Proton Therapy: Advanced Cancer Treatment for Kids – PediaCast 553

Show Notes


  • Dr Timothy Cripe, Dr Joshua Palmer, and Kayla Young visit the studio as we explore proton therapy as a treatment for pediatric cancer. Discover how this technology delivers precise radiation with fewer side effects. We hope you can join us!


  • Proton Therapy
  • Radiation Oncology
  • Pediatric Cancer




Episode Transcript

Announcer:     This is Pediacast. ♪♪♪ Welcome to Pediacast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr Mike Patrick:     Hello everyone and welcome once again to PediaCast it is a pediatric podcast for moms and dads This is dr. Mike coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio It's episode 553 we're calling this 1 proton therapy advanced cancer treatment for kids want to welcome all of you to the program. So we have a really interesting and high tech topic for you this week, proton therapy. And it's really interesting and offers a lot of promise for the future and we'll talk more about that in just a moment Before we get into that though.

Dr Mike Patrick:     I wanted to mention you may or may not know this but the 96th edition of the Academy Awards So the Oscars are gonna air on March 10th on ABC So, you know we have a little bit over a month before the Oscars are on TV. And most of the movies that are up for best picture this year are streaming, or they soon will be. And I thought it might be fun to watch all of those between now and then, and the big show, and then watch the Oscars and see if, if I agree with those whose opinions actually matter. And so I just wanted to share with you a link that I found called where to stream the 2024 Oscar nominees So they're all on 1 page. You can find them easily So if that sounds like something fun to do after the kids go to bed, you know between now and March 10th Watching all of those it makes the it makes watching the the award show a little bit more interesting when you have seen all the shows, or the movies that are up for best picture.

Dr Mike Patrick:     I've already seen Oppenheimer and Barbie. I feel like most of America saw those 2. But I've also seen Killers of the Flower Moon, which was, I really enjoyed, but that leaves The Holdovers, Maestro, Anatomy of a Fall, Past Lives, American Fiction, Poor Things and The Zone of Interest. So Lots more movies that I need to get caught up on if I want to be informed during the Academy Awards, which, you know, here in Ohio in the winter, when it's gray and cloudy and cold outside, it's always nice to have something to look forward to. And so I am, that's My plan is to watch those between now and March 10th.

Dr Mike Patrick:     And I just wanted to mention it and share that link in case it's something that would be interesting for your family as well. Of course, not all of those movies are going to be appropriate for children. But again, that's why I said after the kids go to bed, this is a parent thing. All right. So let's get into our topic a little bit more today.

Dr Mike Patrick:     Proton therapy, it is a form of radiation therapy, but it uses beams of protons rather than light waves to deliver the radiation. And the advantage to that is a little bit of a spoiler alert, but we're going to go into a lot more detail during the course of the program. But it does allow for precise focus of the beam as opposed to light rays, protons you can focus better. And we'll explain why that is. And then that helps to minimize surrounding tissue damage.

Dr Mike Patrick:     And so we see fewer side effects and fewer long-term consequences because the radiation was more likely delivered right where we wanted it to be. And so we're gonna explore how this relatively new technology is being used with a focus of course on pediatric cancer And we have a 3 terrific guests with us this week. Dr. Timothy Kripe. He is the chief of hematology and oncology at Nationwide Children's Hospital Dr.

Dr Mike Patrick:     Joshua Palmer is a radiation oncologist at the James Comprehensive Cancer Center and Kayla Young is an oncology nurse Also with the James so they will be here soon before we get to them I do want to remind you you can find PDA cast wherever Podcasts are found And we do really appreciate when you leave a review, wherever you listen to podcasts so that others who come along looking for evidence-based child health and parenting information will know what to expect. We're also on social media, Facebook, Instagram threads, LinkedIn, and Twitter X simply search for PDA Cast. And the handy contact page is over at if you would like to suggest a future topic for the program. Or if you just want to say hi, that's great too. I read all of those.

Dr Mike Patrick:     Also, I want to remind you the information presented in PDA Cast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider. Also, your use of this audio program is subject to the Pediacast terms of use agreement, which you can find at So let's take a quick break.

Dr Mike Patrick:     We'll get our expert panel settled into the studio, and then we will be back to talk about proton therapy. It's coming up right after this. Dr. Timothy Kripe is division chief of hematology and oncology at Nationwide Children's Hospital and a professor of pediatrics at the Ohio State University College of Medicine. Dr.

Dr Mike Patrick:     Joshua Palmer is a radiation oncologist at the James Comprehensive Cancer Center and an associate professor of radiation oncology at Ohio State. Kayla Young is an oncology nurse in the Proton Therapy Center at Ohio State. They all have a passion for treating and supporting patients and families impacted by cancer, and they are excited to share a relatively new treatment option for some pediatric cancers, an option known as proton therapy. But before we get into that, let's offer a warm Pediacast welcome to our guests, Dr. Tim Kripe, Dr.

Dr Mike Patrick:     Joshua Palmer, and Kayla Young. Thank you all so much for stopping by today.

Dr Timothy Cripe:     Thanks for having us.

Dr Joshua Palmer:     Thank you so much, Peng. Great to be here.

Dr Mike Patrick:     All right, Dr. Palmer, I wanted to start with you. What exactly is proton therapy? I'm sure that this is a term that a lot of folks have not heard of before. What exactly is that?

Dr Joshua Palmer:     It's a great question. We get it a lot from patients and families. Proton therapy refers to a type of radiation treatment that allows for a lower side effect treatment to be delivered. So proton therapy in juxtaposing to what is the most commonly delivered radiation treatment, which is photon therapy. Just to kind of as a background, photon therapy you can think of as light therapy.

Dr Joshua Palmer:     So a light particle will pass all the way through a patient and so that deposits radiation dose through its path length. So the entire area, including the tumor and areas outside of the tumor, will get some radiation exposure or some radiation dose. With proton therapy, we are using a heavy particle, and that's being accelerated, and it has a certain path length. And so by the unique characteristics of the proton beam, it can only pass in and it does not pass out. So we exploit that capability with proton beam treatments to essentially pass into where the tumor is and not radiate or treat areas that are nearby because of the fact that it doesn't pass out near critical areas or normal tissues.

Dr Joshua Palmer:     And so that's quite useful for certain tumor locations and to prevent long-term side effects. And so it sort of is a newer version of radiation therapy that allows for lower side effects.

Dr Mike Patrick:     So this is really the difference between this and conventional radiation therapy, Tim, and correct me if I'm wrong about this, but then the radiation is being carried by something different?

Dr Timothy Cripe:     Well, a little bit, yes, because as Josh mentioned, it's a heavy particle, it's a proton, it's basically what's in the nucleus of a hydrogen atom, stripped of the electron that circulates it. And that particle, because it has mass and weight, it can be controlled more and can deposit the energy. But it doesn't just exist in nature as a high-energy substance. It has to be accelerated. It has to be moved into…

Dr Timothy Cripe:     So there's this incredible cyclotron that's in the center there, that's behind 20 feet concrete walls and that uses electromagnetic forces to take that positively charged proton and accelerate it to 2 3rds the speed of light to then deposit that energy into the patient. It's really a phenomenal physics endeavor.

Dr Mike Patrick:     Yeah, so I just, because I wanna be really clear, and there's part of this that I don't exactly understand, even as a physician, and as moms and dads are listening, it might be difficult. So radiation therapy, you are basically destroying cancer cells with the radiation, or you change their DNA,

Dr Joshua Palmer:     or how exactly does the radiation therapy itself work? So that's a great question. So The mechanism by which the radiation causes this damage is an indirect damage, meaning that when the radiation passes into the cell, it will interact with water and cause free radicals. Those free radicals will then cause damage to the DNA, both single strand and double strand, and by far the most likely is single strand injury, and then that, given enough time, will kill the cell. The important thing about radiation treatment, the way that we deliver it, is that we try to deliver it to as little normal tissue as possible and we do it in a way that allows for normal tissue to repair.

Dr Joshua Palmer:     And that's an important aspect of radiation biology that the Radiation doesn't then cause a ton of damage or lots of second cancers because the body naturally has these mechanisms to repair single-strand damage. The also important thing is that the tumors don't have this capability. They've accrued enough mutations to not allow easy repair of this damage. And so they will preferentially die in given daily fractionated radiation therapy. And so you can imagine that the proton beam and the photon beam, and we also occasionally will use electron beam radiation therapy, all cause this indirect damage to DNA.

Dr Joshua Palmer:     CB. Yeah. So it's interesting because we think about UV light exposure causing cancer,

Dr Mike Patrick:     but then we can also treat cancer. But it all comes down to the radiation damaging the DNA in 1 way or another. And then that can turn a normal cell into a cancer cell, but it can also kill a cancer cell.

Dr Joshua Palmer:     KB it's exactly right.

Dr Mike Patrick:     CB And then I want to bring you in Kayla, as we think about children and proton therapy, what are the key benefits of this treatment as we think about children?

Kayla Young:     Some of the key benefits of proton therapy for children are it provides targeted treatment of tumors near or within sensitive organs while limiting radiation exposure to healthy tissues. This is vital in children whose bodies are still growing and developing. Additionally, proton therapy can result in fewer late effects from treatment, such as limiting the impact on neurological developments and avoiding damage to reproductive organs and protecting fertility. Proton therapy can also reduce side effects during treatment, often allowing children to better tolerate proton therapy. Dr.

Dr Mike Patrick:     Daniel DiLorio And the fewer side effects is because you're damaging, you're only really focused in on where the cancer is. And so healthy tissue is not getting exposed to that radiation as much. And that healthy tissue getting exposed to radiation is what causes the side effects of more traditional radiation treatments.

Kayla Young:     Yeah, that's correct.

Dr Mike Patrick:     And then Dr. Palmer, what challenges or risks, so this sounds great, but there must be some challenges or risks that are associated with this treatment. What are those?

Dr Joshua Palmer:     It's true that there's no perfect tool when it comes to cancer treatment, and there's a lot of benefits to certain treatment types and some sort of trade-offs that we have to make. With proton therapy, the challenge becomes the dependence on density and tissue changes. So I'll kind of go back to the example with photon therapy, it's sort of like hitting the right target, like shooting at a target on the wall. As long as you know that you're hitting the same location, you know that that treatment is very likely to work. With proton therapy, because again, it's so driven in, doesn't exit, and it's a heavy particle, it depends on what it's passing through, where it's going to stop.

Dr Joshua Palmer:     If someone gains weight, loses weight, has some change in internal anatomy, so sometimes if we're treating an area near lungs or in the head and neck where there could be mucus changes or changes in the lungs' density, that can actually change where the proton beam goes Because air density, tissue density, bone density will all change the path length of the proton, so that could mean the difference of putting it into an area that could injure or missing the tumor. And so there's trade-offs in terms of the location of where we're treating and how feasible or accurate we can be. And it's also very challenging for similar reasons to hit moving targets. Because a moving target, we have to be very careful that we're hitting the right location and sort of the confidence that our radiation dose is what we planned it to be. And so we have to do a lot more quality assurance and secondary checks and imaging daily and weekly to make certain that we're doing it correctly.

Dr Joshua Palmer:     So it does introduce a lot more error, potentially, to make certain that it's accurate. But we take a lot of caution and build in a lot of checks to make certain that the treatment every day is delivered properly.

Dr Mike Patrick:     And when you say moving target, you know, my thought as you were saying that is that kids can very easily be moving targets. So how are you able to keep them still during this?

Dr Joshua Palmer:     Good question. So we do use immobilization techniques. And so for certain locations, a mask might be used or certain immobilization devices are used to keep someone still and in a precise location. But depending on age and their ability to listen to instructions, some children may require anesthesia. And So if there's some concern that the patient might actually move, then we use anesthesia.

Dr Joshua Palmer:     We also sometimes will distract patients with music or movies while they're getting treatment to try to continue to keep them lying still. Typically the moving target would be something like a tumor in the mediastinum of the chest, an area that moves with breathing in the heart rhythm, or an area in the abdominal cavity that might move with breathing. For instance, the liver. Areas that have mobile organs can be very challenging for us to treat because those changes can change where the dose goes.

Dr Mike Patrick:     As you give each dose, how long does that process take?

Dr Joshua Palmer:     Good question. So the treatment is a little bit longer with protons, just because of the large physical size of the machine and how it has to rotate. It's a very massive treatment machine. And each delivery of usually 3, sometimes 4 beams, will take about 10 minutes per beam.

Dr Mike Patrick:     Okay, yeah, and that's, I mean, 10 minutes with a moving toddler or a toddler that wants to move could certainly be a challenge, so we can understand why anesthesia might be necessary for that. In terms of recovery, so we know that we have fewer side effects. Do any side effects that do occur typically last about the same amount of time as you compare proton therapy to traditional radiation therapy?

Dr Joshua Palmer:     We typically think of the side effect profiles to be relatively similar in that the time frame of an acute side effect, both during and within the first 30 days, those symptoms will be similar in their timing. But we think of the proton beam treatment will likely have fewer or less intense side effects just because the dose will be less to those organs. And in some cases, it's no dose to many organs, so the side effect profile would just be much better tolerated. The late side effects, there is some interesting changes with proton therapy. We do think that things like long-term damage will be less because many organs are spared of radiation treatment.

Dr Joshua Palmer:     But things like secondary cancers happen less, but happen earlier with proton therapy. The photon-based therapy is usually 10 to 20 years later. With proton therapy, it can happen up to about 3 to 10 years later. But the chance of all of those side effects is far fewer.

Dr Mike Patrick:     Daniel Caneside It is so interesting to me because as we think about skin cancer, for example, and I use this just because with UV light, it's kind of like photon radiation. Actually, it is photon radiation. So, you know, the more often that you're exposed to it, the more chances that you'll end up that DNA got damaged and your regular cellular repair processes didn't happen. But what is it that then makes it like 10 years later that the cancer shows up? Like that's hard for me to understand.

Dr Joshua Palmer:     That's an interesting question and kind of why the radiation biology is important for both protons and photons. The main reason why there's such a long latency period is due to just the accrual of mutations. And it's sort of this random chance. So you can think of it as similar to your example of, say, photon therapy. Exposure and length of exposure does increase the risk, but even say low risk time periods can lead to cancer if you're unlucky.

Dr Joshua Palmer:     And so, what'll happen is if you get this exposure and it causes certain types of DNA injury, and that injury is not repaired, then those mutations, it's kind of like starting like something very small. That small injury that doesn't get repaired may sit around for a while, and then eventually more mutations will occur, and then more mutations will occur, and then over that 5, 10, 20 year period, you start to develop a cancer, if that makes sense. So it's kind of like it was always there, but it doesn't manifest in a visible way for many, for like a decade or 2. And so, it takes that long latency to go through the process similar to you can imagine really how people get cancers in general is this evasion of the ability to repair. And that happens many decades before we actually catch most of these cancers these days.

Dr Mike Patrick:     So if we had a way of figuring out that some of our cells are misbehaving earlier, that would be a great thing, but we certainly aren't there yet. Exactly. Tim, what pediatric cancers then are most commonly treated with proton therapy? I imagine that this isn't so great for leukemia, for example, where the cancer cells are floating around in the bloodstream, but I guess solid tumors are going to be the more likely candidate for treatment with proton therapy?

Dr Timothy Cripe:     Yes, that's correct. And the most common solid tumor in children is brain cancer, the cancers of the brain and spine, what we call the central nervous system. And those actually are the most common cause of death due to disease in children, all comers. So it's very important that we can increase our ability to treat these patients. And radiation has always been 1 of the mainstays of treatment for patients with brain tumors.

Dr Timothy Cripe:     It happens also to be probably the most vital organ you have, and the 1 that's growing the most and the most critical during childhood. So, any sparing of normal parts of the brain that we can and focus in on the tumor with proton therapy could have lifelong effects. So, that's the most common diagnosis that we'll use in proton therapy, tumors of the brain and the spine. But as Josh has alluded to, tumors elsewhere may be amenable. It may not be as important, say, for a tumor of the extremity where there's no vital organs around there, but almost all solid tumor patients could be treated with proton, notwithstanding the movement pieces that Josh talked about.

Dr Mike Patrick:     I know that in, especially cancer therapy in kids, as we think about chemotherapy, there are very specific guidelines for what is used and when it's used. So, for example, it doesn't really matter where I get my cancer treatment. It should, by theory, be the same because everybody's kind of on board with the same treatment plan for a particular cancer.

Dr Joshua Palmer:     Do we have those things in place with proton therapy? Do we know exactly what to give and how much and how often and all that for particular cancers in kids? We do. There are guidances of how to deliver the radiation therapy with proton therapy versus photon therapy. In general, I would say that it's a very similar overall guidance to say doing it with photon-based therapy.

Dr Joshua Palmer:     So the dose that we know works for certain disease types with photon therapy, we commonly will use a very similar regimen with proton therapy, the way that, say, a radiation oncologist will approach those particular situations can be slightly different in that we go through our process of, we do something called contouring and treatment planning, that's different. And so that process is very different than photons. But even that proton-based process for different disease types for children is very standardized. So we know that for different disease sites, we treat it in a certain way. But there are some nuances that, if you use the example of you can get chemo in multiple different centers and the chemo may be similar, the radiation machines, I use the analogy of radiation's often like how you would think of going to a surgeon, that the surgical skill and their tool set and what they have sort of technology-wise is different at different locations, and how they approach cases is different.

Dr Joshua Palmer:     And so a radiation oncologist in the center is similar to that in that the technology matters, their staff matters, and the tools that they have matter, and how they approach cases matters because it can create a lot of differences in how the radiation is delivered and sometimes the long-term toxicities because there's newer versions of proton therapy that are very capable of doing sort of this modulated proton treatment and then older ones that have more scatter-based sort of treatments that might have more what we call neutron scatter, which is a riskier version of proton therapy. And so I think in general, the newer technology is better, kind of like getting a new computer updated every few years. And the kind of overall group and size of the center sort of matters. And that can have implications on the treatment and its outcome.

Dr Mike Patrick:     Yeah, absolutely, really good points. Kayla, from the family standpoint, what can they expect when they bring their child in for treatment at a proton therapy center?

Kayla Young:     Kind of to bounce off what Dr. Palmer was talking about, every treatment is different and it just varies for the patient and their disease and their disease site. But In most cases, children are treated daily, Monday through Friday, for about 5 to 6 weeks. Treatments can take anywhere from 20 minutes to an hour, depending on whether the child needs sedation or not.

Dr Mike Patrick:     Yeah, and actually, when they come in through the door, kinda walk us through what families can expect.

Kayla Young:     Yeah, so usually we have a little child life area. So they come to our pediatric room and there we have toys, video game, interactive board for them to keep calm and have that calm environment. We also have a child life specialist here that will come in and sometimes play with the children or answer any questions that they might have. From there, 1 of our therapists from the machine will come back and grab the child, take them to the machine, and then do the setup depending on if they need a mask or whatever immobilization they might need.

Dr Mike Patrick:     And the anesthesia, if so if a child needs that and then they're getting the anesthesia day after day after day, Tim are there issues with concerns with that? I know all of this is risk versus benefit, right? And certainly the benefit of getting rid of your brain tumor is going to be worth whatever hypothetical risk, but especially in the news there's been more, you know, information about long-term effects of anesthesia in kids, and I just wonder if that's something that a concern that parents have brought to you that they may have. Dr.

Dr Timothy Cripe:     David Cronin I think when patients are in that situation, that's lower down on their list of concerns. It's something that, you know, obviously treating the cancer is utmost top of mind there. I think it's something that people may think about later on because we do have a long-term clinic, a late-effects clinic, we call it, survivor's clinic, And that's when a lot of these issues actually come out, when people sort of reflect, and they're a little bit older, and maybe the patient's even old enough to start thinking about these things. And what did I experience when I was a child? And what are the things that I need to watch out for that might develop over time.

Dr Timothy Cripe:     As Josh mentioned, some of these things can come out later. Cognitive issues, endocrinologic issues, growth abnormalities. So that's really when people start questioning that and then that kind of an issue may come up about anesthesia. I think there's still a lot of unknowns. Certainly people undergo anesthesia all the time and we have treated many patients over many, many decades with daily anesthesia for their radiation therapy and not really seen a difference.

Dr Timothy Cripe:     Dr. Palmer could correct me if I'm wrong, but I've not seen a retrospective comparison of those who got no anesthesia versus anesthesia and everything else matched to see if there's much of a difference. So I think if there is, it's subtle and not the highest priority at the time. Yeah.

Dr Mike Patrick:     And again, the benefit of treating that tumor far outweighs the risk in that situation.

Dr Timothy Cripe:     That's right.

Dr Joshua Palmer:     Yeah, and there's some literature in the anesthesia that has tried to tease out the different anesthetics that are used and whether or not 1 anesthetic is potentially worse for cognition or other late effects than others. I think there's some literature there to support that, but like Dr. Kreib mentioned, it's really challenging because you can't really match it, because historically the patients that get anesthesia, you don't have a good comparison arm because we didn't have a way to get them through without anesthesia. I think that's somewhat changing because we use now distraction devices. And So that's 1 thing kind of unique to kind of our proton therapy team and our pediatric center that we've worked for the last 5 years with a number of large pediatric centers across the US.

Dr Joshua Palmer:     There's a number of video devices for distraction that we've been able to lower the rates of anesthesia. I think in general, I think there is that potential for improvement of some of the long-term effects of daily anesthesia. But I think 1 of the main things we try to prevent is the trauma that surrounds going to sleep and waking up and having those difficult times for weeks at a time. That creates a lot of potential long-term, I would say, emotional effects, I think are relevant. So we try to, in many kids, get them through in a less traumatizing and less anesthesia method, which we use some of the heads-up display movie techniques.

Dr Joshua Palmer:     And over the last 5 years, I would say at the centers that are using these, there's, I would say, probably at least a 50% decline in patients needing anesthesia, which we view as sort of a win because those patients are getting through with less overall traumatic experiences and hopefully benefiting from that long-term. Obviously, because this is a more recent change in radiation oncology and really only affects the U.S., we need much longer outcomes in here. But we have published on those in a prospective trial using this device across a number of centers, including our main collaborators at St. Jude's and Stanford University, but a number of different centers across the US now are trying to integrate this into practice to try to lower the rates of anesthesia.

Dr Mike Patrick:     And I would imagine that as kids, as it becomes a sort of a daily routine, sort of get better with it as time goes on because they know what to expect, there aren't any surprises. Do you see that, Kayla?

Kayla Young:     Yeah, we definitely do see that. We've even had cases where kids will start off needing anesthesia and then halfway through, we're able to get them through without it. Sometimes we use like a light sedative, such as Medivan, just to kind of take that edge off where they can make it for or without.

Dr Mike Patrick:     Tim, what do you think are the next steps then in the advancement of proton therapy for pediatric cancers? What does the future look like?

Dr Timothy Cripe:     I think the future is bright in a number of different ways. We certainly need to continue to study the effects of protons. It is relatively new, as you've said, and so what are the really, really long-term effects and how much better it is. But the technology is constantly improving, the physics is constantly improving, and as Josh could tell you, the ability of the machine that we have installed, which is sort of best in the world at the moment, it can deliver the energy required to treat these cancers actually very quickly, much more rapidly than other machines can. And so there's the potential for what they call flash therapy, which is delivering all the radiation in 1 dose instead of 5 or 6 weeks of treatment.

Dr Timothy Cripe:     And that is looking good in animal models in preclinical, what we call preclinical studies. We will need to test that in patients before, under clinical trials, before it becomes a standard. But I could imagine in the not terribly distant future, a bit distant, but not terribly, that a patient would come in and get just 1 single dose and be done with it, which would be phenomenal.

Dr Mike Patrick:     Yeah, yeah, that would be that would be fantastic. Speaking of the the center itself in the machine that we have here at Ohio State and also used through Nationwide Children's Hospital, Joshua, what what is that place like? You gave us a little bit of a hint that it's a huge machine that there's 30 foot thick or very thick concrete walls around it and all that. Tell us a little bit more about the center.

Dr Joshua Palmer:     So we've integrated the center into what's called the James O. Patient Care Center, which is an ambulatory center that carries a lot of our services. It has imaging services as well as our pediatric service and proton therapy services. We also have the ability to use photon therapy at that center as well, which is critical because certain cancers benefit from either treatment, so we have access to both. And so the therapy center kind of all is located on the first floor, very convenient to get in and out, and allows us to have all of our pediatric team members, child life members, all kind of in 1 house ready for the pediatric patients.

Dr Mike Patrick:     Yeah, Very, very nice. I imagine that this was an expensive thing to build.

Dr Joshua Palmer:     It is. As you can imagine, we've come a long way. These treatment centers used to be about a half a billion dollars back when they were building them initially. That's what The cost was so high and the land cost was so high that it was just not feasible for most places in the world to build 1. The cost is being driven down.

Dr Joshua Palmer:     I kind of used the computer analogy earlier. As technology gets better and you can pack everything and get better designs, It's cheaper. It's still quite expensive. It would cost around $100 million for the center here, which is typical. I think it just depends.

Dr Joshua Palmer:     Like, say,

Dr Mike Patrick:     New York Proton Center costs probably double that just because land in New York is kind of scarce, but depending on where they build, it's usually $100 to $250 million. That's incredible and gives you some sense of why treatments cost a lot. Well, thank you so much, all of you, for stopping by today. Really appreciate this. It's certainly something that was not really on my radar and I hadn't heard of this and it just seems like it's something that's so important and I'm glad we're able to raise awareness for families that this treatment option exists.

Dr Mike Patrick:     So if your child, wherever you're listening from, if your child does have a brain tumor and possibly solid tumors in other parts of the body, this is something to at least ask your doctors about. And I imagine, Tim, that folks could get in touch with you even if they live far away in order to at least get an opinion on treatment and possibly have treatment here even though they may live in a different part of the country? Dr.

Dr Timothy Cripe:     Kroemer Yes, that's absolutely true. We have a number of different disease-focused teams, sarcoma team, brain tumor team, leukemia, lymphoma team, etc., that neuroblastoma, renal tumor team. And so we would connect our anyone wishing to talk with us about their situation with experts on our team and on our website we do have a remote second opinion options and ways to connect with us.

Dr Mike Patrick:     And I'll put a link in the show notes over at for this episode 553, so that folks can find that and get connected with you pretty easily. We'll also have some other interesting resources for you in the show notes, including a blog post that Dr. Kripe wrote called, What is Proton Therapy? That's an interesting 1. And then we do also have an article about the Proton Therapy Center at Ohio State that's treating children and adults.

Dr Mike Patrick:     So if you want to read more about the center itself, we'll have that link in the show notes too. So once again, Dr. Timothy Kreip, Chief of Hematology and Oncology at Nationwide Children's Hospital, Dr. Joshua Palmer, Radiation oncologist at the James Comprehensive Cancer Center and Kayla Young oncology nurse also at the James. Thank you all so much for being here today.

Dr Timothy Cripe:     Thank you, it's been fun.

Dr Joshua Palmer:     Thank you, it was a pleasure.

Kayla Young:     Thank you so much.

Dr Joshua Palmer:     We

Dr Mike Patrick:     We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PDA cast a part of it. Really do appreciate that. Also, thanks to our guests this week, Dr. Timothy Kripe, Chief of Hematology and Oncology at Nationwide Children's, Dr. Joshua Palmer, Radiation Oncologist with the James Comprehensive Cancer Center and Kayla Young, oncology nurse also at The James.

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Dr Mike Patrick:     If you would like to suggest a future topic for the program. Reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show and we love connecting with you on social media. We're on Facebook, Instagram threads, LinkedIn and Twitter X just search for PDA cast. Also want to remind you we have another podcast at Nationwide Children's called PDA cast CME that stands for continuing medical education.

Dr Mike Patrick:     It's similar to this program we turn the science up a couple notches and offer free continuing medical education credit for those who listen. And of course that includes physicians, but we also offer credit for nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. And since Nationwide Children's is jointly accredited by all of those professional organizations, it's likely we offer the exact credits you need to fulfill your state's continuing medical education requirements. Of course, you want to be sure the content of the episode matches your scope of practice. Shows and details are available at the landing site for that program,

Dr Mike Patrick:     You can also listen wherever podcasts are found. Simply search for pediacastcme. Thanks again for stopping by. And until next time, this is Dr. Mike saying, stay safe, stay healthy, and stay involved with your kids.

Dr Mike Patrick:     So long, everybody!

Announcer:     ♪ This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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