Web Review – Less side effects for Sophia thanks to proton therapy

SEATTLE – Less than a year ago, Sophia Thompson, 7-year old, has been diagnosed with a rare form of soft tissue cancer called « rhabdymosarcoma » behind her right eye. Thanks to proton therapy, the young girl survived cancer with no brain damage and intact vision.

As Seattle’s proton therapy center was still under construction at the time she needed treatment, Sophia and her family travelled to the ProCure center in Oklahoma City. Over six weeks, she underwent 28 proton sessions.

Before long, her parents said she was playing pranks on the radiation therapists and giving them nicknames. The biggest challenge was getting her to stop giggling and stay still during each 30 minute treatment. During the therapy, her only side effects were redness and blistering around her eye. Since the end of her sessions, Sophia has experienced no long-term side effects. « She’s back to her old self, bursting full of energy, » her mother said.

Proton therapy is also used to treat patients with tumors in delicate areas such as the brain, spine, lungs or prostate. Sophia would likely have survived with conventional radiation, but she might have suffered from many side effects and damage to her pituitary gland, skull and eye.

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Generosity of hometown secures Proton Therapy for British boy in Boston

Plans are under way for the first Proton Therapy centers to open in the United Kingdom in 2017.

But Jasmin Novakovic, a mother from Aylesbury, couldn’t wait four years.

Her 7-year-old son, Alex, has brain cancer. Terminal brain cancer, her local National Health Service (NHS) physicians informed her. A medulloblastoma.

Despite surgery and chemotherapy, the doctors told Jasmin, “ ‘The cancer has spread everywhere.’ ” And conventional radiation therapy using photons was the last hope for her boy, she remembered the radiation oncologist saying.

“And then she started going through the side effects for photons,” Jasmin said. “She said these are side effects that may or may not happen. The list was endless, absolutely endless. The burns to the body. The secondary cancers. Alex might end up having problems with his heart and lungs. I mean they would be treating his head and spine with photons but would damage all these other healthy organs in the process. It horrified me and sounded so barbaric.”

The discussion with the radiation oncologist that January day “got quite heated,” Jasmin said. Jasmin’s husband had read about proton beam treatments on the Internet and asked if protons might be a viable option to treat their boy.

“The radiation oncologist basically said protons and photons are the same thing and there was no proof that protons worked,” Jasmin said. “I said, ‘Your own NHS website tells us about the benefits of protons over photons. We wouldn’t be getting proton machines in the UK if it wasn’t proven.’ ”

At the parents’ insistence, Alex’s doctor agreed to consult with doctors at a proton center in America. At a subsequent meeting, “She said no one would treat him with protons; the cancer was too advanced,” recalled Jasmin.

Then and there, Jasmin and her husband decided photon treatments would rob Alex of his quality of life if he were to survive. “The most important thing for me is that he have a good quality of life,” she said. “Otherwise, what’s the point?”

They prepared themselves for palliative care for what they thought would be Alex’s final weeks with his family.

“I was in such a state at that point,” Jasmin said. “Thankfully, my brother got in touch with MassGeneral in Boston. And he got Alex’s scans and medical notes sent over to the doctors there. They said they may be able to cure him.”

Jasmin paused for a moment to gather her emotions. “Up until then, I had never heard the ‘cure’ word before in Alex’s case.”

Side effects were discussed, Jasmin added. But they were of no great concern.

Considering Alex’s cancer, proton treatments needed to begin as soon as possible. “We had two weeks to raise £255,000 to pay for Alex’s treatments,” Jasmin said. “Two weeks. My brother took it by the horns. We got a website up and running to let people know about Alex’s cancer. I texted a load of mothers and said look, this is the situation. And they all called the newspapers and radio stations and TV stations. They used Facebook and Twitter. A lot of businesses in our community donated. Alex’s school helped enormously. And other schools did, as well.”

Kids ’n’ Cancer UK, a pediatric cancer charity, also facilitated the urgent fundraising.

In two weeks, Alexander’s Fund raised 158 percent of its goal. “The help we received from our neighbors and the whole community was fantastic,” she said. “It was unimaginable.”

Alex is currently nearing completion of his six-week course of proton beam treatments. “He’s responding very well.” Jasmin said. “He’s having treatments on his spine and head. And an hour and a half after protons, he goes out to play. If he were in the UK now getting photons, he’d be in bed.”

The apartment that Alex and Jasmin have at Christopher’s Haven is “just lovely.” It’s located just a five-minute walk to the proton center. And her neighbors at Christopher’s Haven are families just like Jasmin’s, with a child being treated with protons. “It’s all very comforting,” Jasmin said.

Jasmin is eager to learn of her son’s prognosis from his pediatric oncologist at the Francis H. Burr Proton Therapy Center at Massachusetts General Hospital. A round of chemotherapy may be needed. Doctors won’t know for sure until they see new images of Alex’s spine and brain.

“Once Alex is given the all clear, any leftover donations will stay with Kids ’n’ Cancer to help more kids like him,” Jasmin added.

Web Review – Brave woman with 2 cancers keeps hope thanks to proton therapy

Gloria De La Cruz, 52, has been through two cancer diagnoses in the past seven months and lost half her vision. Fortunately, she was granted the opportunity of proton therapy treatment and has therefore decided to stay positive and fight as hard as she can.

Last August, doctors discovered a cancerous tumor growing on Gloria’s eye and performed and enucleation of her eye. Gloria dealt with this traumatic and painful event, and in spite of the loss, she was just happy to be cancer free. “I was very fortunate to still have an eye left”, she said.

But a month and a half later, she was diagnosed with a deep-seated cancer around her liver. The only treatment option that wouldn’t put her liver and other organs at serious risk was proton therapy.

Unlike regular photon-beam radiation (using X-rays or gamma rays), which leave radiation all along the way, proton beams deposit radiation primarily at the end of their path in the body. This allows radiologists to target cancer cells deeper in the body, with less resulting radiation in the surrounding tissues. And with also fewer potential side effects.

For six-and-a-half weeks, Gloria underwent a 60 to 90 minute radiation treatment every day. Even if she couldn’t feel the radiation itself, she had to hold her arm raised the whole time, which was at times excruciating. “The best thing was when my son taught me how to meditate,” she explains. “It helped me to lay still that whole time.”

Besides, the side effects of her treatment were relatively small, considering she was taking oral chemotherapy doses at the same time. She suffered from constant nausea and fatigue but not much else.

Gloria is grateful for help from friends during the past weeks. And she marvels over how her sons pitched in to keep the household running. But she also sees how this type of treatment made a difference too, particularly given the location and aggressiveness of her cancer.

“Proton therapy is the most amazing thing,” she says. “My chances are so much better because of it.”


  • http://napervillesun.suntimes.com/lifestyles/18876439-423/treating-quality-of-life-too.html

Intensity-modulated proton therapy (IMPT) gives doctors more flexibility to treat complex tumors

As sophisticated as Proton Therapy is today for successfully treating cancers with few side effects, proton beam technologies continue to advance to meet the clinical needs of cancer patients.

The latest generation of proton treatment methods is called intensity-modulated proton therapy or IMPT.

IMPT lets radiation oncologists adjust the precision, depth and intensity of a proton beam to the peaks and valleys of complex spiderlike tumors while avoiding healthy tissue. Tumors like these are typically found in the head, neck or spine. IMPT also is well suited for treating tumors that are next to or wrapped around vital organs such as the heart or pancreas.

This new proton therapy method is particularly attractive when treating children with rhabdomyosarcoma, skull base chordoma and Ewing’s sarcoma, said Dr. Anita Mahajan, medical director of the MD Anderson Proton Therapy Center in Houston, Texas.

Dr. Mahajan recently treated a teenage girl with a skull base chordoma. “The location of her tumor, nestled in between the brain stem and spinal cord, was a deciding factor in using IMPT,” she said.

IMPT improves upon a type of proton treatment called Pencil Beam Scanning (PBS), which has been used in recent years by physicians at MD Anderson and at other proton centers.

PBS delivers a beam spot as narrow as 3 millimeters, about the diameter of a smartphone audio jack. PBS has all but eliminated the need for personalized brass apertures, a kind of beam guide cut to the size and shape of each person’s tumor. Because of the limitations of cutting brass apertures, treating complex tumors with protons had been a big challenge — until PBS was devised.

PBS “paints” protons across the full area of a tumor, one layer at a time using a uniform dose for each layer. IMPT treats a small section of the tumor at a time, adjusting the proton beam dose and depth to wider and narrower contours of the tumor, section by section.

This more refined use of a pencil-thin proton beam, however, requires the latest three-dimensional imaging software to obtain highly detailed pictures of the tumor. In order to provide the benefits of IMPT to cancer patients, many proton therapy centers are investing in more sophisticated imaging technology.

Medical physicists and radiation oncologists are also perfecting how they can calibrate IMPT to account for tumors that move as the patient breathes. Doing so would ensure IMPT’s use to treat lung cancers.

Press release: Provision Center for Proton Therapy Names Medical Director: Board-Certified Radiation Oncologist Will Lead Tennessee’s First Proton Center

The Provision Center for Proton Therapy announced today it has named Marcio Fagundes, M.D., as medical director.  A board-certified radiation oncologist, he comes to Knoxville from the ProCure Proton Therapy Center in Oklahoma City where he has practiced proton therapy and conducted significant research.  He will start his new role on July 15.

“The addition of Dr. Fagundes as medical director is another important step in building our team of proton therapy experts,” said Mary Lou DuBois, President of Provision Center for Proton Therapy.  “He is an extremely knowledgeable and experienced radiation oncologist and will be an invaluable asset to the proton center and its patients.”

Dr. Fagundes will be joining Provision Medical Group, led by Allen Meek, M.D., radiation oncologist and U.S. News and World Report “Top Doctor.” Dr. Fagundes first became interested in proton therapy during his internship and residency at the University of Miami/Jackson Memorial Hospital, where he had the opportunity to guest intern at Harvard University. Upon completion of his residency, he went back to Harvard Medical School for his fellowship, where he began treating patients with proton therapy in 1993.

Dr. Fagundes was an assistant professor at TUFTS University in Boston, where he developed protocols for treatment and retreatment using a new modality, IMRT, which at the time was not yet FDA approved. He is currently the principal investigator in Oklahoma for the University of Pennsylvania’s retreatment protocol using proton therapy. He earned his medical degree at Universidade Federal do RGS in Porto Alegre, Brazil, where he is originally from.

“I am extremely honored to be able to introduce patients to proton therapy in Knoxville,” said Marcio Fagundes, M.D., medical director of the Provision Center for Proton Therapy.  “One of the most rewarding aspects of being a proton therapy radiation oncologist is seeing patients who have been able to resume normal, active lives as cancer survivors.  The opportunity to relocate to Knoxville and to provide proton therapy to this area is a privilege.”

The Provision Center for Proton Therapy will begin treating patients in early 2014.  Prior to opening, Dr. Fagundes will be educating local and regional physicians and community members about how to become involved with the center and about the benefits of proton therapy, the most advanced cancer treatment in the world.  Protons are routinely employed in treatment of various disease sites including prostate, pediatric, sarcoma, brain, lung, and breast cancers.  Dr. Fagundes will spearhead proton therapy clinical research trials and retreatment protocols at Provision Center for Proton Therapy.

The Provision Center for Proton Therapy is part of Provision Health Alliance’s comprehensive outpatient cancer treatment campus located just off Middlebrook Pike at Dowell Springs.

“The unique setting of Knoxville’s proton center is unlike any other in the country or even the world,” said Dr. Fagundes, M.D.  “The comprehensive campus at Dowell Springs is both patient and physician-friendly and is the new model for future healthcare delivery.”

A frequent speaker on proton therapy, Dr. Fagundes has published dozens of articles in peer reviewed journals.  Most recently, he developed a “Phase II Study of Post-operative, Cardiac Sparing Proton Radiotherapy for women with Stage III, Loco-Regional, Non-metastatic Breast Cancer,” in collaboration with Dr. Eugen Hug at ProCure. The results showing the advantages of proton therapy in cardiac and coronary artery sparing were accepted to the PTCOG (Proton Therapy Co-Operative Group) and ASTRO (American Society of Therapeutic Radiation Oncologists) meetings this year.

For more information, visit www.provisionproton.com

About Provision Center for Proton Therapy Opening in early 2014, the Provision Center for Proton Therapy will be the first of its kind in Tennessee and only the second in the Southeast. Proton therapy, the most advanced form of radiotherapy in the world, uses a single beam of high-energy protons to treat various forms of cancer.  Different from conventional radiation therapy — in which beam energy dissipates as it passes through the body — proton beams can be fine-tuned with millimeters of accuracy to deliver maximum energy within the controlled range of the cancerous tumor.

Open to all credentialed physicians and health systems in the region, the Provision Center for Proton Therapy will have three treatment rooms and will be able to treat up to 1,000 cancer patients annually, and will bring in many patients from outside the area.  The center brings to Knoxville an advanced cancer treatment capability that presently is available in only a handful of cities. When completed, it will be one of only 14 in the nation.

Seattle Cancer Care Alliance Proton Therapy, A ProCure Center Names New Associate Medical Director

Seattle Cancer Care Alliance Proton Therapy, A ProCure Center, has recruited two expert radiation oncologists from the University of Pennsylvania. Dr. Ramesh Rengan joins SCCA Proton Therapy as the new associate medical director and Dr. Smith “Jim” Apisarnthanarax as a practicing radiation oncologist. Both physicians will also join the University of Washington School of Medicine as Associate Professors.

“Our center is dedicated to recruiting the nation’s top talent in radiation oncology,” stated Annika Andrews, president of SCCA Proton Therapy, A Procure Center. “Dr. Rengan and Dr. Apisarnthanarax bring extraordinary leadership and expertise to our center. Their prestigious backgrounds, research interests and passion for patient care make them an ideal addition to our growing expert medical staff.”

Dr. Rengan is a board-certified radiation oncologist who specializes in radiation treatment for lung cancer and melanoma patients at Seattle Cancer Care Alliance. Dr. Rengan was previously the Chief of Thoracic Service and Assistant Director of Clinical Operations for the Department of Radiation Oncology at the University of Pennsylvania. He completed his residency in radiation oncology at Memorial Sloan-Kettering Cancer Center and earned his medical degree (MD) and doctorate (PhD) from University of Michigan Medical School and Rackham School of Graduate Studies in biological chemistry.

Dr. Rengan’s areas of research involve the development of clinical and translational (bench-to-bedside) initiatives designed to improve clinical outcomes in lung cancer and melanoma patients. His research interests also include understanding the biology of lung cancer tumors in order to make radiation treatment more effective. Dr. Rengan is also interested in investigating proton beam radiotherapy as a tool to optimize the treatment of a number of solid tumors, including lung cancer. He is the co-chair of the IHE-RO Planning Committee for the American Society for Therapeutic Radiology and Oncology (ASTRO) and the translational co-chair of the ASTRO Annual Spring Refresher Course.

“We are very excited to have both Dr. Rengan and Dr. Apisarnthanarax join our team to help further advance and refine the use of proton therapy,” said Norm Hubbard, executive vice president of SCCA. “Both physicians have impressive experience treating patients with proton therapy and will be great additions to our recently opened center.”

Dr. Apisarnthanarax is a board-certified radiation oncologist who specializes in treating gastrointestinal cancers at Seattle Cancer Care Alliance, including liver, esophagus, stomach, pancreas, rectal, and anal cancers. Dr. Apisarnthanarax was previously the Associate Residency Program Director and Assistant Professor of Radiation Oncology at the University of Pennsylvania School of Medicine. He completed his residency in radiation oncology at University of North Carolina and earned his medical degree from Brown University Warren Alpert Medical School. He has also completed a research fellowship in experimental radiation oncology at MD Anderson Cancer Center.

Dr. Apisarnthanarax’s research interests include optimizing the treatment of liver cancers, integrating proton beam radiation therapy into the multidisciplinary care of cancer, and using novel functional imaging to personalize cancer care by decreasing normal tissue toxicity and assessing cancer treatment response. He was recently recognized as Educator of the Year by the Association of Residents in Radiation Oncology (ARRO) for his work at the University of Pennsylvania School of Medicine.

For more information about proton therapy, visit www.sccaprotontherapy.com or follow SCCA Proton Therapy on Twitter @SCCAProtons.


Home Away Boston offers oasis for families of children getting proton beam treatments

All it took was one phone call.

And Danielle Yumul had secured a furnished, two-bedroom apartment in Boston with a kitchen and laundry — rent-free. And a 10-minute shuttle ride to her youngest daughter’s proton beam treatments at Massachusetts General Hospital.

“I could not believe it was this easy,” said Danielle, mother of two daughters who have endured serious health complications over the years. “In between surgeries and watching my children suffer and fight for their lives, a lot of my time was spent fighting with insurance companies, hospitals, doctors’ billing services, collection agencies. Nothing was ever this easy.”

“That’s the point,” said Martha Bernard Welsh, executive director of Home Away Boston. “We wanted to make housing easy, safe and comfortable for families traveling from far away to MassGeneral for proton beam treatments. Childhood cancer is so disruptive to family life, so draining on emotions and finances, at least we could ensure housing was one thing not to worry about.”

During other health crises, housing had been a huge frustration for Danielle and a drain on the energy she needed to tap for her kids’ care. Doctors at a New York hospital performed two heart surgeries on Alyson before her first birthday. Danielle lived for four weeks in a parent’s room at the hospital. A cot for sleep. A locker for her belongings.

A year after Alyson graduated high school, she underwent two brain surgeries at a Pennsylvania hospital to remove a brain tumor. Danielle lived in the hospital’s nearby family housing facility with a common kitchen two floors down and a coin-operated laundry room three floors away.

“This was $60 per night for three weeks.” Danielle said. “And believe me, I was so grateful to have a room available for us. I was lucky.

“But when Alyson left the hospital after her first surgery and before we learned she would need the second surgery, she had to stay with me at this family facility. She still required close observation. But when I had to go down to the kitchen to cook her a meal or down to the laundry to wash clothes, I had to leave her alone. It was so unnerving.”

In Boston during Alyson’s eight-week proton beam regimen at Massachusetts General Hospital, mother and daughter lived in one of three Home Away Boston apartments located in fairly new apartment building in the Charlestown Navy Yard neighborhood. The venue offered comfort, rest and peace of mind that helped strengthen Danielle and Alyson during their fight with cancer.

“It provided a place I could prepare a meal, heat up food for me and Alyson and not have to leave her alone,” Danielle said. “It provided a washer and dryer, so I didn’t have to leave her. It provided fantastic views of the harbor, which distracted us and took our minds off our circumstances, as we watched the big boats, ripples in the water and ducks swimming. It was calming. It was mesmerizing. It was relaxing. And that was during the Boston winter with 25 inches of snow in one pop.”