Antonio Conde Moreno, 51, is head of the Radiation Oncology Department at La Fe Hospital in the Spanish city of Valencia and coordinator of the national monitoring platform for Spain’s Proton Therapy Implementation Plan. He believes that proton therapy is the missing piece in existing cancer treatment techniques and will place the Spanish public healthcare system at the forefront of Europe’s fight against cancer, a disease that is being diagnosed earlier and cured with fewer side effects. He is optimistic, but cautious.
Question. The number of times we go around in circles just to avoid saying the word cancer…
Answer. It has to do with an atavistic fear, because we think we’re talking about something incurable. Often, people talk about a “long illness,” or even worse, a “long and painful illness.” Fortunately, this is changing, because we’re diagnosing it earlier and curing it more effectively with fewer side effects. It’s such a common and recurring disease that we have to start normalizing it. If we don’t name it, we stigmatize the patient. They already have enough to deal with just being sick.
Q. Where does your interest in radiation oncology come from?
A. I’ve always been interested in oncology in all its facets. At first, I was drawn to surgery, but when I discovered this specialty, I decided to pursue it. I saw that we could treat and perform operations without surgery, because with radiation you can reach very complex, sometimes almost impossible-to-reach, areas and produce an effect similar to having removed the disease. It’s also something completely linked to technological advancements, and most treatments are non-invasive, requiring no sedation or hospitalization.
Q. We have internalized radiotherapy, chemotherapy, immunotherapy… but what is proton therapy?
A. One of the tools we have to treat cancer is the use of radiation. For most patients, we use photons, which are high-energy beams of light that we use to kill the cells we target and isolate. With proton therapy, we use particles called protons, which are found inside atoms. These particles have a particular physical property: when they enter the body, they come to an abrupt stop, and beyond the point where they stop, they emit no radiation. Therefore, when we use them, we can reach a specific area while ensuring that the dose beyond that point is zero. This is important for certain patients for whom differences in radiation dose beyond the tumor site will have a real impact on their quality of life once they are cured.
Q. Which patients?
A. Children in particular. We’re interested in the tissue where the disease is located, but it’s very important that the rest of the body receives zero dose so it can continue developing without lasting effects. It’s also suitable for adolescents and young adults, up to age 26. Furthermore, there are other patients for whom this technique is very useful, such as those with tumors in very deep locations and near critical structures, like the base of the skull. And it’s also indicated for patients who need to be irradiated again, who have healthy areas that can’t tolerate further radiation doses. It’s not a technique for all patients, and it doesn’t replace what’s already being done; it’s the complement we were missing.
Q. As coordinator of the national monitoring platform for Spain’s Proton Therapy Implementation Plan, where do you think Spain will rank when it is completed?
A. To discuss this matter, I’d like to mention a recently published scientific article that analyzes the factors influencing cancer outcomes in different countries. The first aspect is the country’s economic level, which is understandable, but the second is access to radiotherapy, which is more important than many other programs and techniques. Having access to technology and advancements has an impact, and initiatives involving investment in high technology automatically translate into benefits for patients.
In Spain, there was a time when our equipment was becoming obsolete; much of it hadn’t been replaced, and there were significant differences between public and private centers, between cities… it was a very inequitable system. That’s when the Amancio Ortega Foundation made its first financial donation to replace that equipment. Later came the High Technology Investment Plan (INVEAT), financed with €750 million [$865 million] from Next Generation EU funds, which brought the remaining outdated equipment up to date. This brought us to the highest European and global standards in terms of access and technology, but the only technique missing was proton therapy, which was only practiced in two private centers in Madrid.
This time, the Amancio Ortega Foundation has donated €280 million [$323 million] to establish 10 centers in Spain, €28 million [$32 million] for each machine, while the regional governments are responsible for building the centers. The goal is for Spain to have a network where this technique can be offered, coordinated by the Ministry of Health, similar to the system we already have for organ transplants. We must ensure equity within the system.
Q. Where will those 10 centers be located?
A. A selection was made based on regions with larger populations and higher patient volumes. Santiago de Compostela in Galicia, San Sebastián in the Basque Country. There are two in Madrid (one at La Paz Hospital and the other at Fuenlabrada Hospital). In Catalonia, there are two in Barcelona. One in the Valencian region in La Fe Hospital; two in Andalusia, Málaga and Seville; and the tenth is in the Canary Islands. Another public project in Santander, the Marqués de Valdecilla Hospital, has also been added, where a proton therapy unit has been installed. The goal is for it to be completed in 2028.
Q. By that date, will there be enough trained specialists?
A. With all these technological advances, there is an increasing need for specialists, not only radiation oncologists but also hospital medical physicists, with whom we work closely. In Spain, we have a very rigorous MIR (medical residency) training system, and the training for medical physicists is three years, while the training for oncologists is four. We will need to extend these periods by another year. If we are going to be the country with the greatest access to this therapy in the world, we need to prepare for it.
Q. With the Barbacid case — a cancer study in which Mariano Barbacid’s team eliminated tumors in mice, but media coverage overstated it as a potential cure for humans — was the problem a lack of prudence or a lack of clear explanations?
A. When reporting news related to health, it’s crucial to present it as truthfully as possible and to keep expectations realistic. I believe there has been progress, but it’s important to be cautious and describe it for what it is: something achieved in animal studies, which is the first step toward achieving it in humans. The news is good, but going from that to saying the disease has disappeared could lead to false expectations.
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