Last month, ADVANCE was given the opportunity to see the future of cancer therapy--up close and personal with one giant cyclotron. Proton therapy, soon to be offered at Penn Medicine's Abramson Cancer Center in Philadelphia, provides radiation dose that offers more precise delivery than conventional radiation therapy in treating tumors.

We toured the Roberts Proton Therapy Center, the first such facility in the mid-Atlantic region--joining only six centers in the nation (with three more under construction). Expected to open this winter, the excitement was palpable: this center will soon become world's most comprehensive proton therapy center.

Our day began with a seminar during which credentialed speakers explored the background of radiation and proton therapies, and detailed the importance of clinical trials and comparative effectiveness studies. Amid debate on health care and soaring costs, benefits of the new, expensive treatment must be demonstrated clinically to move the modality forward.

According to Stephen Hahn, MD, chair of the department of radiation oncology at Penn Medicine, this was one of the major missions for opening the center: "to identify those patients who really benefit from proton therapy in a meaningful way that we can measure."

Determining which patients and body parts are treated most successfully with protons is achieved through different levels of research through patient care and trials. Through partnership with the National Cancer Institute (NCI) and other groups including academic and private practice collaborations, a national registry is underway to determine the best care for the ideal patients. Health IT--including the electronic radiation oncology record--will also be playing a large role in data comparison.

Protons bring the great benefit of treating tumors with little expense to healthy tissues, with the ultimate goal of "reducing the morbidity and mortality from cancer," Dr. Hahn says. Lower doses make for shorter treatments, which means side effects and costs go down, while quality of life improves. "The more efficient we are, the less treatment time there is, the better it is for patient care," says Dr. Hahn

One thing was clear: no one was claiming that protons were the answer to cancer. Protons will work along with other methods, including conventional radiation therapy, chemotherapy and surgery, "to augment other therapies and make them work better," according to James M. Metz, MD, associate professor of radiation oncology at the University of Pennsylvania School of Medicine and a vice chair of clinical division in the department of radiation oncology.

Developments in imaging have enabled such a multidisciplinary approach, letting us know where tumors sit and how they move, notes Dr. Metz. The center will be the first proton facility with precise imaging integrated onto the equipment, enabling precise, real-time tumor tracking.

While other methods of conventional radiotherapy utilize imaging and often multidisciplinary strategies, there are accuracy limits, says Vikram Bhadrasain, MD, chief of the clinical radiation oncology branch of the NCI. "The trouble with all these technologies. [they are] very precise, but not always very accurate.We're not always able to identify boundaries with a high level of confidence."

With a new level of confidence in the promise of proton therapy, the center is projected to treat 3,000 patients a year in five rooms. Many pediatric cases will integrate protons, as well as prostate and other hard-to-treat tumor cases, including those close to critical organs such as the spinal cord.

Boasting a construction price tag as high as $150 million, precision throughout development has been paramount. Richard Maughan, PhD, professor, vice chair and director of the medical physics division in the department of radiation oncology at Penn, joined Dr. Metz in showcasing the "guts" of Penn's proton project during our visit. In an exclusive, behind-the-scenes look, check out our photo slideshow of key equipment components and video clips from the treatment underbelly and room tours.

Kerri Reeves is senior associate editor of ADVANCE.