After months of heated debate, two of the biggest hospital systems in Washington, D.C., won approval Friday to build expensive proton beam centers for cancer treatment.

Together, the two high-tech expansions are expected to cost $153 million. The green light comes despite questions about whether the proton beam treatment is more effective than less expensive options.

Johns Hopkins Medicine will be allowed to build a two-room proton center at Sibley Memorial Hospital. MedStar Health's Georgetown University Hospital will be allowed to move forward with a one-room facility. Hopkins had requested permission to build a four-room center.

The controversial decision was made by Amha Selassie, the director of the city's health planning and development agency.

The two centers, about three miles apart, will compete for patients in the Washington area, particularly for those with private insurance. They will also be competing with a five-room facility under construction in downtown Baltimore.

Proton beam therapy is controversial. It costs nearly twice as much as standard radiation treatment, yet hasn't been shown to provide superior care for the vast majority of patients.

While the treatment has shown promise for treating brain and spinal tumors in children, the Hopkins facility is explicitly banned from treating pediatric cancers. That's because Sibley Memorial Hospital doesn't have a pediatric unit, nor does it have a permission from the city to build one.

Hopkins, MedStar and the Maryland Proton Treatment Center will all have to turn to treating adult cancers — largely prostate cancer, for which proton therapy hasn't been proved to improve results for patients or to reduce side effects — to stay profitable.

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