Here’s how Dr. James McGee explains proton beam therapy in layman’s terms:
Imagine you're holding a rope with a tennis ball at one end. With your wrist, you’re spinning the ball round and round, letting out just an inch or two of slack on the rope.
If you hit someone when the ball’s only out by a few inches of rope, it’s probably not going to hurt. But if you spin the tennis ball around when the rope is 4 feet long … ouch.
Now imagine that tennis ball is a proton. It's inside a machine called a cyclotron that is doing the work of your wrist and the rope to increase the proton’s energy, by rapidly and continuously switching the polarity on large magnets inside the machine.
As the protons gain energy, they travel in circles of increasing radius until they are spun out into a beam delivery tube. On the other side of the tube, there’s a human body. And inside that body is a tumor. And in the course of about a minute, that tumor can be hit with thousands of hyper-charged protons, killing it with energy.
By 2023, there will be one of these machines in Peoria.
OSF is in the process of building out a $237 million Cancer Institute, where the proton beam gun will take center stage. There are fewer than 40 proton beam guns in the United States; the next closest are in Chicago and St. Louis.
OSF Breaks Ground On New $237 Million Cancer Institute
For central Illinois, the possibilities for innovation and research cannot be understated, said McGee, likening OSF’s current position to being on the precipice of a steep hill.
“I went to Oslo, Norway, and they (took) me up to the top of this famous ski jump,” he said. “You know, one of the ones for the long distance jumps. And I can remember getting to the top of that, and looking over that and thinking, ‘Oh my gosh, as soon as you start down this, the world kind of explodes around you.’ And I think that's where we're at in cancer."
He continued, "I think that we're at that, that tipping point right now, where we've spent a very long time caught climbing a very tall hill. But now we're at the point where there's a confluence of the physics and engineering with the immunotherapies and the biology and the genetics and all these things are, are coming together. And I really feel that this whole world of cancer medicine, cancer therapy, understanding cancers and so forth, is really going to explode.”
What makes proton beam therapy different from radiation or chemotherapy?
McGee said these traditional treatments are lengthy and often debilitate the immune system, leaving patients susceptible to other illnesses while eradicating their cancers.
Proton beam therapy can be done in minutes and it only targets the tumor.
While there's still a lot we don't know about this therapy, McGee sees Peoria as a potential hub of innovation. With the Jump Simulation center, OSF already is engineering cancer treatments using virtual reality and 3D printing.
In its most rudimentary form, proton beam therapy began in the '50s, but for decades, the application of the therapy was limited, McGee said.
“It was a beam that would come in and stop,” he said. “That was good, but it wasn’t life-changing.”
Nearly 15 years ago, a company called Varian bought a company in Germany that had developed a technology that could deliver 50,000 “packets” of radiation to a tumor. Back then, the treatment took 35 to 50 minutes. The Varian-produced proton beam gun opening at OSF will deliver that many “packets” in seconds, McGee said.
McGee plans to work with engineers at the University of Illinois to devise new uses for the proton gun. He's even giving the U of I lab space in the new cancer center.
“It's very early on. And that's good. That's where you want a big investment to be, right?” he said. “I think this will be a tremendous asset to the people of downstate Illinois, who to this point have been really unable to have proton therapy because of access. And I think it's a, it's a tremendous potential for us to participate in meaningful, really meaningful, clinical research in cancer.”
To Paris and back
Before coming to OSF in 1989, McGee trained all over the world, working with cancer experts leading the way in breakthrough technologies such as radiation therapy and genetic testing. But he always knew he wanted to come back to central Illinois.
McGee grew up on a farm four miles north of Illiopolis, between Decatur and Springfield. His parents grew corn, wheat, oats and soybeans. His maternal grandfather founded the Illinois Black Angus Association.
“When he died, he left me some cows and a bull,” McGee said. “And that was my occupation until I went away to medical school. Pretty much paid my way through school.”
McGee said he didn’t grow up knowing he wanted to be a doctor. Like many of his neighbors, his parents “lived on the edge” financially, but they noticed the town’s doctor always made a good living.
After graduating from Quincy University, McGee attended medical school at Loyola.
It wasn’t until his senior year that he fell in love with his career — more specifically, the study of cancer, and the relationship between medical science and engineering and physics. He took an internship in Africa and worked in an 800-bed hospital as one of three providers.
He also began learning about radiation oncology.
“I thought cancer was much more interesting than other diseases,” he said. “There was very little known about it.”
At the time, there were only seven comprehensive cancer care centers in the United States. One was at the University of Chicago. McGee wrote to the director and applied from Africa. He was offered a spot.
While in Chicago, McGee learned medical physics from students who worked under Enrico Fermi, the physicist who led the first controlled nuclear chain reaction under the school’s stadium. He trained under Dr. Janet Rowley, who discovered a link between genetics and leukemia. One professor, Dr. Charles Higgins, received the Nobel Prize for linking breast and prostate cancer with hormones.
“Nothing was nearly as enchanting as the notions around how physics and engineering could be used to treat cancers,” McGee said.
From there, he worked with Dr. Gilbert Fletcher, the man whose ideas about radium would lead to the creation of MD Anderson. He later worked at the University of Paris, where a German doctor took a 4-milimeter long piece of iridium to treat hundreds through high-rate brachytherapy.
“I thought it was the most fascinating, wonderful thing in the world to try to understand the connection between the genetics and the physics and engineering, and the human patient, and so forth,” McGee said.
But from Paris, McGee heard the heartland calling.
“I always wanted to still come back to rural America, especially central Illinois,” he said. “So after all this fancy training and stuff, I came back.”
McGee worked in Springfield for nine months before settling in Decatur, where he worked for nearly nine years. At the time, OSF in Peoria was the country’s largest general hospital that did not offer radiation therapy.
In 1985, McGee approached the OSF administration about expanding its cancer care. And in September of 1989, OSF brought McGee on staff to bring radiation to central Illinois.
Because of his background, McGee has a personal understanding of the challenges facing rural communities — especially when it comes to cancer treatments.
“Rural people by their nature are more independent,” he said. “They're not always, you know, standing in line to complain, or get a handout. You know, they want to solve their own problems and they don't want to take help from people. They don't, well, they don't want to burden other people.”
A big challenge facing rural communities and cancer care is a lack of data, McGee said. Because people are so geographically spread out, it’s harder to identify clusters of cancer,and it's hard to get people to travel to Chicago or St. Louis to enroll in a clinical trial.
“As the situation has gradually gotten better in terms of cancer incidence and mortality in the inner cities, its continued to get worse in rural America,” he said. “I think we do have to find ways to take masses and masses of data to identify where we're going to find these clusters and these . .... I want it to be known that we don't want the cancer center to just be all about technology. We want it to be about public health.”
Providing 'optimal' care comes at a cost
McGee says cancer is a family business.
His older daughter, Dr. Mackenzie McGee, works alongside him as an oncology radiologist at OSF. His younger daughter, Keelin McGee, works for Varian, the company manufacturing proton beam machines.
And, at the age of 25, Keelin was diagnosed with cancer.
“Young adults are tough,” Dr. James McGee said. “In children, you know, we have a lot of things in place … the Heller Center, St. Jude, all that. For the adults, we have a lot of things in place, because those cancers are pretty common. But when you're 25 years old, that's not easy. That's the hardest group for support groups. It’s the hardest group because they still can get all the side effects lifelong.”
Knowing Cincinnati Children’s Hospital had proton beam therapy — and knowing that clinical trials were underway — Keelin McGee fought to get treatment in Ohio.
Her father said it was the best course of action.
“With conventional radiation … she would never have been able to continue her athletic pursuits,” he said. “She would have had a 70 or so percent chance of cardiac disease and coronary artery disease that would have been very limiting. By the time she was 40, she would have had lifetime high risk of bilateral breast cancer. She would have had chronic anemia due to radiation to the bone marrow, and the spine. And thyroid cancer from scattered radiation to the virus. So there were plenty of reasons why protons were helpful.”
Today, Keelin is cancer free.
“Sometimes, I get kind of aggravated, because you know, people will sometimes say, ‘Well, the indications for proton therapy are so limited,’ you know, because if you look at the insurance company, you know, if you're not a particular pediatric patient …” said James McGee. “(But) in every cancer type, lung cancer, breast cancer, brain tumors, whatever, there's 7% or 10% of patients where our current methods of radiation are still not optimal.”
It can be a challenge getting insurance companies to pay for proton therapy — and many other innovative treatments.
OSF surgeon Dr. Sonia Orcutt recently printed a 3D model of a tumor inside a Canton man's liver before performing what ended up being a life-saving surgery.
The scale model of the liver, about the size of an average apple, cost $11,000 to manufacture. As an "experimental" procedure, insurance companies won't cover the costs. That means organizational foundations eat those expenses, making application limited to all but the most complex cases.
But McGee is hopeful.
His daughter's work with the National Alliance of Proton Therapy — a group Keelin McGee founded — is swaying the needle. And with more clinical trials, comes more data.
“The benefits of proton therapy for head and neck cancers, in terms of ability to preserve salivary gland function swallowing, have been shown in clinical trials over many years,” he said. “So, you know, you just have to keep presenting your case to people in a variety of ways. … Both the legislators and insurance coverers.”
The entire top floor of the new Cancer Institute in Peoria will be devoted to research. Downstairs, engineers from the U of I will work with doctors envisioning all the ways in which the new proton gun can work. McGee plans to hire staff from the University of Illinois College of Medicine-Peoria.
Beyond the innovation, McGee said he wants patients to know the center is first and foremost a treatment facility.
“It is tremendous technology. But that's not all it is,” he said. “We're working very hard to create a oncology service line to bring together all the components of OSF Healthcare around the state, you know, to ensure a better quality of care. It's an effort that the proton therapy has sparked, I think. … The commitment to that led to a real surge of commitment to research. … I think that will benefit other types of research in the healthcare system. And I hope that it will allow for some serious discussions about how rural America gets better care. In general, I think we're really missing the boat in terms of that.”
