The first domestic proton therapy system has treated more than 100 patients, and the charging standard is disclosed.

On March 26th, the first domestic proton therapy system was used to treat more than 100 patients.

Proton therapy is an anti-cancer weapon, one of the most advanced tumor radiotherapy methods in the world, a "tumor directional blasting artifact" and a "jewel in the crown of tumor radiotherapy". Protons can fully protect the normal tissues around the tumor and achieve a "precise attack" on the tumor.

The first proton system treatment room made in China. The Paper reporter Zhang Chengjun photo

On the same day, reporter The Paper (www.thepaper.cn) learned from the Tumor Proton Center of Shanghai Ruijin Hospital that the first domestic proton therapy system was put into trial operation in the hospital on July 19th, 2023. After the treatment fee standard was approved by the state, the Tumor Proton Center of Shanghai Ruijin Hospital officially started operation on November 24th, 2023. In just over four months, the number of clinical patients has reached 100. The tumor diseases covered include head and neck tumors, breast cancer, chest tumors, abdominal and pelvic tumors, spine and trunk and limbs tumors, etc. There are adults and 3 children and adolescents in the treatment patients.

In view of the treatment cost, the hospital revealed that the charging standard is that each course of treatment for the same indication does not exceed 170,000 yuan. In addition, the hospital also said that in order to better serve tumor patients, Ruijin Hospital opened outpatient clinics in Ruijin Hospital General Hospital in Huangpu District and Tumor Proton Center in Jiading District every Monday to Friday, and the radiotherapy department of the hospital took the lead in setting up a clinical pioneering and innovative team of domestic proton therapy system, including medical staff, physicists and technicians, to escort proton therapy in an all-round and full-cycle manner.

On March 26th, the first domestic proton therapy system was used to treat more than 100 patients, and the 100th patient, Aunt Chen, took a group photo with medical staff and therapists. Photo courtesy of Ruijin Hospital

Among the 100 cases treated, more than 20 tumor species were covered.

Aunt Chen, who is 70 years old, is the 100th patient treated by this proton system. Her symptoms of sacral pain have lasted for more than 10 years.

In July, 2022, Aunt Chen found a huge mass in the sacrococcygeal bone after magnetic resonance examination in a hospital, and then went to Ruijin Hospital for PET-CT examination, which was suspected to be a malignant lesion. Subsequently, the surgical and pathological examination showed that the common chordoma involved the soft tissue beside the bone. In February 2024, Aunt Chen relapsed more than one year after surgery.

After the recurrence, Aunt Chen received the first domestic proton therapy system, and the whole radiotherapy process lasted about 40 minutes. "For this patient, proton therapy can effectively protect the rectum and sigmoid colon while giving enough dose to the tumor." Chen Jiayi, director of the radiotherapy department of Ruijin Hospital, said that proton therapy can not only greatly reduce the side effects, but also effectively improve the curative effect of curing tumors. Patients with solid malignant tumors may benefit from proton therapy, especially in the treatment of central nervous system tumors, head and neck tumors, chordomas in various parts, left breast cancer, prostate cancer, mediastinal malignant lymphoma and childhood tumors.

Among the 100 patients treated by the first proton therapy system made in China, there were also 3 children and adolescents. The treatment process was smooth and safe without obvious discomfort.

The 14-year-old girl Xinxin (a pseudonym) is one of them. She was diagnosed as central diabetes insipidus, growth hormone deficiency, pituitary hypofunction and gonadal hypofunction in a hospital more than four years ago due to symptoms such as dry mouth, polyuria and stunted growth. In July 2023, this child went to Ruijin Hospital for diagnosis because of his short stature and decreased bone mass, and was finally diagnosed as pituitary germinoma.

From August 28th to September 27th, 2023, this girl began to receive the first proton therapy system made in China. During radiotherapy, diabetes insipidus gradually improved and her height also increased. "Protons better protect the normal tissues such as brain stem and hippocampus of the child. After three months of radiotherapy, her intracranial lesions shrank obviously and her height increased by 6 cm." Chen Jiayi said.

Chen Jiayi said that among the 100 cases currently admitted, including 29 cases of head and neck, 35 cases of breast cancer, 22 cases of chest tumors, 9 cases of abdominal and pelvic tumors, and 5 cases of spinal and trunk tumors, more than 20 kinds of tumors can be treated now, not only radical treatment, but also postoperative assistance, postoperative recurrence, postoperative residue, and few metastatic radiotherapy.

Zhao Ren, vice president of Ruijin Hospital, said that since the clinical treatment, the proton therapy professional team in radiotherapy department, including clinicians, physicists, technicians and nursing staff, has ensured the safe and effective proton therapy in all directions, ensuring the maximum benefit of proton therapy for every patient. Up to now, all patients have been successfully treated, and there is no treatment toxicity of degree 3 or above, and some patients have shown good short-term efficacy.

Physiotherapists treat patients with proton radiotherapy. Photo courtesy of Ruijin Hospital

The maximum duration of treatment for the same indication is not more than 170,000 yuan.

Zhao Zhentang, an academician of China Academy of Engineering and director of Shanghai Light Source Science Center, also said that the first proton therapy system made in China adopts the internationally advanced IMPT-PBS (full name: pencil beam scanning intensity-modulated proton therapy) technology, which can "scan layer by layer" bit by bit, realize three-dimensional carved dose coverage, and achieve "lower toxicity and more accuracy" to the greatest extent. Proton fixed beam and 180-degree rotating beam are carried out in parallel. The fixed beam is accurate and efficient, and the 180-degree rotating beam is free and flexible, which can realize the individualized radiotherapy scheme for each patient more comprehensively.

Chen Jiayi said that since the beginning of clinical treatment, the patients admitted have both the "traditional strengths" of proton therapy and the "China characteristics", which fully reflects the "rooting" of proton therapy in the medical field in China.

"Head and neck tumors are the traditional strengths of proton therapy. The head and neck are often adjacent to multiple key normal organs, and functional protection is particularly important. Head and neck tumors often need higher therapeutic doses. Proton therapy can achieve a good balance on the seesaw of curative effect and toxic reaction." Chen Jiayi further indicated that the treated patients with head and neck tumors included not only skull base tumors of various pathological types, but also meningiomas, pituitary tumors, gliomas, adenoid cystic carcinoma and so on, which remained or recurred after operation.

However, the "China characteristics" of domestic proton therapy are obvious in domestic high-incidence species such as breast cancer, lung cancer, esophageal cancer and other chest tumors.

"For breast cancer patients, from breast-conserving postoperative radiotherapy, mastectomy postoperative radiotherapy, combined regional lymph node irradiation, reconstruction postoperative radiotherapy, to locally advanced radical radiotherapy, and then to radiotherapy for patients with recurrence and oligometastasis, the first proton therapy system in China covers almost all clinical scenarios of breast cancer radiotherapy. There are no adverse reactions such as radiation dermatitis of degree 2 or above, breast edema, radiation pneumonia and sore throat in the treated patients." Chen Jiayi said.

In view of the treatment cost, the hospital revealed that the charging standard is that each course of treatment for the same indication does not exceed 170,000 yuan. Specifically, the first proton treatment cost is 40,000 yuan, and then each additional treatment will be charged 15,000 yuan. The maximum treatment for the same indication does not exceed 170,000 yuan. It is worth mentioning that this treatment has also been included in "Huhuibao".

Zhao Zhentang also introduced that for proton therapy, the multi-angle and control technology of rotating beam is the most critical technology. At present, the 360-degree rotating beam treatment system is being debugged. Compared with the 180-degree rotating beam treatment system that has been put into use at present, the new generation system will be more accurate in treatment positioning and more conducive to improving treatment efficiency.

"According to the current plan, the 360-degree rotating beam treatment system is expected to be debugged in October this year and gradually opened to patients." Zhao Zhentang said.