Danya Dubin: five years after proton therapy

The young pioneer patient from St. Petersburg treated at the first Russian proton center in 2018 is feeling well today.

The first Russian Proton Therapy Center built by the Berezin Sergey Medical Institute (MIBS) in St. Petersburg began to actively treat cancer patients with the country’s breakthrough radiation technique in January 2018. Today, among the patients of the center there are those who have crossed or are about to cross the five-year milestone since their proton therapy treatment. The five-year recurrence-free period is considered a clinically significant indicator in oncology.

Surgery didn't work

One such patient is Danya Dubin, the first child from St. Petersburg who was admitted to the Proton Therapy Center in the spring of 2018 with a diagnosis of atypical meningioma in the anterior cranial fossa. Danya was only 4.5 years old at the time, but he had a long and complicated treatment history behind him that included cranial trepanation and a number of surgical procedures.

Atypical meningioma, a tumor formed from the cells of the cranial arachnoid mater, is extremely rare in children. It is more common in the elderly. As it turned out later, the "trigger" for the child's neoplasm development was phacomatosis - a genetic disease that provokes the formation and progression of various tumors and hematomas in the organs. Fortunately, in Danya's case, the tumor did not spread to the brain, but actively developed in the nasal cavity, making breathing difficult for the child.

The fierce fight with the disease brought no results: a follow-up MRI after another surgery showed that the tumor continued to grow again. "We had already been fighting for Danya for two and a half years by that time. And at some point we started to feel desperate," recalls Ekaterina Dreling, Danya's mother.

Hope for protons

They were rescued from despair by a consultation with Nikolay Andreevich Vorobyov, Head of the Proton Therapy Department of the MIBS, to which his parents brought him after seeing a TV coverage about radiosurgery in the MIBS. Nikolay Andreevich said that neither Gamma Knife nor Cyber Knife is indicated in this case due to the localization of the tumor and the young age of the patient. But the first proton center in Russia is being completed in St. Petersburg, which will offer the best radiation method for pediatric patients.

"Proton therapy, being a highly precise and highly effective radiation treatment for tumors, was clearly preferred over traditional (photon) therapy for Danya Dubin," says Nikolay Vorobyov. According to him, the meningioma was located in the anterior cranial fossa, not far from the eye and auditory nerves, and irradiating the tumor with photons ran a high risk of affecting these areas, which could lead to visual and hearing impairment. In addition, radiation exposure of the growing brain often leads to cognitive developmental delays. Protons, heavy charged particles, unlike photons - X-rays, allow to minimize these risks: they deliver almost all energy exactly to the target, effectively destroy pathological cells, while sparing healthy tissues and organs.

Support of St. Petersburg

The conversation with the doctor took place in the summer of 2017, and Danya Dubin's family began to look forward to the launch of the Center. "We knew that the treatment was very expensive and that the Obligatory Medical Insurance policy would not cover it. But when the Center called us in early 2018 and invited us to therapy, we were ready to sell the only apartment we had just paid off. We were already packing our bags," says Ekaterina.

Fortunately, we did not have to part with our housing: St. Petersburg allocated quotas for its residents, and Danya Dubin became the first child from St. Petersburg who underwent proton therapy with the support of the city. Since then, for the 6th year in a row, 100 quotas were given each year and St. Petersburg can rightfully be considered as a city where all children with cancer eligible for proton therapy are treated free of charge.

In 5 years of operation, the first Russian proton center in St. Petersburg has carried out proton therapy for almost 3,300 patients, almost half of whom are under 18. Now more than 90% of patients receive high-precision therapy with government support.

Disease under control

Danya is remembered by the MIBS team not only as a "ground breaker". To this day, he remains the smallest patient of the proton center who was able to complete the entire course of therapy without anesthesia. At the time of treatment, the boy was only 4.5 years old, but he courageously endured all 30 radiation sessions, without moving an inch. The boy tolerated the treatment successfully, without any side effects from radiation: there was no hair loss, skin burns and nausea. His parents didn’t even notice any increased fatigue. For six weeks, without complaints and excuses, Danya would come daily with his dad to the treatment center on Glukharskaya Street.

Danya also undergoes follow-up MRI’s like an adult – without anesthesia, he patiently lies still for 40-50 minutes. The parents brought the child to the MIBS for magnetic resonance imaging according to special protocols exactly at the time scheduled by the doctors, and each time the answer received by e-mail gave them a reason to be happy: the tumor does not grow.

Almost five years after completing the course of proton therapy, the Dubins decided to come for a face-to-face consultation with Nikolai Andreevich Vorobyov, and again heard a positive conclusion: everything is going well, the scan is “clear”. Of the post-radiation complications, only increased nasal dryness remained, but, according to Nikolai Andreevich, over the years this problem may get alleviated.

Otherwise, Danya is an ordinary child, lively, agile, intelligent. The treatment, as confirmed by numerous foreign clinical studies, did not affect either the intellectual or physical development of the child. Now Danya goes to the second grade, he is a chess and robotics enthusiast, not a big fan of physical training, but he loves to play active games with his younger brother and prefers not to think about his illness.

Photo: Danya Dubin with his family