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3 In 1946 Harvard physicist Robert Wilson ( ) suggested: Protons can be used clinically Accelerators are available Maximum radiation dose can be placed into the tumor Proton therapy provides sparing of normal tissues Modulator wheels can spread narrow Bragg peak Robert Wilson Wilson, R.R. (1946), Radiological use of fast protons, Radiology 47, 487.

4 Robert Wilson suggests use of protons First treatment of tumors (brain) First large-field proton treatments in Sweden Large-field fractionated proton treatments program begins at HCL, Cambridge, MA 1990 First hospital-based proton treatment center opens at Loma Linda Univ. Med. Ctr nd proton center opens at Mass General more centers open in TX, FL, and IN additional centers open in OK, PA

5 Protons are particles with a positive charge found in the nucleus of an atom In Proton Therapy protons are produced by a machine called a cyclotron. Proton Therapy Cyclotron

6 Protons exit from the cyclotron and are directed by magnetic fields to the patient

7 Protons deposit their maximum energy in the tumor and then stop

8 Traditi onal 6x 1980 Traditi onal 15X Field Vertex D Conform al 1995 IMR T 2000 Prot on 2009

9 Protons deposit their maximum energy in the tumor and then stop

10 Pediatric Cancer Brain Cancer Lung Cancer Prostate Cancer Colorectal Cancer Spinal Cord Cancers Eye Cancers Base of Skull Sarcomas Breast Cancer Head & Neck Cancer Esophageal Cancer Gantry treatment room

11 Significant decrease in side effects Significant cost savings by decreasing short & long term complications in pediatric cancer patients Decrease in secondary cancers later in life from unnecessary radiation exposure. Decreased travel for East Tennessee patients and families

12 2 Example: Improvements in Pediatric Cancer* Side Effects Protons Photons Restrictive Lung Disease 0% 60% Reduced Exercise Capacity 0% 75% Abnormal EKGs 0% 31% Growth Abnormality 20% 100% IQ Drop 10 Point by 6 Yr Old 1.6% 28.5% Risk of IQ score <90 15% 25% *Head, Neck, & Chest Treatment Areas J. Metz M.D. Reduced Normal Tissue Toxicity with Proton Therapy Comparative effects for lung cancer treatment. Oncolink

13 2 Example: Improvements in Lung Cancer Acute Side Effects Protons Conventional Radiotherapy (Photons) Nausea/Vomiting 0% 30% Shortness of Breath 0% 16% Esophagitis <5% 31% Fatigue <5% 23% > 5 lb Weight Loss 0% 34% J. Metz M.D. Reduced Normal Tissue Toxicity with Proton Therapy Comparative effects for lung cancer treatment. Oncolink

14 Example: Improvements in Prostate Cancer Modality Dose Recurrence Complications Conventional Radiation <60GY 38% 22% Conventional Radiation 60-65GY 36% 35% Conventional Radiation 70GY 28% 45% Conventional Radiation >75GY 20% 60% PROTONS 75GY 5% 12% N. Mendenhall M.D., Presentation, University of Florida,

15 Currently Only 7 Centers Operational in US TPT

16 Operating Under Development

17 Portions of 5 States: Tennessee Kentucky North Carolina Virginia Georgia 2014 Population: 4,021, Cancer Incidence: 22,727

18 Additional 4 States: Alabama Ohio South Carolina West Virginia 2014 Population: 22,725, Cancer Incidence: 123,409

19 Improve the Health of Tennesseans Now Tennessee Ranks 29th in Cancer Incidence but 46th in cancer deaths according to the latest NCI data Improve Cancer Patient Benefits Now Market Interest is Growing Beyond Research Cancer Patients of Knox County & East Tennessee are Traveling Outside State for Service Need for More Centers to Perform Research If Not Now, When? If Not Us, Who?

20 Building 43,000 Sq. Ft. 4 Vaults Cyclotron Vault 3 Treatment Vaults Building Costs $23 Million Equipment Costs $45 $50 Million Completion Time Months

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23 East Tennessee Healthcare Center Dowell Springs Medical / Business Park Population Center of Knox County

24 Economic Impact Study by Dr. Murray / UT 45-50% of Patients Travel from Outside of State Patients Will Spend 6-8 Weeks in Area Will Employ ~40 Medical Professionals $30 Million Annual Impact on Community Create over 500 jobs in the state

25 For further information contact: Scott Warwick ProVision Healthcare

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