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Cancer on firing line

05-07 4Synchrotron Accelerator Room en.jpg
Mayo Clinic Physicist and Ph.D. Michael Herman discusses proton beam technology in the Synchrotron Accelerator Room in the Richard O. Jacobson Building.

After years of development and construction, Mayo Clinic will formally unveil the Richard O. Jacobson Building on Saturday, with proton beam radiation treatment of cancer patients to begin next month.

The long-awaited event comes 13 years after Mayo began research on the idea, four years after it announced a $100 million gift from its namesake donor, three-and-a-half years after breaking ground, three years since a daylong pour of concrete needed to build 8-foot underground walls and two years after the final beam was lifted into place.

It completes a complex project that dominated the north end of downtown for years and incorporates a $10 million gift from Lawrence W. and Marilyn W. Matteson to launch the clinic into the growing field of proton beam radiation therapy. The project is one of two planned proton beam facilities announced by the clinic in 2010, with the other now underway in Scottsdale, Ariz.

During a tour of the site offered to the Post-Bulletin, Mayo radiation oncologist and proton beam therapy program director Dr. Robert Foote described his feelings at the center's long-in-the-making moment of completion.

"Ecstatic," said Foote with quiet exuberance. "We're very excited to finally open after all these years of planning and construction. Now, we get to cure cancer."

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When it comes to shrinking tumors, proton beam technology has unique advantages over traditional radiation therapy. Because the beam can be managed to shed all of its energy at a specified peak at the end of its trajectory, it does not expose surrounding tissues with as much radiation or even exit the body with damaging radiation, minimizing side effects that carry their own medical and human costs.

In addition, Mayo has invested in "pencil beam" technology, a smaller, 5 mm diameter beam containing tens of millions of charged particles painted across the tumor by image-assisted, individualized prescription. Patients will receive the treatment in its four rooms via 5 minute-long exposures and two to three beams in fixed positions. Patients generally return for 25 to 30 treatments over the course of five weeks.

Engineering, health innovations

The center comes on line with a host of other engineering and health-delivery innovations -- refinements in design and technology that are either unique to the facility or found only among a small number of locations offering proton beam therapy.

As a feat of engineering, the $188 million center's hardware and infrastructure has a closer resemblance to large-scale public-sector initiatives. It includes a particle accelerator that uses magnets to spin protons to 60 percent of the speed of light, particles which are then shot along a hundred yard long beam that can be directed into one treatment room at a time. The entire room is encased in eight feet of concrete to meet radiation shielding standards.

Its four rotating 160-ton gantries and underground proton accelerator showcase technologies first made possible by the decades-old use of particle physics in medicine. They also illustrate the modern costs required to offer the latest in radiation oncology.

The Richard O. Jacobson Building merges those priorities with features familiar to all signature Mayo buildings — attention to patient efficiencies and the intent to integrate multiple care systems at the level of design.

To reduce disruptions in care and increase the use of the treatment rooms, for example, waiting areas in the Jacobson Building feed into changing areas and patient consultation rooms. These then merge with physician-designed anesthesia suites — long poses require young children be treated under anesthesia — and designers situated the technology in close proximity to proton beam treatment areas, a Mayo innovation. (Other facilities tie up treatment rooms with anesthesia services.) Nearby MRI rooms enable the Jacobson Building staff to monitor progress on tumor shrinkage without transferring anesthetized patients into a separate building on campus.

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Because the center places childhood cancers among its first priorities, Jacobson Building patient areas, hallways and even ceiling views are designed with the needs of children and adults in mind. Halls are adorned with regional nature photography and playful artwork. Those same hallways perform a functional role when it comes to accommodating the laws of physics: Because stray decaying neutrons do not turn corners well, the corridors approaching the treatment rooms are designed in subtle zig-zag configurations.

It's been a long road to this point, not just because of the considerable demands of the project. An added weight on its construction arose thanks to timing: Its construction was marked by the start of the Affordable Care Act in 2010 and the clinic's Destination Medical Center plan in 2013.

The DMC initiative has surmounted legislative hurdles, but the proton beam centers triggered debates about rising medical costs and the penning of an opinion article in the New York Times calling it "exhibit A" for a "medical arms race" to develop the expensive machinery.

The therapy costs 70 percent more than regular radiation therapy according to some estimates, and coverage by insurers remains an early hurdle, but Foote says the clinic has no concerns about demand for proton beam therapy. Critics foresaw a future in which expensive treatment centers sit within close proximity of one another and elevate costs for as yet uncertain outcomes. (Research is still needed on the question of its advantages in prostate cancer.) In response, Mayo Clinic CEO John Noseworthy wrote all Mayo proton beam therapy patients will become part of a registry to track outcomes, and the clinic "will use the proton beam only if it is the best treatment for the right patients."

For Foote, the technology's benefits for children are clear. Organs are developing in children, and excess radiation causes extra medical problems as they age.

"We can cure 85 percent of kids with cancers," he says, "but two-thirds of them will have chronic health problems related to the radiation exposure of conventional treatment. Twenty percent of them will die. It can take decades to emerge."

Mayo research published in the journal Radiation Oncology shows early proton beam technology exposed children with Hodgkin lymphoma to 50 percent less radiation than conventional therapy. Data from early proton beam patients show the return of malignancy was reduced from 12.8 percent to 6.4 percent.

"In a sub-population," he said, "it eliminated side effects completely."

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