Plans for an $85 million proton therapy cancer center in the Baton Rouge Health District have been scaled back significantly, with the developer cutting the treatment capacity in half in an effort to make the center more financially viable.

The proton center was announced last spring by Gov. John Bel Edwards' administration in a unique deal that offered up traditional economic development tax incentives to a cutting-edge, and controversial, medical treatment.

Also last spring, the Edwards administration announced another $100 million proton therapy center planned for New Orleans, a partnership between Provision Healthcare, University Medical Center and the LSU Health Sciences Center. Those talks fell apart, and Louisiana Economic Development said the company discontinued its discussions for the facility. The firm said it is looking for another clinical partner and site.

The Baton Rouge center was initially set to open in late 2019 but now won’t begin construction until then, said Steve Hicks, chief executive officer of Provident Resources Group, the Baton Rouge nonprofit developing the center. The new plans also call for one treatment room, instead of two, which would mean a $45 million to $50 million investment, he said.

“Quite frankly, to manage the success of the project, we’d rather have a waiting list, unfortunately,” to handle the risk of the project and make sure demand is there, Hicks said.

“We can always come back and add on a gantry, a second treatment room.”

Proton therapy uses massive, multimillion-dollar machines to shoot protons at cancerous cells, killing them by damaging the DNA inside. There are 28 proton facilities in the U.S., according to Scott Warwick, executive director of the National Association for Proton Therapy, and in 2016 they treated 9,177 patients.

Hicks said low third-party reimbursement rates from insurers is the biggest obstacle to the project. Unless insurers agree to increase their reimbursement rates, Hicks said he will have to pursue “financial assistance” to make the numbers work. That could mean trying to find low-interest loans and subordinate debt.

Proton therapy is an expensive and controversial treatment, and critics say the treatment hasn’t produced measurably better results than other, more traditional cancer treatments.

But proponents say the treatment is a far better option for patients with certain types of cancer, especially children, because it provides a targeted dose of radiation, sparing healthy tissue that could be damaged in traditional radiation.

“Even the greatest proton therapy skeptics would agree that if proton therapy were the same cost as other types of technology, there would be proton therapy centers in every small, medium and large marketplace in America,” said Jonas Fontenot, chief operating officer and chief of physics at Mary Bird Perkins Cancer Center, which is a clinical partner for the Baton Rouge facility.

Mary Bird Perkins Cancer Center decided to become involved to ensure patients have every option available, Fontenot said. He also disputes the idea that proton therapy is experimental and said there is evidence the treatment is useful for a growing list of cancer types.

Not everyone agrees.

Baton Rouge General was listed as one of the partners of the facility when the Edwards administration announced the plans last May. Less than a month later, Baton Rouge General pulled out of the deal, questioning the therapy’s clinical outcomes.

“While there is some promise in treating a limited number of childhood cancers with protons, controlled clinical trials have not demonstrated superior outcomes for the vast majority of cancers in adults,” compared with radiation therapy, Baton Rouge General CEO Edgardo Tenreiro said at the time.

Louisiana Economic Development Secretary Don Pierson conceded it is rare for the state agency to become involved in medical deals like the proton centers announced last year. The agency offered up $16 million in incentives over a 10-year period in exchange for 150 jobs at the two centers.

The reason it moved forward, Pierson said, was twofold. First, the centers are thought to attract patients from throughout the Gulf South, which would bring patients and families to Louisiana for extended periods of time, bringing in “visitor revenues.”

Secondly, he said, “people want every option to address and eradicate cancer.”

“It is likely to be an unusual circumstance that would bring LED into the medical sector” again, Pierson said.

He added that Louisiana Economic Development will revisit the Baton Rouge proton center to determine what incentives will be offered and said no state dollars were at risk because the incentives are performance-based. The developers of the New Orleans facility “discontinued discussions” with the state agency about their planned proton center in the New Orleans medical corridor.

The company behind that facility, Provision Healthcare, said it is moving forward, despite University Medical Center abruptly pulling out of the deal over state budget uncertainty. The Tennessee-based company is seeking another clinical partner, and has engaged Tulane University and Ochsner, but plans to build an independent center if it can’t land a partner.

“We’re still planning on coming,” said Provision CEO Terry Douglass, who cited “tremendous” success at a three-room Knoxville, Tennessee, proton center. “We believe New Orleans has a higher potential than Knoxville or Nashville. We’re very bullish about providing proton therapy capabilities in New Orleans.”

Provision won’t pick a site until it determines whether it will have a clinical partner, and it will be 30 months at the earliest before a Proton Center in New Orleans sees patients.

Provident’s equipment provider, Ion Beam Applications, recently posted a larger-than-expected quarterly loss, with Reuters reporting the Belgian company has been hurt by delays in the construction of proton therapy facilities and reduced order intake. The company builds the multimillion-dollar machines that actually provide the proton therapy treatments.

Fontenot, of Mary Bird Perkins Cancer Center, said the cost of the technologies for proton therapy are dropping, and have presented the option — like in Baton Rouge — for one- or two-room facilities.

“I’m optimistic that south Louisiana will end up with a proton therapy center at some point,” Fontenot said.

Follow Sam Karlin on Twitter, @samkarlin.