Spotlight on proton therapy as cancer patient Ashya King departs Prague

Ashya King, photo: CTK

Five-year-old British brain cancer patient Ashya King has just completed a six week stint at the Proton Therapy Centre in Prague. His case caught the attention of the world, with stories of parental abduction, imprisonment and finally, a promising new kind of radiotherapy undertaken in the Czech Republic. Doctors say the treatment has been successful, and now the boy has returned to Spain for further medical procedures.

Ashya King,  photo: CTK
Last Friday, October 25, a paparazzi-style media scrum gathered outside Prague’s Proton Therapy Centre for the final time to cover the Ashya King story. Shortly before 1pm, the 5-year-old British boy was wheeled out by his mother Naghmeh to face the cameras. “Ashya!” the photographers beckoned, hoping to catch a glimmer of a smile or a wave from this child, finally freed from six weeks of radiotherapy in this Czech medical centre. The media scrum would have been an unsettling, even grotesque sight, but for the fact that this is exactly what the King family wanted – needed in fact. Simply put, publicity translates into the funds required to hope to ultimately cure young Ashya’s brain tumour.

Jiří Kubeš,  photo: CT
After appearing before the press, Ashya and his mother stepped inside a waiting ambulance and departed the scene. The child’s father Brett then emerged from the medical centre accompanied by the Proton Therapy Centre, Jiří Kubeš, to face the cameras. After giving a positive report on his son’s health, stating that Ashya was feeling better, able to communicate non-verbally, and even drinking on his own, Brett turned to the overall experience at the centre:

“It was worth everything, because the treatment has been so gentle on him. You see, they measure it. The dosage is 1.8 Gy. An X-Ray that you might give a child is a milligray. So that would be like a thousand X-Rays a day. But this proton therapy is so much more gentle than we could have even imagined or hoped for. So we are very happy with the treatment. Fair enough, he has lost a little bit of hair, and he has a little bit of redness [on his head] but that is the only side-effect. It hasn’t affected anything else. His appetite is back, he can distinguish between flavours, and has no problems with that.”

Southampton General Hospital,  photo: The official Facebook page of the Southampton General Hospita)l
Back in August, the Kings took their son from the Southampton General Hospital in Britain. They were unhappy with the treatment received by their sick son who had already been subjected to two operations over the summer to remove a tumour, which left the boy in a partially disabled state. They then flew to Spain, where the family have a property, but the Kings found themselves under arrest in Madrid, forced to spend 72 hours in jail while a judge mulled a British extradition request. Bowing to public pressure, the British authorities ultimately dropped the proceedings. Ashya, no longer a warden of the UK courts, was then flown by private jet from the Malaga hospital where he was receiving treatment, to Prague. At first, he was offered conventional chemotherapy at Prague’s Motol hospital. This was rejected by the family. And so the Kings turned to the hope of a more modern kind of treatment than conventional X-Ray radiation therapy, namely proton therapy. This, they hoped, might prove more effective on Ashya’s brain tumour – with more targeted elimination of the tumour, and fewer side-effects, which can often lead to the damage of other organs.

Proton Therapy Centre,  photo: Archives of the Proton Therapy Centre
Ashya then spent six weeks receiving 30 separate rounds of proton therapy treatment, which will be paid for, at a reported cost of 70,000 pounds, by the British National Health Service. Proton Therapy Centre director Jiří Kubeš described the procedure to the press:

“The boy was first anesthetized. After that, he was moved to the special radiotherapy bed, which is custom made for each child. And then, with the child lying down on his belly, the radiation session was undertaken. In the fist phase, this took around 30 minutes; in the second phase, this is usually quicker – around ten minutes. And then this process is complete and the boy is awakened from the induced sleep. We then waited until he was definitely fully awake, and he was sent back to our colleagues at the Motol hospital.”

Brett King,  photo: CTK
The treatment now fully completed, Brett decided that the time was not yet right to return to the UK and will instead complete his son’s treatment in Spain.

“Last week, and even the week prior to that, we were deciding on: what should we do now? Should we go back to England? Or should we go back to Spain, because [our other] children had to be enrolled in school in Spain. And we have a property there. So we decided to go back to Spain. We don’t feel 100 percent safe, if you like, about going back to England. We still have something inside us that something might happen. That we will be in trouble again and Ashya will be taken away from us. So for the time being, we just want to go back to Spain, relax, get this [further] treatment out of the way that Ashya has to have. And then hopefully, after they have done this investigation in England, and everything has been settled, then we can go back to England.”

Proton Therapy Centre,  photo: Archives of the Proton Therapy Centre
And what about the whole rollercoaster ride, escape from one country and arrest in another?

“Of course, if anyone asked me now at the end of everything ‘would you do the same thing again?’ I would say ‘of course, without any doubt’. Because, I’ve spoken to my wife about this before...people said: ‘didn’t you take a big risk – it ended up very badly for your wife and yourself?’ But what parent who loves their child thinks what risk is there going to be in this for me? Any child that falls over on a boat or something, the parents without thinking would jump in. You won’t think ‘well I might drown’. The main thin is to look after your children. So, we’re very happy that he got the treatment in the end, and it was worth whatever trials we had to go through ourselves. We’re not important. Spending time in prison was bad, but Ashya getting through this, keeping him with us is the main goal. And we’ve been able to achieve that.”

Iva Taťounová,  photo: Sky News
I spoke with Iva Taťounová, Director for Strategy at the Prague Proton Therapy Centre and began by asking her to sum up the prognosis for Ashya.

“Ashya was here for six weeks and he underwent proton therapy for a tumour which had been previously operated on in Southampton called medulla blastoma. And since we have a lot of experiences with treating children that have this tumour, we were approached by the family and we were able to offer Ashya the treatment. This went very well, and was as without complications as we expected. And yesterday he left the Czech Republic for Spain, where he is going to continue with further necessary treatment.”

And the outlook for him can be described how? Do doctors believe it is likely his tumour will be cured?

Proton Therapy Centre,  photo: Archives of the Proton Therapy Centre
“It is really hard to say and it would be unprofessional to make any type of predictions, but as far as the worldwide community of oncologists and radiotherapists is concerned, children who have this kind of tumour and receive this treatment have a 70-80 percent chance of being cured. And we know right now that the tumour didn’t spread, so consequently we have high hopes.”

And because of the Ashya King story, the eyes of the world have also been on your Proton Therapy Centre. This is obviously publicity that your institution welcomes. Are you also glad that this has put a spotlight on this particular kind of therapy, which presumably you believe is going to be of greater use in the future as opposed to conventional chemotherapy?

Ashya King with his mother,  photo: CTK
“We are not comparing ourselves to conventional chemotherapy. We are a proton therapy centre and offer a higher standard of radiotherapy. And since proton therapy is less harmful than conventional radiotherapy, we certainly hope that people will be more aware of it, will know that this radiotherapy exists, and they are also more informed that there are more and more proton therapy centres in the world being built. Even the United Kingdom will have its own proton therapy centres in 2018, and medulla blastoma, which Ashya unfortunately succumbed to, is one of the afflictions that will be treated there. So we are of course very happy that we were able to help Ashya, but this is not any kind of exceptional situation for us because we have treated more than 25 kids with this tumour, and we have already treated more than 380 patients since we opened in December 2012. We have also treated many other patients from the United Kingdom suffering from prostate cancer, and also with neck tumours, brain tumours, lymphomas, or pancreatic cancers and the future in terms of radiotherapy is definitely with protons.”

Proton Therapy Centre,  photo: CT24
And you have patients from all over the world, many children too.

“We have had the privilege to treat people from 23 countries.”

Presumably it is a very expensive procedure for a patient to have.

“I wouldn’t say that it is an expensive treatment. Because if you put together all the expenses of an operation, conventional radiotherapy, and then the pharmaceuticals that you have to pay for in order to treat the side effects, then that is even more expensive than just to have an operation, or to just have proton therapy. So I would disagree that it is expensive.”