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Proton beam therapy at Manchester’s Christie Hospital

23 April, 2019

Manchester. If you aren’t from the area, it might conjure images of post-industrial decline: derelict factories and miserable streets, United vs. City in the smog and the drizzle, Ewan McColl’s eponymous “Dirty Old Town”. And you’d be wrong (well, partly). From its days as the red-bricked hub of the Industrial Revolution, to the glass towers rising into its modern-day skyline, Manchester has always been a city of progress, pushing the boundaries of what is possible. Here was where Rolls met Royce; where Pankhurst led the way for women’s suffrage; where scientists first developed the stored-program computer and split the atom.

The latter of those breakthroughs is all the more relevant today, as it paved the way for an advance in cancer treatment that has just become available for the first time in the UK. It seems fitting, then, that the first centre to offer this treatment – proton beam therapy – for cancer is in Manchester.

The Christie

The Christie Hospital is a Manchester institution and a trailblazer in its own right. It has been the site of a number of world firsts in cancer treatment: the first use of cultured bone marrow for leukaemia treatment; the first single harvest blood stem-cell transplant; the invention of photo-dynamic therapy for skin cancer.

The cancer centre was established way back in 1892, named for Richard and Mary Christie who helped to found the organisation. It has been providing care for cancer patients for over a century. Funded partially by the NHS (it became part of the then-new organisation in 1948) and partially by donations to the Christie Charity, it is now the largest single-site cancer treatment centres in Europe, with over 44,000 patients treated per year. Top Doctors Damir Kosutic, Noel William Clarke, and Gareth Evans are among the skilled clinicians who practice there.

The Christie © Copyright Gerald England and licensed for reuse under this Creative Commons Licence.

Being born in nearby Ashton, I have grown up, lived, and worked in Manchester and the surrounding area most of my life. In that time, I have crossed paths with the Christie and the incredible work they do. Many people, myself included, will have friends and relatives who have been treated there, and will probably be donating money to the charity or engaging in fundraising activities to help them to continue to provide the best treatment for cancer patients.

The opening of the new proton beam therapy service is the latest example of this.

What is proton beam therapy?

Proton beam therapy, or PBT, is an advanced form of radiotherapy, using radiation to kill cancerous cells and shrink tumours. PBT is highly precise in targeting tumours, with minimal damage to the surrounding healthy tissue compared with traditional radiotherapy.

The reason for this precision is that, unlike other forms of radiotherapy which use X-rays, PBT utilises a high-energy beam of protons, which is focussed on the tumour.

What is a proton?

Ok, protons? X-rays? PBT? Let’s slow down for a moment!

For those of us that were never too good at science or who can’t remember GCSE chemistry/physics, here’s a crash-course.

Everything in the world is made up of tiny particles called atoms. These, in turn, are made of three even tinier particles: protons, neutrons, and electrons. Protons and neutrons are clumped together in the centre of the atom, called the nucleus, while electrons whizz around, orbiting the nucleus at incredible speed. Protons are positively charged, while electrons are negatively charged.

Author: AG Caesar; Source: Wikimedia commons

For a while, atoms were thought to be the smallest type of particle, until electrons were discovered in 1897.

Then in 1909, scientists based in Manchester under Ernest Rutherford discovered the nucleus and the existence of a new particle within it: the proton. Rutherford also theorised that a third sub-atomic particle, the neutron, also existed within the nucleus, and was eventually proved correct. In 1917, Rutherford and his team successfully split the atom, resulting in the release of protons.

When fired at high energy, protons can destroy cancerous cells. They can pass through the skin like X-rays. A machine outside the body called a cyclotron is used to speed up the protons, providing them with the high level of energy they need to reach the required depth in the body to hit their target.

A UK first

Proton beam therapy is a relatively new development in the field of cancer treatment. Research is ongoing, with scientists agreeing that there are a number of challenges to overcome before it reaches its full potential. That said, it has proven useful in treating a number of different kinds of cancer, mainly in the United States.

The Harvard Cyclotron Laboratory began treating patients in 1961, treating 12,000 patients before closing in 2002 to make way for the Frances H Burr Proton Therapy Center at Massachusetts General Hospital. With advances in technology and a greater understanding of how proton beam therapy can help, the first hospital-based high-energy proton facility exclusively for patients opened at Loma Linda in California in 1990. Ever since, there has been increasing interest in PBT from both clinical oncologists and manufacturers, resulting in more and more hospitals investing in the treatment.

The last decade has seen proton beam therapy facilities open in France, Germany, Italy, Poland, Russia and Sweden, with many more planned. Finally having reached British shores, it seems somewhat poetic that a treatment utilising protons has come home to the city where they were discovered all those years ago. A second unit in the UK is planned to open at University College London Hospitals, London in 2020.

The Christie charity

Although officially an NHS trust, The Christie frequently goes above and beyond what the NHS can fund to provide its patients with the best treatment options and cutting-edge techniques, such as PBT. It manages to do this thanks to the kindness of public donations to the Christie Charity. One of the largest hospital charities in the UK, £15.4m was raised last year thanks to the dedicated volunteers and fundraisers. If you are interested in learning more about The Christie Charity, visit their site.