Competition is getting ready to heat up in Michigan for a controversial new form of cancer therapy. Michigan's only active center for the treatment, called proton beam therapy, in Royal Oak, celebrated its first anniversary.

Beaumont Health's Proton Therapy Center in Royal Oak treated more than 107 patients since it opened June 28, 2017, far surpassing its conservative projection of 40 patients, said Craig Stevens, M.D., Beaumont's chairman of radiation oncology.

Stevens said Beaumont attracted more than double the patients it projected its first year because its ProteusOne machine "works well." He said doctors were able to treat a wider range of cancers because they were able to configure it to do the work. Ion Beam Applications S.A. of Belgium develops ProteusOne.

"We were able to do more types of patients and larger numbers. We did more head and neck and less gynecology than we expected," Stevens said. "We didn't do as much lymphoma treatments. Tumors in the heart are greater to treat with protons because the heart dose with protons is much less than X-rays."

Meanwhile, McLaren Health Care Corp.'s proton beam center, which was completed two years before Beaumont opened its center, expects to finally open in late summer or early fall, causing Grand Blanc-based McLaren to scramble to hire consultants to complete the project, said Greg Lane, McLaren's chief administrative officer.

MedPAC report

Because Medicare's payment rates are substantially higher for proton beam therapy than other types of radiation therapy, the Medicare Payment Advisory Commission, or MedPAC, called proton therapy "low-value care" in a June annual report because of high prices and limited clinical use.

MedPAC noted from 2010 to 2016, spending and volume for proton beam therapy in fee-for-service Medicare grew rapidly, driven by a sharp increase in the number of proton beam centers and Medicare's relatively broad coverage of this treatment. During that period, spending rose from $47 million to $115 million. 

But Stevens said MedPAC's evaluation is outdated and does not directly apply to Beaumont's proton center, which he says is state-of-the-art with what is known as pencil beam scanning. He said doctors only conduct cancer treatments that are proven to be clinically effective over traditional radiation therapy.

"(MedPAC) tried to apply the standards used for drug approval to radiation therapy," said Stevens. "In general you would agree that less dose better than more dose. The trick is to prove that clinically. You would not pick an X-ray plan with a higher dose."

"I talked with Blue Cross a couple of weeks ago, and they look at a dose to normal structures," he said. "You look at radiation dose for breast cancer. They mostly live for decades after treatment."

You look at an acceptable dose to the heart for breast cancer treatment, if you can get the heart dose down under 70%, as we did a couple of weeks ago, that is great," said Stevens.