As soon as he arrives at his new workplace at the particle therapy center in Marburg, Sebastian Adeberg is confronted with a ticklish situation. On the one hand, there is a spirit of optimism among the staff of this special facility for the treatment of tumors. Because the new future contract concluded at the end of February for the University Hospital Giessen and Marburg also serves their work. On the other hand, she and Adeberg face two hurdles together with the executive floor of Germany's third-largest hospital. For example, a new service contract is required with the medical technology manufacturer Siemens Healthineers, which built the heart of the facility, the 90 x 50 meter particle accelerator. Even more important at the moment, however, is an agreement with the health insurance companies on further financing. From next week, both sides will talk about it.

Thorsten Winter

Correspondent of the Rhein-Main-Zeitung for Central Hesse and the Wetterau.

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These talks are marked by the economic pressure that health insurance companies are under. They expect a minus of about 17 billion euros for the current year, with an upward trend. The contracts still in force for the particle therapy center run until June 30, as the Chairman of the Management Board of the University Hospital, Gunther Weiß, says. The management team is aware of the concerns of the payers. Nevertheless, Weiss also says: "We assume that we will be able to convince the health insurance companies to continue the financing."

Higher efficacy thanks to heavy ions

From the point of view of the University Hospital, there are a number of reasons for this. The Particle Therapy Center is one of only two facilities of its kind in Germany – the other is located in Heidelberg. From there, the cancer and radiation physician Adeberg moved to the Lahn. Both locations exchange ideas. After a very bumpy start of the plant in 2015, the Heidelberg company was in charge of the plant for some time. It is now a subsidiary of Rhön-Klinikum AG, which has owned 2006 percent of the UKGM University Hospital since 95. Particle therapy had been launched at the time by the government under Roland Koch (CDU) as a "lighthouse project".

The system owes its special radiance in two senses to its technology. It can fight tumors with both hydrogen ions and heavy ions. For the second variant, the particle accelerator shoots carbon ions. This type of radiotherapy is characterized by the significantly higher biological effectiveness compared to the other variant. This in turn is due to the much denser energy output to the irradiated tissue, it is said in Marburg.

Rays hit tumor all around point by point

Sylvia Heinis, commercial director at the UKGM in Marburg and doctor, raves about the precision of the heavy ion administration. Accordingly, the rays hardly damage the surrounding tissue on the way to the target and then fan out in the tumor. The ulcer is previously screened in 3 D. As a comparison, White chooses the image of a tangerine that is hit by rays all around point by point – and not just from one side.

With this type of therapy, the facility can also treat patients for whom there is little or no help, including children. The diseases therefore include malignant tumors on the spine, at the base of the skull and in the neck as well as pancreatic cancer. Among others, the former Hessian Prime Minister Volker Bouffier (CDU) has benefited from particle therapy in Marburg. Most recently, according to a clinic spokesman, 350 cancer patients were treated in four of the therapy rooms within a year.

A deficit is accepted

Particle therapy is not a profit center. Rather, the opposite has been the case since the beginning: "We do not earn any money with the investment," emphasizes Weiss. He estimates the minus incurred over the course of the year at a small amount of millions. The hospital shoulders this deficit in the knowledge of the benefits of particle therapy. Their value is also known in the state government: The future contract for the university hospital, which runs until 2033, allows 750,000 euros to be spent annually on the plant.

New software and equipment required

The money is also needed on the Lahn. Adeberg said, "The particle therapy center is in a state where it works well." However, it does not hide the need to invest in imaging equipment and the software essential for operation. So far, the computer needs two to three days for a treatment plan. With new software, this should be much faster in the future. After the desired investments, the plant will be at a level to provide top medicine for the next few years, as Adeberg continues. Incidentally, it is completely normal to regularly renew technology.

However, the cash registers would like to see a better data situation. With two centers in Germany, however, this is difficult to guarantee: "We all need staying power," says the 38-year-old Adeberg. For him, there is no question that particle therapy has a future. In Asia, it will be expanded. Australia is planning four such plants. He is a member of a committee that deals with this and plans to work with his Australian colleagues. In view of this, White is "energetically optimistic" before the talks with the funds.