can, in some cases, be an alternative to the expensive trips that many patients have to make to the United States or Europe.
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Eddie is an Australian news reporter with over 9 years in the industry and has published on Forbes and tech crunch.