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Frequently Asked Questions

Frequently Asked Questions

Questions about registration, costs, preliminary examinations, duration of treatment, course, and therapy:

How do I register?

Everything you need to know about registration can be found under Registration for Proton Therapy.

Can’t I simply come in to the RPTC with my documents for a medical consultation?

Our primary objective is to help as many patients as possible. With a treatment capacity of 2000 patients per year, optimal organization and appropriate planning are extremely important. Reviewing documents for each patient is generally a rather involved and time-consuming process. Many cases are discussed and examined jointly in the Tumor Board. Only those patients who are being seriously considered for proton therapy are invited to come in for a consultation.

Can’t I just download your registration form from the website?

Personal contact with our patients is very important to us. Additionally, this allows us to document the course of treatment and the timetable of incoming inquiries from the very beginning.

How can I obtain the medical records I need to send in?

You can usually obtain complete medical records from your family physician. As the attending physician, he/she will be happy to assist you for his own record-keeping purposes.

My doctor’s office is refusing to supply my medical records - what should I do?

Please contact your family physician. He/she can request records for you at any time. In the unlikely event that this approach is unsuccessful, please contact Patient Management. Our staff will be happy to assist you.

Do I need a medical referral for proton therapy at the RPTC?

Basically no. Please discuss this with Patient Management when you call to schedule your first appointment.

Is proton therapy reserved for private patients?

No. Proton therapy is available to all patients insured under statutory health insurance schemes or with private plans.

Will my health insurance company pay for proton therapy?

All relevant information can be found in the section entitled Payment of Charges.

What do I need to bring to the initial consultation?

please see Admission Procedures.

How long does the initial office consultation last, and what happens during this discussion?

The initial office consultation lasts about 30 minutes. Along with your medical history and a physical examination, the physician will discuss your illness and treatment options.

Can the consultation be combined with the preliminary examinations?

If all charges up to this point have been settled and proton radiation treatment will likely proceed, additional preliminary examinations can be performed immediately afterward.

Does the patient have to come in person to the consultation? Can’t the appointment take place via telephone because it’s so far to travel?

In principle, the patient should come in person. If there are particularly difficult circumstances associated with your case, please discuss this with the Patient Management staff.

How long is the wait between the initial consultation and the actual start of treatment?

The amount of time differs for each individual case and depends on the respective end payer. The wait time is usually about a week.

How long will it take until I can start therapy/radiation?

This depends on many different criteria, such as general patient demand, date of receipt of the registration paperwork, urgency (children are given priority, for example) as well as ensuring costs are covered. These factors can vary greatly between one person and the next. Two to three weeks is a good rule of thumb.

Do I need to fast before coming to the diagnostic appointments? Do I need to stop taking my medications?

In general, you do not need to fast or stop taking any medications. You will need to fast in the case of certain tumors, such as those in the area of the bile ducts, the pancreas or bladder, or in the case of certain examinations, such as PET-CT with FDG contrast medium. If this should be necessary, Patient Management will provide you with the information you need.

Do I need to fast before my radiation appointments? Do I need to stop taking my medications?

Only patients receiving anesthesia need to fast before coming to their radiation appointments. Patients can usually continue taking their medications.

Does the patient feel the radiation? Is anesthesia necessary?

Radiation cannot be felt by patients and is completely painless; in addition, each session generally lasts only 60 to 120 seconds. Therefore, adults are not anesthetized for radiation treatments. However, children, who tend to be less cooperative, are sometimes given light, short-term, fully monitored anesthesia so they do not move allowing the beam to be precisely guided to the tumor. Anesthesia is also beneficial if organs that move with respiration, such as the lungs or liver, are being irradiated, since these organs move a few centimeters during normal spontaneous respiration; this would prevent us from irradiating the tumor in a single pass and reduce the precision of treatment. For this reason, we administer anesthesia to the patient and after controlled ventilation with 100% oxygen, “apnea” is induced for the brief radiation period to ensure the tumor is "stationary" and can be precisely targeted. For small children, an additional form of anesthesia is used: a light twilight sleep during which the child breathes spontaneously and only “sleeps” during the actual procedure. Continuous monitoring and control by anesthesiologists ensures the safety of our patients at all times.

More information about the anesthesia procedure.

How long does treatment take?/How many radiation sessions are needed?

The length of treatment, indicated by the number of daily radiation sessions, is different for each individual and depends on the particular tumor and the tumor localization. More information about this can be found in the menu under Course of Therapy and Radiation Session.

Questions such as ”What can be treated with proton therapy? Can my diagnosed problem be treated? Does it make sense to register?“

Can proton therapy only treat particular types of cancer?

Proton therapy is not reserved for a few select kinds of cancer. It is available in any case where X-ray therapy is an option. Proton therapy is also appropriate for tumors that were previously poor candidates for radiation treatment because they were situated too close to vital organs.

How do I find out whether my disease can be irradiated with protons?

Theoretically, every tumor that can be irradiated with conventional radiation therapy with x-rays can also be irradiated with protons. Proton therapy is also appropriate for tumors that were previously poor candidates for radiation treatment because they were situated too close to vital organs.You can find more information about this in the Treatment Spectrum as well as in the list of tumors already treated at the RPTC. However, only the radio-oncologist with formal and technical qualifications in proton therapy can decide whether proton irradiation is indicated in your particular case; he or she makes this decision using your medical records and images that are already available.

My attending physician/the hospital advises against proton treatment. Can I still register with the RPTC?

Only the radiation therapist with formal and formal and technical qualifications in proton therapy can assess whether or not proton therapy is indicated. If possible, however, your attending physician should indicate in the area provided on the registration form whether the tumor appears essentially suitable for treatment with any radio-therapy method.

I have already been treated with photons (conventional radiation therapy / x-rays). Can I still be treated with proton therapy?

This is often possible. However, this requires an individual case decision by a radio-oncologist with formal and technical qualifications in proton therapy. Such a decision can only be made after reviewing your documents.

Can proton therapy also be administered if the tumor has not yet been examined?

There must be at least one histological finding (tissue examination).

Which pre-existing conditions would preclude treatment with proton therapy?

Given the rather rare exclusion criteria, we can’t give a one-size-fits-all answer to this question. We often cannot decide until after reviewing your documents.

Can prostheses, stents or pacemakers cause problems during proton radiation?

Yes, they may cause some issues. Please be sure to indicate this during registration and when scheduling appointments. Each individual case will need to be reviewed.

Is proton therapy successful in treating metastases, or are there any limitations concerning the number of metastases or previous treatments?

Individual metastases can be irradiated (please see Treatment Spectrum). Patients with multiple metastases are generally not eligible for radiation therapy.

Are mobile organs such as the prostate at all suitable for high-precision irradiation such as proton therapy?

Organ movements are a basic problem in radiation, and not just in the case of proton therapy, since they always require a higher planning volume – that is, a larger safety margin around the tumor. Of course, proton therapy preserves the favorable ratio of helpful to harmful radiation to protect healthy tissue regardless of planning volume.

To ensure with the greatest possible certainty that mobile organs are always irradiated in the same position, which allows us to use smaller safety margins, there are several methods used successfully in X-ray and proton radiotherapy. For the prostate, one option is a rectal balloon to bring the prostate into a specific predefined position. Alternatively, the prostate can be marked with gold beads that can be adjusted into the desired position during X-ray position monitoring performed prior to each radiation session. A third method involves determining the relative position of the prostate in the body before each radiation session using a stereotactic ultrasound examination. For the “fixation” of organs that move with respiration, such as the lungs or liver, there are two options. One is so-called respiratory gating. Here, the respiratory excursion (the degree of lung inflation) is measured and the beam is only released during the correct respiratory position. A second method is irradiation during apnea: the anesthetized patient is irradiated during a brief respiratory stop in a precisely defined position. The latter is used at the RPTC.

Can proton therapy replace surgery for breast cancer patients or be used as post- surgery- irradiation instead of irradiation with x-rays?

No, the tumor must first be surgically removed. Moreover, current technology does not permit the movable breast to undergo follow-up proton therapy. For more details, see the Treatment Spectrum section under The following are not treatable.

Can proton therapy be used in the case of elevated PSA values following prostatectomy?

In general, proton therapy can also be used following prostatectomy, in the case of recurrence or metastases.

Is it possible to treat ocular tumors with radiation?

Yes. Malignant tumours of the eye have been treated with proton radiation for many years now because proton beams are the only form of radiation that can be stopped directly at the tumor. X-ray radiation penetrates deeper and would cause damage to the optic nerve and areas of the brain located behind the tumor.
A technically advanced procedure is used at the RPTC. Initially, the tumor is localized using MRI. Under local anesthetic, three miniclips are positioned in the area of the connective tissue sacs and visualized on the MRI scanner. This provides a three-dimensional visualization of the eye. On the basis of observation, the physician can then mark spread-out-areas on this image. These are areas where melanoma cells have already infiltrated the retina. Another MRI scan is taken after radiation planning is complete. A fixation light point is adjusted so that the eye is in the correct position for radiotherapy. Optical monitoring of the iris prevents any eye rotation or focus in other directions.

In the radiation unit, a rotating chair, the eyes are again fixed on a light point. The position of the pupils is continually monitored. Two X-ray machines are set up with intersecting beams and used to guide the tumour into the precise position for irradiation with the help of marker clips. During this time, the head is fixed in position with an upper-jaw bite plate. A radiotherapy session of this kind lasts about 60 seconds.

Isn‘t the proton beam used at the RPTC too “high-energy” for eyes or other small tumors near the surface of the skin?

No, because both the energy (corresponding to the speed and thus the penetration depth of the protons) and the intensity (current intensity or number of protons emitted) of the proton beam used at the RPTC can be reduced to zero. This is accomplished by a) using braking elements to slow the beam down to the desired energy level (speed and depth of penetration), and b) precisely controlling the number of accelerated protons. This enables the proton acceleration equipment at the RPTC to irradiate any tumor between skin level and a depth of approximately 38 cm. A more detailed description of the eye therapy site can also be found under "Fixed Beam Therapy Site".  

Questions about proton therapy itself:

Is proton therapy used only curatively or also palliatively (for relief of symptoms)?

Proton therapy can be used curatively as well as palliatively.

Is a definitive cure possible with proton therapy?

If adverse effects occur, they can generally be reduced by 67% to 80% compared to X-ray therapy. This is crucial for patients’ quality of life and well-being. For example, some patients suffer from persistent dry mouth following radiotherapy due to the nearly unavoidable exposure of the salivary glands to radiation. This makes talking and eating difficult. Proton treatment can prevent these adverse effects. Whether and which adverse effects may occur largely depends on the particular indication. Your physician will explain this to you in more detail during the consultation.

What are the adverse effects of proton therapy?

If adverse effects occur, they can generally be reduced by 67% to 80% compared to X-ray therapy. This is crucial for patients’ quality of life and well-being. For example, some patients suffer from persistent dry mouth following radiotherapy due to the nearly unavoidable exposure of the salivary glands to radiation. This makes talking and eating difficult. Proton treatment can prevent these adverse effects. Whether and which adverse effects may occur largely depends on the particular indication. Your physician will explain this to you in more detail during the consultation.

Are there any large-scale studies comparing proton and X-ray therapy ?

For ethical reasons, prospective comparative studies in medicine cannot include more than 10,000 patients in each group. The radiation protection legislation in force today precludes comparative studies between protons and X-rays because participants are subjected to a high radiation load during radiotherapy. However, there are empirical evaluations for more than 70,000 patients worldwide. This number continues to grow, providing a growing body of evidence corroborating the success of this therapy.

What clinical studies on proton radiation have been completed to date?

For more information, please see the section entitled "Clinical Case Studies". Your attending physician may review these studies on the appropriate professional portals such as:

Are there already case studies/statistics on proton therapy at the RPTC?

Click here for a list of tumors that have already been treated at the RPTC.

Given the launch in March 2009, there are currently insufficient analyzable data available. Cancer statistics are usually published only at the 5-year mark. However, statistics compiled abroad are already available.

What kind of track record does the RPTC have?

The successful treatment of tumors generally has to be tracked over the long term. Our case studies can give you some initial impressions.

What is the advantage of proton therapy over other modern radiation methods, such as IMRT, Cyber Knife or Rapid Arc?

All of the methods mentioned above configure the dose for tumor localization better than their predecessor methods, but they all rely on X-ray radiation, posing a hazard to healthy tissue. The physical problems of X-ray radiation – X-rays are a “shoot-through method“ – are still present.

Isn’t it possible to deliver a high dose to the tumor with the IMRT method (Intensity Modulated Radio-Therapy with X-rays) just as with proton radiation?

With the IMRT method, it is actually often easier than with conventional X-ray radiation to modulate the 100% isodose (the limit of the area of radiation which receives the full tumor dose = 100%) to the planning volume. Achieving the full tumor dose in this area, however, generally comes at the price of considerably higher doses in the healthy tissue and correspondingly greater adverse effects than with proton therapy. Also, the IMRT method cannot change the physical limits of X-ray radiation. X-ray radiation has a harmful-to-helpful radiation ratio that is up to three times higher than proton radiation.

The tumor is frequently surrounded by smaller metastases of cancer cells. Could the steeper decline in dose at the border between healthy and diseased tissue with proton therapy (compared to X-ray therapy) mean that these malignant metastases do not get?

It is absolutely correct that the macroscopic (detectable by magnetic resonance imaging or CT scanning) tumor is frequently surrounded by even smaller areas of cell metastasis. This is precisely the reason why a safety margin – similar to the one also in X-ray radiotherapy as well, incidentally – is always included around the tumor. The margin area always encompasses any undetectable metastases and the immediate lymph drainage area. Ideally, this total volume, known as the clinical target volume, is irradiated with the full tumor dose. The tissue outside of the clinical target volume which is free of small tumor metastases can then benefit from the steep decline in radiation dose which is typical of proton radiation.

In addition, using the scanning method in proton therapy makes it possible to copy nearly any X-ray irradiation plan in the wider area around the tumor. Thus, for example, an area around the tumor could be irradiated with a lower dose of protons to simulate the dose decrease that is normally blurred in the case of photon radiation. Even here, the healthy tissue outside of this transitional margin would still receive significantly less damaging radiation than it would with photon radiation. Because protons permit this steep decrease in dose, in practical usage, the high dose area can be extended further “past” the tumor wherever needed. With X-rays, the “blurring” often forces technicians to direct radiation back closer to the tumor!

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