Inside Proton Therapy: Precision in Cancer Treatment
Episode Summary
In this solo episode, David Raubach takes listeners on a comprehensive tour of the Oklahoma Proton Center (OPC) — the first private proton therapy facility in the United States, which opened in August 2009 as just the sixth proton center in the country. Built through a partnership between local physicians, a regional hospital system, and a company called Procure, the OPC began construction in 2007 and has since treated over 6,000 patients from all 50 states and 15 countries. David explains the center's unique position as one of only five proton centers in the southwest and one of only two in the state of Oklahoma, drawing patients from as far away as Alaska.
David grounds the conversation in the physics of proton therapy, explaining how the OPC's cyclotron — a particle accelerator — drives proton particles to two-thirds the speed of light, or approximately 120,000 miles per second. At that velocity, a proton could circle the Earth nearly five times in a single second. This precision matters clinically because protons can be targeted and stopped inside a tumor, depositing maximum radiation at the cancer site while sparing healthy tissue and critical organs beyond it. By contrast, conventional X-ray radiation cannot be stopped once it enters the body and continues depositing dose beyond the tumor — a fundamental physical limitation with real consequences for patient side effects.
Two disease sites receive particular attention as case studies in proton therapy's clinical advantage. For left-sided breast cancer patients, the proximity of the heart to the radiation field is a serious concern — David introduces OPC's "Know Your Gray" campaign, noting that one gray of radiation is equivalent to tens of thousands of dental X-rays, and that cumulative cardiac dose during a breast cancer course can carry long-term risks up to heart attack or heart failure. For head and neck cancer, David cites a randomized trial from MD Anderson demonstrating a 13% absolute reduction in feeding-tube dependency among patients receiving proton therapy versus IMRT, illustrating how sparing the swallowing muscles can preserve quality of life during and after treatment.
David walks through the patient journey from first contact to treatment start, a process that typically takes two to three weeks. After a consultation with one of OPC's radiation oncologists — Dr. John Chang, Dr. Mark McLaughlin, or Dr. Mark Story — patients receive a treatment-planning CT scan that maps tumor location and surrounding tissue density. Dosimetrists then build an individualized treatment plan, and before any beam reaches the patient, a full mock treatment is delivered into a radiation-sensing box to verify proton count, energy, and field shape. The OPC also enrolls nearly every patient on a prospective registry trial, generating years of follow-up data on disease control rates comparable to outcomes at MD Anderson, Mayo Clinic, and Memorial Sloan Kettering.
The episode closes with practical guidance on insurance, support resources, and patient advocacy. David notes that Medicare offers broad proton therapy coverage and that commercial payer denials can frequently be overturned through appeals — a process OPC's financial counselors actively manage. The Proton Pals Foundation provides supplemental support for housing, transportation, food, and mental health needs when insurance falls short. David also emphasizes the clinical importance of community: peer support networks reduce stress, and stress management directly influences immune function and treatment outcomes. His overarching message is that patients should advocate for themselves, seek multiple opinions, and demand a full playbook of options before choosing a treatment path.
What You’ll Learn in This Episode
- Oklahoma Proton Center History: Opened in August 2009 as the sixth proton center in the United States and the first privately developed proton facility in the country, built through a partnership with Procure.
- Cyclotron Speed: OPC's particle accelerator drives protons to two-thirds the speed of light — roughly 120,000 miles per second — fast enough to circle the Earth nearly five times in one second.
- Bragg Peak Advantage: Unlike X-rays, protons can be stopped precisely inside the tumor, delivering maximum dose to cancer cells while sparing healthy tissue and critical organs beyond the target.
- Know Your Gray: OPC's patient awareness campaign urges cancer patients to ask their doctor exactly how many gray of radiation will reach their heart or other critical organs — one gray equals tens of thousands of dental X-rays.
- Cardiac Dose in Breast Cancer: Left-sided breast cancer and internal mammary node treatment frequently places the heart near the radiation field; cumulative cardiac dose from conventional radiation can lead to heart attack or heart failure years after treatment.
- MD Anderson Oropharyngeal Trial: A randomized trial showed a 13% absolute reduction in feeding-tube dependency for oropharyngeal cancer patients receiving proton therapy versus IMRT, highlighting quality-of-life benefits for head and neck cases.
- Pediatric Cognitive Protection: Multiple studies document less IQ loss and lower cognitive impact in pediatric brain cancer patients treated with proton therapy compared to conventional radiation, because fewer healthy developing brain cells are exposed.
- Treatment Planning Process: After a consultation with Dr. John Chang, Dr. Mark McLaughlin, or Dr. Mark Story, patients receive a 3D planning CT scan; dosimetrists then design an individualized plan and verify it with a full mock delivery into a radiation-sensing box before the first actual treatment.
- Prospective Registry Trial: Nearly every OPC patient is enrolled in a prospective data registry, generating long-term follow-up information — 6 months, 1 year, 2, 3, and 5 years post-treatment — that benchmarks OPC disease-control rates against top national cancer centers.
- Insurance and Appeals: Medicare offers broad proton therapy coverage; commercial insurer denials are common but frequently reversed through appeals managed by OPC's dedicated financial counseling team.
- Proton Pals Foundation: OPC's charitable foundation fills financial gaps for patients who need help covering housing, transportation, food, physical therapy, or mental health support during treatment.
- Community and Stress Reduction: Clinical studies show patients with strong social support networks have better treatment outcomes; OPC's patient services team actively facilitates peer connections among patients undergoing proton therapy.
Whether you are weighing your first treatment decision or seeking a second opinion after an initial diagnosis, the Oklahoma Proton Center's message is clear: knowledge is the most powerful tool a cancer patient can carry. From understanding the gray of radiation reaching your heart, to knowing that a commercial insurance denial is not the final word, to recognizing that peer community can influence your immune response and your outcomes — every piece of information David Raubach shares in this episode is designed to put control back in the patient's hands. The OPC team, including its physicians, dosimetrists, financial counselors, and patient services staff, stands ready to help any patient — regardless of where they ultimately choose to be treated — navigate that journey with clarity and confidence.
Full Transcript
Read Full Transcript
David Raubach: I want to thank you for joining us on today's episode of the Cancer Project podcast. Today I get the opportunity to talk about a place near and dear to my heart, the Oklahoma Proton Center. I want to tell those of you that are potentially interested in coming to the facility for treatment or want to know a little bit more about what we do — just talk about who we are, the history of the center, cancers that we treat, what to expect when you show up to the facility.
David Raubach: First off, I think it's important to start with the history of the facility. The Oklahoma Proton Center opened in August of 2009. When it opened, it was just the sixth proton center in the country. The first proton center in the United States opened at Loma Linda University in 1990. After Loma Linda, you had proton centers open at the University of Florida Proton Therapy Institute, the University of Indiana, MD Anderson Cancer Center, and then Massachusetts General Hospital — which is the teaching hospital for Harvard University.
David Raubach: Then a group of doctors in conjunction with the local hospital system partnered with a company called Procure to develop the first private proton therapy facility in the United States, right here in Oklahoma City. Construction started in 2007. As I mentioned, the center opened in 2009. Today we're treating over 700 patients a year. We've treated over 6,000 patients since we opened. We've had patients come from all 50 states and 15 different countries for treatment.
David Raubach: Back when there were just six proton centers in the United States, a lot of patients who needed access to proton therapy didn't have it in their local communities. And so we had all of these patients coming to Oklahoma City for world-class cancer care. Today we're still one of just five proton centers in the southwest and one of just two proton centers in the state of Oklahoma. We get patients that travel from northeastern Oklahoma, from the Tulsa area, from around Wichita, southern Kansas, the panhandle of Texas, northwest Arkansas — and from time to time we still get patients that travel from as far away as Alaska.
David Raubach: Another question we get is what types of cancer do we treat at the Oklahoma Proton Center? If you think about proton therapy, what we're doing is taking a high-energy beam of proton particles — these subatomic particles that exist within the nucleus of an atom — and accelerating them to really, really high speeds. In fact, our cyclotron, or particle accelerator, can actually accelerate protons to two-thirds the speed of light.
David Raubach: To put that in perspective, the circumference of the Earth is 25,000 miles. If you're talking about two-thirds the speed of light, that's a speed of about 120,000 miles per second. So at 120,000 miles per second, that proton can circle the Earth almost five times in one second when it comes out of our cyclotron. That's how fast these proton particles are traveling.
David Raubach: We then take this beam of high-energy proton particles and target them directly at cancer cells. So if you think about what types of cancers can be treated with proton therapy, you really need to think about: do we have a target to shoot the beam of protons at, and does this target show up on imaging? Any solid tumor that shows up on diagnostic imaging like an MRI, a PET scan, or a CT scan can potentially be treated with protons. That includes brain cancers, breast cancers, head and neck cancers, lung cancers, prostate cancer, soft tissue cancers, lymphomas, GI cancers like liver cancer, ocular melanomas, and cancers in both the pediatric and adult populations.
David Raubach: The reason proton therapy can be beneficial is that with protons we have the ability to stop those particles inside cancer cells. Our goal when delivering radiation is to get as much radiation to the cancer cells as possible and as little radiation to healthy tissue. Because we can stop that radiation inside the tumor, we spare healthy tissue and critical organs beyond the tumor from exposure. Additionally, protons deposit less energy as they travel through the body on the way to the tumor than X-ray radiation does.
David Raubach: With X-rays, you get more radiation along the path getting to the tumor, and X-rays cannot be stopped inside the body — so they continue traveling beyond the tumor and hit healthy tissue and critical organs, depositing radiation that can result in side effects for patients. So there's less radiation going into the body with protons, and then no radiation beyond the tumor. That's the fundamental physical difference.
David Raubach: Let's talk about what those specific side effects can be, starting with breast cancer. A lot of times with breast cancer you have very radiosensitive organs and structures in close proximity to the field you're trying to treat — specifically, the heart. For left-sided breast cancer patients, or patients where we're treating the internal mammary nodes, the heart can be right near or even inside the radiation field. So it becomes really critical to do everything possible to reduce or eliminate dose to the heart.
David Raubach: The heart is also really sensitive to radiation. It doesn't take a lot of radiation to potentially do damage — we're talking about damage up to the point of a heart attack or heart failure for patients years down the road after treatment. When we create a proton plan, we're able to craft the treatment plan in such a way that we deliver most if not all of the dose into the breast or chest wall, and then stop that beam of protons before it ever reaches the heart.
David Raubach: Whereas with X-rays, we do everything we possibly can to keep dose off the heart — but because of the physical properties of X-rays, because they can't be stopped inside the body, it's really challenging to deliver all of the radiation we need to all of the areas where there might be cancer cells while completely eliminating dose to the heart.
David Raubach: One of the phrases we'll use is "Know Your Gray." We measure radiation in units called gray. One gray of radiation is equivalent to tens of thousands of dental X-rays. If you think about the last time you went to the dentist and got an X-ray — the tech likely provided a chest shield because they were concerned about one dental X-ray hitting your heart. Well, think about that times a thousand, or ten thousand, or a hundred thousand — that's the amount of radiation being used to treat breast cancer.
David Raubach: So when we say "Know Your Gray," literally what we're saying is know the gray of radiation — know the amount of radiation that your heart is being exposed to going through treatment. Your radiation oncologist has that information. When they do the treatment plan, they're looking at the dose to the tumor but also at the dose going to critical structures. You as a patient can ask: how much radiation is being delivered to my heart, and is there any way to reduce that?
David Raubach: At the Oklahoma Proton Center, all of our patients are assessed for both proton therapy and traditional X-ray-based photon radiation therapy. Our doctors look at both treatment plans — how much radiation is going to the tumor and how much is going to healthy tissue like the heart — and then pick the plan that delivers the least radiation to healthy tissue while still hitting the prescriptive dose to the tumor.
David Raubach: Let me transition to head and neck cancers. These are frequently treated with radiation — and there can also be chemotherapy, immunotherapy, or surgery involved. These can be cancers of the tongue, tonsils, throat, or nasal cavity, and there are a lot of really sensitive critical structures in that region. One of the main challenges is ensuring patients are getting adequate nutrition — getting the calories and liquids they need — because the swallowing muscles can be in the radiation field.
David Raubach: A lot of head and neck cancer patients end up needing feeding tubes to supplement the nutrition they can't get through swallowing during treatment. A recent randomized study that came out of MD Anderson looked at the difference in feeding-tube dependency for oropharyngeal cancer patients getting traditional radiation versus proton therapy. What they found was a 13% absolute reduction in feeding-tube dependence for patients getting proton therapy versus patients getting IMRT — which is the most precise form of X-ray-based radiation available.
David Raubach: At the Oklahoma Proton Center, one of our mantras is "More than a cure, quality of life." Yes, our primary objective is to treat the cancer and kill all the cancer cells. But we can't forget the importance of ensuring that patients maintain as high a quality of life as possible going through treatment. That applies across all disease sites.
David Raubach: Another cohort of patients we treat is pediatric patients. Pediatric cancers can have a devastating impact — not just acutely during treatment, but because these patients are still developing. When you intervene with chemotherapy, surgery, or radiation in a child, there can be a lifelong impact. Multiple studies have shown that patients who received traditional radiation had more IQ loss and a bigger cognitive impact than patients who received proton therapy for brain cancer.
David Raubach: Brain cells are developing inside pediatric patients. When you deliver radiation into the brain, you are going to have an impact when you hit those healthy cells. That has been measured across multiple studies — we see a bigger cognitive impact on patients receiving traditional radiation because there's more exposure to healthy brain cells. With proton therapy, we're delivering less radiation to healthy tissue, and for a lot of patients that means fewer side effects.
David Raubach: Another question we get asked is: how do I know if proton therapy is right for me? The best thing you can do is talk to a doctor who is experienced and skilled in using proton therapy on a regular basis. We've seen a lot of times patients will talk to doctors who aren't using proton therapy regularly, and those doctors say they're not sure if it's right for that particular cancer. It's imperative — whether it's Oklahoma Proton Center or one of the now 45 proton centers in the country — to talk to a doctor who uses proton therapy on a regular basis.
David Raubach: Proton centers are also the ones that have the treatment planning systems needed to create a specific proton plan for a particular patient. Most facilities without proton therapy won't have access to the proton-specific treatment planning software that can actually show — for that individual patient — how protons can be used and what benefit there might be. So if you want to know if proton therapy is beneficial for you, talk to a proton center or to a doctor using it on a regular basis.
David Raubach: Another question we get is about insurance. Will insurance cover proton therapy? With Medicare specifically — and a lot of our patients are on Medicare — Medicare offers broad coverage for proton therapy. It's very rare, if ever, that we see a Medicare patient unable to get coverage for proton therapy. And that applies to Medicare Advantage plans as well.
David Raubach: On the commercial insurance side — big payers like Blue Cross, Aetna, Cigna, United Healthcare, as well as smaller payers — all of these companies will assess proton therapy coverage on a case-by-case basis. We have a fantastic team of financial counselors at the Oklahoma Proton Center who work with patients every single day to figure out their coverage. And a lot of times we see patients get told no initially by their insurance companies, then we go through an appeals process and get those cases approved. So don't ever let an initial no be the final answer.
David Raubach: Our financial counselors will work with patients to figure out what the coverage will be and what the out-of-pocket costs might be — whether that's a deductible or coinsurance. And the other great thing at the Oklahoma Proton Center is we have a foundation called the Proton Pals Foundation. One of its main purposes is to step in where patients can't cover the full cost of their care or have ancillary expenses they can't cover — things like housing, transportation, food needs, physical therapy, or meeting with a mental health professional.
David Raubach: Another question we get asked is how long the process takes. What should I expect if I call the proton center today? The first thing that will happen when you reach out is you'll get scheduled to talk with one of our radiation oncologists. We have a fantastic team of doctors: Dr. John Chang, Dr. Mark McLaughlin, and Dr. Mark Story. They've been working in the field of protons for many years and have treated hundreds if not thousands of patients with proton therapy.
David Raubach: If you and your physician decide that proton therapy is the best option, we'll schedule you for a treatment-planning CT scan. This is a three-dimensional image of your body that shows us where the tumor is, but also tells us what types of tissues those protons will have to travel through before reaching the tumor. That tells us how fast the protons need to be traveling when they exit the accelerator and enter the treatment room — how fast they need to travel to get to the tumor and then stop.
David Raubach: At that point, a team of dosimetrists — these are the specialists who work with our treatment planning system — work in conjunction with the doctors on a patient-specific treatment plan. What they're doing is figuring out the best way to get all of the protons we need to kill all the cancer cells, while exposing as few healthy cells and as few critical organs to radiation as possible.
David Raubach: After that, we actually go through and deliver a mock treatment. We use a box that has radiation sensors inside it. We put that box in front of the proton beam and tell the software system to deliver your treatment — but deliver it into this box. We're measuring whether the right number of protons are coming out, whether they're coming out at the right energy, and whether the shape of the field is what we expected. We run through and deliver an entire treatment as if it were your treatment into this detection box. Assuming everything looks good, we let you know we're ready to start.
David Raubach: Frequently for patients, from initial consult to treatment start, it takes about two to three weeks. If it's an urgent case, sometimes we can move things along a little quicker. If a patient's cancer is slower-growing or they need to get through other treatments first, we can push it out a little further. But about two to three weeks from reaching out to the facility to starting treatment is what patients should expect.
David Raubach: Another question we get asked is: how do I know if the cancer is gone? How do you know the treatment is working? First, we deliver those mock treatments ahead of time, so we have a strong understanding of how many protons are coming out of the beam line, at what energy, and in what field shape. We frequently also do diagnostic imaging during or right after treatment, which gives us visual indication of what's happening with tumors. Not every tumor will necessarily change in shape or size during or immediately after treatment, but over time we should see evidence that the treatment has worked.
David Raubach: Some cancers also emit biomarkers that can be measured. Prostate cancer is a great example — one of the primary screening methods is PSA, or prostate-specific antigen. If we see an increase in PSA that turns out to indicate cancer, then deliver radiation to the prostate, we would expect to see PSA drop back down to a more normal level or even below pre-treatment levels when that patient was healthy. That's another way we detect whether cancer is still present or whether it's gone.
David Raubach: We've been using radiation to treat cancer for over a hundred years. At this point there are literally millions of patients over the past 100-plus years who have been treated with radiation, and many of them were enrolled in clinical trials. At the Oklahoma Proton Center, we enroll almost every single patient we treat on what's called a prospective registry trial. We agree upfront to gather information about their treatment and then follow that patient after treatment for 6 months, 12 months, 2 years, 3 years, 5 years.
David Raubach: We compile that data and look at our disease control rates — whether that means achieving total remission, or keeping a cancer localized when we know complete elimination isn't the near-term goal. What we've seen at the Oklahoma Proton Center is that when we follow these patients years after treatment, we're seeing the same very effective disease control with minimal side effects that you see at top cancer centers like MD Anderson, Mayo Clinic, and Memorial Sloan Kettering.
David Raubach: Another thing we talk about — and our patient services team helps facilitate this — is the importance of creating a community as you go through treatment. Clinical studies have documented that patients who have a network or support system going through treatment have better outcomes. Part of the reason is that a support system helps patients get to treatment, access food and housing, stay on their medications. But there's also a stress component that can impact cancer outcomes.
David Raubach: As you go through chemotherapy, radiation treatment, proton therapy, or immunotherapy, your body's immune system is going in and helping fight the cancer. Stress can impact your body's ability to fight the cancer directly and to stay healthy going through treatment. A community or support system helps patients manage that stress. There's also a solidarity in knowing that other patients are walking through the same thing you're going through. Part of what we do at OPC is create opportunities to facilitate that connection among patients undergoing proton therapy.
David Raubach: I hope what we talked about today was helpful as you're thinking about proton therapy and how it can be used to treat cancer. We have this amazing facility here in Oklahoma City that has treated over 6,000 patients since we opened and had fantastic outcomes treating breast cancer, prostate cancer, lung cancer, head and neck cancers, liver, esophageal, soft tissue sarcomas, and ocular melanomas. If you have questions — if you want to talk to a doctor or another patient that's gone through proton therapy — definitely reach out to us at the Oklahoma Proton Center.
David Raubach: Even if you don't end up coming to our facility, the best thing you can do as a patient is to be your own advocate. You are going to care about your body and your treatment more than anybody else. Own that. It's okay to get a second opinion and a third opinion, to talk to patients that have gone through different treatments, and not just accept the first option that's presented to you. Each patient is different. Each cancer is different. Be your own advocate and make the decision that's best for you. We'll look forward to talking to you again on the next episode of the Cancer Project podcast.
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