Cancer patients in India face twin challenges when it comes to accessing proton beam therapy (PBT): there are not enough facilities offering the treatment, and the cost can run into tens of lakhs of rupees.
The PBT is considered a viable alternative to radiation for treating solid tumours, especially for head and neck cancers.
The privately-run Apollo Hospital said on Tuesday that it has treated up to 900 patients in its Chennai-based Proton Cancer Centre, of which 47% of cases are brain tumours. Patients with cancers of the prostate, ovaries, breast, lungs, bones and soft tissues have also seen promising results in terms of recovery through proton beam therapy, said Sapna Nangia, radiation oncologist at Apollo Proton Cancer Centre.
Unlike radiation which uses X-rays, PBT uses protons to tackle cancer. While radiation can prove toxic to the whole body, protons can destroy cancer cells precisely by targeting tumours, thus saving adjoining organs.
“This has proved useful in the cases of young women whose ovaries and reproductive function could be salvaged through the therapy,” Dr. Nangia said.
Apollo Hospital is the only centre in the whole of South and West Asia offering the PBT. With the Indian government shelving a project to install a PBT unit in the All India Institute of Medical Sciences (Jhajjar), there is a huge unmet need for access to the treatment, official sources told The Hindu.
Another project that is yet to see the light of day is the proposed PBT unit at the National Hadron Beam facility of Tata Memorial Hospital in Navi Mumbai. The foundation stone for the project was laid by former Prime Minister Manmohan Singh in 2014.
Over 24,000 people die each year because of brain tumours, according to the International Association of Cancer Registries. “In India, the estimated number of cancer incidence cases in 2022 was over 14 lakh,” said Harish Trivedi, CEO of Apollo Proton Cancer Centres. Even if the PBT can be helpful in select cases of cancer among these, the estimate is substantial,” Dr. Nangia says.
Children in need
According to another estimate drawn by Tata Memorial Hospital, approximately 40,000 children in India are diagnosed with cancer every year and up to 1,400 of them would potentially benefit from the PBT.
Currently there are 42 PBT machine installations in the U.S., followed by Europe (35), Japan (26), China (seven), Taiwan (three) and South Korea (two), while India has only one.
“In the U.S., each unit of proton beam therapy serves a population of 7.9 million, while in India there is one unit for 1,412 million people. The ratio is very skewed,” Dr. Nangia explained.
The PBT unit in the AIIMS was meant to benefit poor patients as the treatment would have been free of cost. Currently, Apollo Hospital has been able to reduce the cost from nearly ₹1.2 crore (as charged in the U.S.) to between ₹5 lakh and ₹30 lakh, Mr. Trivedi added.
But setting up a PBT centre is fraught with infrastructural and regulatory challenges stemming from safety concerns from the Department of Atomic Energy. A PBT machine is a huge contraption, up to three storeys tall and costs nearly ₹500 crore. “Apollo has imported the machine from France-based Ion Beam Applications. Other companies like Japanese MNC Hitachi and U.S.-based Varian Medical Systems manufacture the high-end expensive contraption,” Dr. Nangia said.
Mr. Trivedi added, “Also, there are concerns of safety, as hydrogen is a highly volatile element and we have to run daily checks to prevent leak.”
