SINGAPORE - An 18-year-old woman from the United Arab Emirates will become the first patient in Singapore to receive state-of-the-art proton beam therapy to shrink any remnants of a cancer tumour in her nose. Her treatment will start this week.
After a two-year delay, largely due to the Covid-19 pandemic, Singapore’s first proton beam system is finally operational.
On Monday, Mount Elizabeth Novena Hospital (MNH) became the first healthcare institution to receive the licence to operate this multimillion-dollar system.
Two others, the National Cancer Centre Singapore (NCCS) and the Singapore Institute of Advanced Medicine Holdings (SAM), are waiting to obtain their licence to start similar treatment.
Each proton beam machine costs between $80 million and $100 million. The one at the NCCS is the most expensive as it will have four gantries – each containing a large magnet to focus and direct the beam – for patients and one for research, while the systems at the other two locations have one gantry each.
The availability of proton therapy here is great news for patients who have cancers located in sensitive areas such as the head or the neck.
Oncologists here will no longer need to send their patients to Taiwan or South Korea for such treatment. Thailand also has proton therapy since early last year, but its use is currently restricted to Thai nationals.
While proton therapy is no better at killing cancer cells or shrinking tumours than conventional radiotherapy, it causes significantly far less damage to surrounding healthy tissues and organs.
This is because with proton therapy, the beam stops where the tumour is. With conventional radiotherapy, the beam that destroys the cancerous cells goes all the way through the body, causing damage along its path.
Dr Lee Kuo Ann, a radiation oncologist at MNH, explained: “Proton particles stop in the tumour and do not expose normal tissues on the other side of the tumour to radiation.”
This should reduce side effects, he said, and will reduce growth and developmental issues in children and young adults.
He said Ms Fatema Khilfa, the woman from the UAE, is a good candidate for proton therapy, given the location of the tumour. She has been successfully operated on and now needs radiotherapy to reduce the risk of the cancer recurring.
Using proton beam instead of conventional radiotherapy “should reduce the severity of loss of taste, mouth ulcers and dry mouth”. It also reduces any future risk of radiation-induced cancers, he said.
SAM’s chief operating officer Paul Yeo said there is much less collateral damage from radiation to normal tissue.
“When protons enter the body, they do so with very little dose deposition at the entrance region, but will deposit all of their energy (dose) over the tumour target. There is no dose beyond the target.”
At MNH, treatment will usually be carried out five days a week for up to eight weeks. Each session lasts about 30 minutes – although the actual radiation takes only five minutes – because of the need for precise positioning. Treatment is usually painless, and patients can resume normal activities after each session.
But the added benefit comes with a hefty price tag.
Dr Peter Chow, MNH’s chief executive officer, said proton beam will cost 2-2.5 times that of conventional radiotherapy.
Treatment will cost about $60,000-$70,000 at MNH. But Dr Lee said: “The reduction in side effects may translate to cost savings in managing the side effects of radiation.”
At SAM, proton beam therapy will cost about three times the price of conventional treatment, said the cancer centre’s Mr Yeo.
This is one reason the Ministry of Health (MOH) has restricted the types of cancer that proton beam is allowed to treat. Aside from tumours in the head and neck, proton beam can also be used to treat prostate cancer. In patients below the age of 25 years, it can also be used for spinal and pelvic cancers.
There is also a list of criteria for MediShield Life coverage, one of which is where the “expected rate of severe side effects from other treatments is unacceptable”.
Integrated Shield Plans (IP) provide varying cover for proton beam therapy, with the maximum capped at $100,000 a year.
MNH’s Dr Chow said his hospital will be “benchmarking treatment prices competitively against other centres in the region”. His centre has the capacity to treat up to 500 patients a year.
Both MNH and SAM expect a mix of local and foreign patients.
SAM is hoping to receive its licence to operate proton beam therapy within the month. “We have patients, including children, waiting from Singapore as well as overseas,” Mr Yeo said.
Proton beam therapy is particularly important for children with cancer in the head as it can reduce possible damage to the brain, eyes and ears, he added.
His centre expects to treat 24 to 28 patients a day once it starts.
SAM’s director of photon therapy will be Dr Robert Malyapa, who has nearly 20 years of clinical experience in treating both adults and children with proton therapy in the United States and Switzerland, Mr Yeo said.
The NCCS said it will share details of its plans for proton therapy after it receives the licence.