Unconventional ideas in medicine can stay obscure forever, but with a little luck and a lot of perseverance, it's still possible to put a really good one into practice. Or so the James M. Slater, MD, Proton Treatment and Research Center at Loma Linda University Medical Center would suggest.

Officially re-named at a high-profile December ceremony, the proton center now honors the physics-trained physician who was central to its creation. A member of the San Bernardino County Medical Society since 1970 and vice chair of LLUMC's Department of Radiation Medicine, Dr. Slater pressed his ideas for an innovative, safer type of cancer radiation treatment for about twenty years before the university built the facility. The technical details were only part of the struggle; he also had to convince university officials that it was worth investing in. And, more importantly, that it worked.

Proton radiation treatment first interested Dr. Slater while he was a resident during the 1960s, watching patients suffer from conventional X-ray treatments. "I realized what was doing it--it was the normal tissue that we were injuring," he says. With a background in physics, "I knew that there were better ways to do it, and better particles than X-rays," he adds. Protons seemed like a good candidate.

Dr. Slater pushed for protons beginning with his 1970 appointment as head of LLUMC's radiation oncology section. "I'd meet with [each dean] and talk with them and tell them what I wanted to do," he says. "Nobody argued against it or anything--I suspect some felt it would never happen."

From the late 1970s to the early 1980s, Dr. Slater began visiting cutting-edge labs in the United States, Russia and Sweden, each of which was exploring the use of protons for irradiating cancers. He set up meetings between lab administrators and LLUMC department chairs, and arranged for visiting speakers--mostly physicists--from places like Lawrence Berkeley National Laboratory, Los Alamos Scientific Laboratory and the Fermi National Accelerator Laboratory. The intellectual cross-pollination eventually led to a physics-heavy meeting of LLUMC administrators and physician department chairmen with Fermilab's director.

As Loma Linda officials became more comfortable with protons, Dr. Slater and colleagues asked big industrial firms whether they could build a proton-beam device for patient care. It would have to differ considerably from those used by research labs, favoring precision over sheer power. "General Electric, Westinghouse, Siemens, and so on ... they all declined," he recalls. "It was beyond anything they could do."

The answer was to again enlist basic physics researchers. "After visiting [laboratories] nationwide and worldwide, I decided Fermilab just outside Chicago was the ideal one," Dr. Slater explains. And with the 1984 assent of Fermilab's administration, the U.S. Department of Energy, which owns the institution, and the Universities Research Association, which guides its operations, Fermilab researchers designed and built Loma Linda's first proton treatment device by the decade's end. At its heart was the smallest synchrotron--a kind of particle accelerator--in the world.

Proton treatment kills cancer cells in a way similar to common gamma radiation, including X-rays; by ionizing cellular machinery and rendering it useless. But there's one critical difference, says Dr. Slater: "We have the ability to focus protons far better than we can other particles, like X-rays, which are photons." X-rays deliver a peak of ionizing energy only a couple of centimeters under a patient's skin, and continue to damage tissue after they reach the tumor target and continue through the patient's body.

In contrast, focusing protons on a tumor limits most cellular damage to the target itself. Says Dr. Slater: "We treat the whole volume of the tumor--we can electronically guide the proton beam into any shape or configuration that a tumor is growing in, and do that in a three-dimensional pattern. That's physically impossible with X-rays. With sub-millimeter precision, proton beams can treat brain and eye tumors with much higher comparative doses of radiation than conventional treatments--while limiting damage to those critical organs. The treatment is also gaining popularity for pediatric cancer, where conventional radiation causes terrible damage to patients' small bodies, says Dr. Slater.

The Center treated its first patient in 1990, and had treated several thousand before a second device was built for Massachusetts General Hospital. The LLUMC facility features three treatment rooms with gantries, in addition to a fixed-beam room for head and neck treatments, and a room reserved for research conducted by NASA, visiting scientists and Loma Linda investigators. Technology developed at Loma Linda University to plan and guide proton treatments has since been incorporated into X-ray devices worldwide, Dr. Slater says. Proton treatment is gaining worldwide popularity too, he adds.

From here, LLUMC is refining the technique. Soon robots will place patients into the proper position very accurately and quickly. That move will help bring down the treatment's price--Dr. Slater estimates that it currently costs about twice as much as X-ray therapy. "The cost is the only downside that we have, and we're working hard to get that down, and it will happen," he says.

"I think at this point in time everybody's extremely pleased with it," Dr. Slater reflects. Maybe now, with a building to his name and a successful cancer treatment under LLUMC's belt, he and his peers can rest just a moment.