As Noah Reeb takes an inventory of blessings — “my home, my favorite sports, my friends, my family, my dogs” — one point of gratitude prompts glee beyond what might be expected of a 9-year-old with brain cancer.
“I’m so happy!” Reeb cheers. “I don’t have to leave!”
Reeb is one of the first patients to receive proton therapy, an advanced form of radiation treatment, in the Mountain West.
Long restricted to bigger cities, the new Senator Orrin G. Hatch Proton Therapy Center at the Huntsman Cancer Institute in Salt Lake City is poised to treat hundreds of patients who previously would have to relocate for the therapy or forego it altogether.
“It’s just a miracle,” said Taylor Lambert, whose six-week treatment for a brain tumor is nearly over. “It got up and running right in the nick of time for me.”
If her only option had been to go out of state for the treatment, she added, “My husband ... couldn’t leave his job for a month and a half. So we wouldn’t have been able to afford it.”
(Chris Samuels | The Salt Lake Tribune) Bill Salter, senior director of radiation oncology at the Huntsman Cancer Institute, shows the institute's new proton therapy machine for treating cancer, Tuesday, June 22, 2021.
Proton therapy is a more focused, precise form of radiation than the traditional photon therapy.
In photon therapy, radiation passes into the body, through the cancer, and continues out of the body behind it. The rays are aimed at multiple angles so the cancer gets the brunt of the radiation — but the tissue around the cancer also is exposed to low doses, said oncologist Dr. Ryan Price.
That exposure can cause organ damage or even trigger new cancer development, said Dr. Matthew Poppe, another oncologist at the institute.
Proton therapy drastically reduces that risk because the ray enters the body and stops on the cancer itself rather than passing through it. That means far less tissue is exposed to the radiation.
“It’s able to target that specific area rather than blasting through my brain with radiation,” Lambert said. With her tumor pressing against her pituitary gland, she said, that reduces the risk of future endocrine problems from 3% to 5% with conventional radiation, to about 1% with proton therapy.
Meanwhile, the lower, more focused doses can reduce side effects like nausea and diarrhea and may require fewer treatments, said Dr. Robert Foote, an oncologist at the Mayo Clinic in Rochester, Minn. Those improvements can drastically improve patients’ quality of life while they are undergoing treatments, he said.
“People feel better, they don’t need to be hospitalized as frequently or on as many medications, and they can continue to work,” Foote said.
But not every cancer patient who needs radiation will be eligible for the upgrade. About 2,000 to 2,500 patients a year undergo radiation treatment at Huntsman Cancer Institute, Poppe said, but the new proton therapy facility will be able to treat only about 250 patients a year.
“We’re going to quickly find the need is more than our capacity,” Price said.
For some patients, the benefits of proton therapy are too slim to justify filling such a high-demand slot. For instance, Price said, “it’s a wash” if the cancer is growing in a part of the body that isn’t prone to organ damage in conventional radiation treatments.
And some patients opt out, Foote said, because their insurance plans still don’t cover proton therapy even though it has become more effective and less expensive.
“it’s just taken years for the technology to mature and develop to the point where you can manufacture [the machinery] commercially. Initially the equipment was quite expensive ... but like most things, it becomes smaller, faster and less expensive,” Foote said.
The system at the University of Utah campus, for example, is unusually compact, said engineer Adam Bunker-Worley. The equipment that generates the radiation there is adjacent to the equipment that administers it; in other facilities, the radiation typically travels in pipes between two separate structures.
(Chris Samuels | The Salt Lake Tribune) Bill Salter, senior director of radiation oncology at the Huntsman Cancer Institute, shows the 125-ton gantry and cyclotron that comprise the institute's new proton therapy machine for treating cancer, Tuesday, June 22, 2021.
Because proton therapy so significantly reduces the risk that radiation will later cause new cancer, children are often high-priority candidates, Price said.
Children have longer to live after their treatments, Poppe said, which means the mutations that the radiation causes in surrounding tissue have more time to trigger new cancer developments. Radiation causes secondary cancer in one in every 1,000 adults who undergo it, Poppe said; in children, the risk is 10 to 30 times higher.
Meanwhile, the risk that conventional radiation treatments will cause organ damage also may be higher in children — especially those whose cancer is in still-developing brains.
“That can affect memory, IQ, hormone production,” Poppe listed.
While Lambert, 23, said she would have accepted the elevated risks of conventional radiation therapy in Utah if proton therapy hadn’t been available here, the benefits to 9-year-old Reeb would have been too significant to pass up.
In December, Reeb began having sudden and severe headaches, and doctors in February found a tumor the size of a ping pong ball in the center of his brain, said his father, James. Had proton therapy not launched at the Huntsman Cancer Center during his treatment, Noah Reeb would have had to move temporarily to another city; the facilities nearest to his Highland home previously were in Seattle, Phoenix and San Diego.
“It would have split up the family right when he needed all of us,” said Reeb’s mother, Jacque.
Instead, Reeb has been playing flag football with his friends, seeing his sisters every day, and asking his parents for high-energy music playlists to listen to during treatments, even though they’re not sure he can lie still under the proton beam while captivated by a bop.
“I’m just happy to be able to stay in the state,” Jacque said.
