Proton Radiation Therapy, a New Weapon Against Cancer

26 Feb 2019 News

The oncologists demand that Spain equip itself with specialized rooms to offer this treatment

In August 2014, the case of four-year-old British boy Ashya King made headlines. The little boy had been diagnosed with medulloblastoma, a type of malignant cranial tumor. He had received surgery and was waiting to be treated with chemotherapy and radiotherapy when his parents decided to remove him irregularly from the hospital in the United Kingdom where he was admitted and travel to Prague for proton treatment.

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4 benefits of proton therapy

26 Feb 2019 News

1) PRECISION OF ADMINISTRATION

Proton therapy offers the ability to guide treatment beams within millimeters of a target. Providers can be more selective about areas affected by treatment and give higher doses of radiation. This is particularly beneficial for cases in which conventional radiotherapy dose limits on surrounding organs, such as the brain or spinal cord, must be established.[1] With greater accuracy in targeting, patients require fewer treatment sessions and experience fewer side effects.[2]

2) MINIMAL DAMAGE TO SURROUNDING HEALTHY TISSUE AND VITAL ORGANS

As a highly-conformal treatment option, proton therapy can help patients avoid the effects of traditional photon therapy such as hearing and vision loss, heart disease, and radiation burns.[3] In children, whose organs and bones are still developing, leaving surrounding tissue unexposed to radiation can stave off future growth problems. When tumors are located near vital organs, precise radiation beams give providers a more efficient and direct way to treat unhealthy cells.[4]

3) FEWER SIDE EFFECTS THAN PHOTON THERAPY

Proton therapy is non-invasive and painless. It reduces the incidence and severity of side effects associated with traditional photon therapy.[5] Many patients report maintaining the quality of life they had pre-diagnosis – continuing at their jobs, going to the gym, and enjoying time with family.[6] With lower treatment exposure to healthy tissue, the likelihood decreases that secondary malignancies will develop as a result of unnecessary radiation exposure.[7]

4) COST SAVINGS DUE TO SHORTER THERAPY DURATION AND ADVERSE EFFECTS AVOIDANCE

The fact that proton therapy can be used to deliver higher doses of radiation and has the ability to leave surrounding tissue undisturbed, are key factors in cost savings for both short- and long-term care costs.[8] Often times patients require fewer treatments with proton therapy than with traditional X-ray therapy, and many patients can receive proton therapy treatment in an outpatient setting. The ability to couple proton therapy with other treatments, such as chemotherapy, also increases the likelihood that cancers can be eradicated with greater efficiency.

With proton therapy technology continuing to evolve, smaller, more compact systems are emerging – allowing a greater number of facilities to offer the treatment. This treatment expansion is likely to result in better patient outcomes – particularly for pediatric patients and those with tumors near vital organs.

Fuente: protominternational.com

 

Outcomes after Proton Therapy for Treatment of Pediatric High-Risk Neuroblastoma

26 Feb 2019 News

Background

Patients with high-risk neuroblastoma (HR-NBL) require radiation to the primary tumor site and sites of persistent metastatic disease. Proton radiotherapy (PRT) may promote organ sparing, but long-term outcomes have not been studied.

Methods

Sequential patients with HR-NBL received PRT: 2160 cGy(RBE) to primary tumor bed and persistent metastatic sites, with 3600 cGy(RBE) to gross residual disease.

Results

From 9/2010-9/2015, 45 patients with HR-NBL received PRT following systemic therapy, primary tumor resection, and high-dose chemotherapy with stem cell rescue. Median age was 46 months at the time of PRT (range 10m – 12y); 23 (51%) were boys. Primary tumors were adrenal in 40 (89%); 11 (24%) received boost. Ten metastatic sites in 8 patients were radiated. Double scattered (DS) proton beams were used for 19 (42%) patients, in combination with x-rays for 2 (5%). The remaining 26 (58%) received pencil beam scanning (PBS), available since 1/2013. We observed 97% freedom from primary site recurrence at 3, 4 and 5 years. Overall survival rates were 89%, 80%, 80% and disease-free survival rates were 77%, 70%, and 70%, at 3, 4, and 5 years, respectively. With median follow-up of 48.7 months from diagnosis (range 11 – 90 months) for all patients (57.4 months for those alive), 37 (82%) patients are alive, and 32 (71%) are without evidence of disease. One patient experienced locoregional recurrence; the remaining 12 (27%) experienced relapse at distant, non-radiated sites. Acute toxicities during treatment were mainly grade 1. No patient has experienced WHO G3/4 long-term renal or hepatic toxicity. PBS plans required less planning time and resources than DS plans.

Conclusions

We observe excellent outcomes in patients treated with PRT for HR-NBL from 2010-2015, with 82% of patients alive and 97% free of primary site recurrence. No patient has experienced long-term renal or liver toxicity. This treatment maximizes normal tissue preservation and is appropriate for this patient population.

Source: redjournal.org

Cancer diagnosis leads to career

19 Feb 2019 News

Andrew Porter becomes a Cincinnati Children’s/UC Health Proton Therapy radiation therapist after his own experience with pediatric cancer and lifesaving proton therapy

At the age of 15, Andrew Porter didn’t think that 10 years later he’d be living and working in Cincinnati, helping pediatric and adult patients overcome cancer at the Cincinnati Children’s/UC Health Proton Therapy Center.

The Lizton, Indiana native was in the middle of his own battle with cancer.

“I was diagnosed with non-metastatic pineal germinoma, a cell tumor found near the pineal gland in the brain,” he says. A high school athlete, Porter says he’d been noticing problems on the baseball field with coordination as well as migraines and fatigue. “I have a family history of migraines, so that’s what my doctors were treating, but when things got worse, they sent me for a scan, and the cancer was discovered,” he adds.

Porter’s physician at Riley Children’s Health in Indianapolis put together a treatment plan for him that involved chemotherapy and proton radiation at the Indiana University (IU) Health Proton Therapy Center, formerly known as the Midwest Proton Radiotherapy Institute.

Proton therapy is a form of radiation treatment used for certain types of cancers and lymphomas. A major advantage over traditional forms of radiotherapy is its ability to deliver radiation to a tumor area with remarkable precision, sparing healthy tissues. There are only 27 proton therapy centers in the U.S.

“It was amazing to be so close to this cutting-edge facility and treatment,” he says. “I remember making the hour and a half drive daily and dreading the treatment, but as we turned into the parking lot for the facility, I would find myself excited to see the radiation therapists. I loved going for treatment there because of them and the way they made me feel. I always felt safe—like a home away from home.”

This was when Porter had a realization about his future that set him on the path for where he is today.

“I said to my parents, ‘I think I want to be a radiation therapist,’” he remembers, adding that he “did his homework” during treatments by asking all about the profession. “Throughout this experience, I was searching for meaning and a purpose. I felt like I was being called into this field for a reason, and I felt like I needed to give back to someone going through this just like my team had given to me—they gave me hope and helped me stay positive. It really felt like it was all meant to be.”

Porter was found to be cancer free in July 2009, but he experienced other issues as a result of his treatment, including avascular necrosis—death of bone tissue due to a lack of blood supply—in his hip. It required an unconventional hip replacement at 18 years old, but allowed him to boat and waterski again—two of his favorite pastimes. He also had corrective surgery on his eye, as the tumor put pressure on his right eye muscle leading to double vision and a “lazy eye.”

However, throughout it all, he kept his goal of becoming a radiation therapist in mind, and after graduating high school in 2011, he worked toward his associate’s degree in radiation therapy at Ivy Tech Community College, Bloomington. He also earned an advanced proton therapy specialist certificate.

“While I was earning my degree, the IU Health Proton Therapy Center shut down, and I was a bit discouraged, because it was my dream job, but little did I know that the UC Health Proton Therapy Center would be opening in 2016,” he says. “It was all part of a plan.”

And when Porter graduated in 2016, the proton center in Cincinnati was looking for new and eager radiation therapists.

He’s been working at the facility since it opened, and sees purpose in every day and in every patient with whom he interacts.

“I love what I do,” he says. “Because of my own battles, I’m able to connect with people in a unique way and build relationships. In my job, I try to take cancer and treatment off of the patient’s mind and make them smile and laugh for a bit. I share my story when I feel it is appropriate, but everyone has their own journey and story. I’m just there to give support in any way that I can and to share time with him or her. I can’t express how much I appreciate my supervisors and team of therapists allowing me to share my experience and even encourage it.

“I’m actually thankful for my diagnosis because it helped jumpstart my life, and it gave me a goal and a purpose. It helped me get through one of the toughest events of my life, and I’m so grateful for the support I had and my good outcome, which is helping me give back today.”

Source: uc.edu

Proton Therapy for Esophageal Cancer

19 Feb 2019 News

Treating esophageal cancer with an adequate dose of radiation can be difficult because of the close proximity of the esophagus to critical structures, such as the heart, lungs and spinal cord. Because protons deposit their highest dose of radiation at the tumor or area of concern, proton therapy can be an excellent choice for treating patients with esophageal cancer.

Proton therapy offers patients and their doctors a unique option for effectively treating esophageal cancer while reducing damage to other critical organs and tissues. The MD Anderson Proton Therapy Center is one of the few centers of its kind treating esophageal cancer with proton technology.

With proton therapy for esophageal cancer, treatments typically take about 15 to 30 minutes each day and are delivered five days a week for approximately four to seven weeks. The course of treatment and length of time per treatment each day varies based on each patient’s individual case. Most patients tolerate the treatments extremely well and are able to continue to work and exercise during their treatment course and immediately after treatment is complete.

Source: mdanderson.org

Proton therapy for treatment of intracranial benign tumors in adults

8 Feb 2019 News

Proton therapy for treatment of intracranial benign tumors in adults: A systematic review

Introduction

The depth-dose distribution of a proton beam, materialized by the Bragg peak makes it an attractive radiation modality as it reduces exposure of healthy tissues to radiations, compared with photon therapy Prominent indications, based on a long-standing experience are: intraocular melanomas, low-grade skull-base and spinal canal malignancies. However, many others potential indications are under investigations such as the benign morbid conditions that are compatible with an extended life-expectancy: low grade meningiomas, paragangliomas, pituitary adenomas, neurinomas craniopharyngioma or recurrent pleomorphic adenomas.

Materials

Given the radiation-induced risk of secondary cancer and the potential neurocognitive and functional alteration with photonic radiotherapy, we systematically analyzed the existing clinical literature about the use of proton therapy as an irradiation modality for cervical or intracranial benign tumors. The aim of this review was to report clinical outcomes of adult patients with benign intracranial or cervical tumors treated with proton therapy and to discuss about potential advantages of proton therapy over intensity modulated radiotherapy or radiosurgery.

Results

Twenty-four studies were included. There was no randomized studies. Most studies dealt with low grade meningiomas (n = 9). Studies concerning neurinoma (n = 4), pituitary adenoma (n = 5), paraganglioma (n = 5), or craniopharyngioma (n = 1) were fewer. Whatever the indication, long term local control was systematically higher than 90% and equivalent to series with conventional radiotherapy.

Conclusion

Proton-therapy for treatment of adult benign intracranial and cervical tumors is safe. Randomized or prospective cohorts with long term cognitive evaluations are needed to assess the real place of proton-therapy in the treatment of adults benign head and neck tumors.

Source: sciencedirect.com

Preliminary result of definitive radiotherapy in patients with non-small cell lung cancer

8 Feb 2019 News

Preliminary result of definitive radiotherapy in patients with non-small cell lung cancer who have underlying idiopathic pulmonary fibrosis: comparison between X-ray and proton therapy

Background

Idiopathic pulmonary fibrosis (IPF) is associated with fatal complications after radiotherapy (RT) for lung cancer patients; however, the role of proton therapy to reduce the incidence of life-threatening complications is unclear. Herein, we present the preliminary results of early-stage lung cancer patients having IPF and treated with RT, with a focus on the comparison between X-ray and proton therapy.

Methods

From January 2010 to October 2017, we retrospectively reviewed the medical records of 264 patients with stage I-II non-small cell lung cancer (NSCLC) treated with definitive RT alone. Ultimately, 30 patients (11.4%) who had underlying IPF were analyzed. Among these, X-ray and proton RT were delivered to 22 and 8 patients, respectively. Treatment-related complications and survival outcomes were compared between X-ray and proton therapy.

Results

The median follow-up duration was 11 months (range, 2 to 51 months). All living patients were followed-up at least 9 months. Treatment-related death occurred in four patients (18.2%) treated with X-ray but none with proton therapy. Most patients died within one month after the onset of pulmonary symptoms in spite of aggressive treatment. In addition, the 1-year overall survival (OS) rate in patients treated with X-ray and proton was 46.4 and 66.7%, respectively, and patients treated with proton therapy showed a tendency of better survival compared to X-ray (p = 0.081). Especially, in GAP stage II and III subgroups, patients treated with proton therapy showed significantly increased survival outcomes compared to X-ray (1-year OS rate; 50.0% versus 26.4%, p = 0.036) in univariate analysis.

Conclusions

RT is associated with serious treatment-related complications in patients with IPF. Proton therapy may be helpful to reduce these acute and fatal complications.

 

Source: biomedcentral.com

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