Title: WEB REVIEW – “My breast cancer was close to my heart”

On her daughter’s second birthday, Liz d’Amato, mom of three, received a life-changing phone call. Her doctor diagnosed her with breast cancer. Discover her inspiring story of courage, battle and survival.

As a 47-year-old woman, mammograms were part of Liz’s regular health care regimen, and when she went to her doctor in September 2012, it was just for a routine check-up. However, a month later, her doctor asked her to come back for further testing. When she received the results, she was “shocked, devastated, upset and sad,” she remembered. “I didn’t know what to think. I had invasive ductal carcinoma in the left breast, grade 2, two foci (one measured 0.1 cm and the other was 3 cm). Extensive ductal carcinoma in situ was also present.”

Liz’s sister had already been through a similar experience, which gave her hope as she faced her own battle. A treatment plan was devised for Liz, including eight chemotherapy treatments, which she describes as the toughest four months of her life.

After that ordeal was over, she met with a radiation oncologist at a hospital to determine if radiation was necessary. She had read an article about proton therapy and brought it up. Fortunately, the doctor was familiar with it. “I really wanted to make sure I had options,” she explained. “Because my cancer was on the left side close to my heart, the doctor confirmed that I would be a good candidate for proton therapy. I knew this was the best option for me.”

Liz was referred to ProCure Proton Therapy Center in Somerset, New Jersey. Proton therapy is a more targeted type of radiation that results in less damage of the surrounding tissue, which was critical for her heart and lungs. She underwent 26 treatments and reported that it was far easier on her than chemotherapy was. It only became tough for her the last week and a half of treatment.

She had a great experience at the treatment center, which boosted her morale and kept her optimism up. Two weeks after her last treatment, her doctor reported the good news: she was healing very well. She has now a lot to look forward to, with her three children and her husband to grow old with.

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Protons may lower risk of radiation-related heart disease among breast cancer patients

If only Dr. Julie Bradley could speed up time, she would confirm what she suspects: Breast cancer survivors treated with protons will be much less likely to die from heart disease than those treated with photon radiation.

But Bradley is no wizard.

She’s a radiation oncologist at the University of Florida Proton Therapy Institute in Jacksonville, Florida. And she and other researchers are working to find clear signs that indicate harm to the heart caused by unintentional irradiation — many, many years before that harm finally plays out as heart disease.

“What can we do to identify anything earlier, some kind of cardiac biomarker, and not have to wait five or 10 years?” Bradley asked. “Is it identified by imaging or by a lab test? We don’t know yet.”

If they succeed, cancer researchers may be able to compare the incidence of such cardiac biomarkers among breast cancer survivors treated with photon radiation and those treated with proton radiation. The possible scarcity of such biomarkers among proton patients would demonstrate a clear clinical advantage for protons in treating some breast cancers.

“Cardiac disease or death is 5 to 15 to 20 years down the road for many cancer survivors treated with photons,” Bradley said. “We tend to see higher heart doses in photon radiation plans for regional nodal breast cancer and left-sided breast cancer. And over time, we’ve seen an increase of cardiac death among those cancer survivors.”

Bradley and other proton therapy specialists predict that five or 10 years after successful treatment with surgery and protons, breast cancer survivors will show a lower incidence of cardiac death. And that waiting is what frustrates Bradley. “If we can identify that earlier, rather than waiting 10 years, we can help people a lot earlier using protons,” she said.

Until those biomarkers are discovered, clinicians like Bradley are gauging which types of breast cancers are optimal for proton beams primarily based on reduced radiation exposure to the heart and lungs.

“We’re doing lots of work to define which breast cancer patient populations are best treated with protons,” said Bradley. “Women at risk for lymph node involvement are one major group. Left-sided breast cancer patients are another. In looking at the literature, the increase in heart disease is really reported for left-sided breast cancer patients treated with photons.

“Women who have a family history of cardiac disease are another group we think would benefit from protons,” Bradley continued. “You don’t want to add another cardiac risk factor like unintended photon radiation. Finally, there is a group of women who have chest walls shaped in such a way that it makes it hard to avoid the heart with any kind of radiation. We think protons may be best for each of these groups.”

Bradley recently presented preliminary findings of a pilot study of 11 women with breast cancer, aged 42 to 73, who, after surgery, underwent proton treatment of regional lymph nodes. The unintended radiation dose to the heart was significantly decreased by using protons, Bradley said.

According to an abstract of the pilot study published in the International Journal of Radiation Oncology, the median mean heart dose from unintended proton radiation was 86 percent lower than the unintended photon radiation dose.

“Proton and conventional radiation treatment plans were developed for each patient,” Bradley reported. “The superior plan, as defined by organ-at-risk-sparing and target coverage, was used to deliver the radiation. For all 11 patients, the proton plan better met dosimetric goals and, therefore, was used for treatment delivery.”

Bradley hopes to expand the study to include as many as 24 breast cancer patients. More information can be found at clinicaltrials.gov.

WEB REVIEW – What is breast cancer ?

Breast cancer is a kind of cancer originating from breast cells. It usually starts off in the inner lining of milk ducts (ductal carcinoma) or the lobules that supply them with milk (lobular carcinoma). As a malignant type of tumor, breast cancer is able to invade other parts of the body.

Incidence:

Breast cancer is the most common invasive cancer in females worldwide. It accounts for 16% of all female cancers and 22.9% of invasive cancers in women. 18.2% of all cancer deaths worldwide, including both males and females, are from breast cancer.

Symptoms:

The first symptoms of breast cancer are usually an area of thickened tissue or a lump in the breast. Most lumps are not cancerous but should however be checked by a health care professional. Other unusual signs can also be detected, such as pain in the armpits or breast unrelated to the menstrual period, redness of the skin, rash around the nipple, swelling in the armpit, fluid leaking out of the nipple, skin starting to peel, scale or flake, etc.

Cause:

Breast cancer comes from a mutation in the DNA of breast cells causing them to proliferate uncontrollably. The exact cause of this mutation is still unclear, but risk factors have been identified: prior history of breast disease or family history, age, race, reproductive and menstrual history, radiation exposure and dietary factors. However, the relative effect of these risk factors in any given case is variable and very difficult to determine.

Treatment:

The National Comprehensive Cancer Network (NCCN) lists different types of treatment for breast cancer: surgery, radiation therapy, chemotherapy, hormone therapy and monoclonal antibody therapy. Proton therapy, a state-of-the-art type of radiotherapy, is currently breaking new ground in the treatment of breast cancer, allowing to better spare healthy vital organs close to the tumor, such as the heart and lungs.

 

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From the editors – October is Breast Cancer Awareness Month

Dear Readers,
October is Breast Cancer Awareness Month. Breast cancer still touches too many of our moms, sisters and daughters. Proton Therapy Today is willing to help, to support the huge effort that is being made by thousands of people worldwide and to help them raise awareness about this disease. Over the next ten days, we will publish a series of articles and reviews about breast cancer and how proton therapy can help in certain cases. Stay Tuned!

The Breast Cancer Awareness Month, marked in countries across the world every October, helps to increase attention and support for the awareness, early detection and treatment as well as palliative care of this disease. Awareness about the disease is vital as there is little knowledge on the causes of breast cancer. Early detection of the disease remains critical to the success of treatment. When breast cancer is detected early, treatment options are available and there is a good chance of cure.

As of today, The National Comprehensive Cancer Network (NCCN) lists different types of treatment for breast cancer: surgery, radiation therapy, chemotherapy, hormone therapy and monoclonal antibody therapy.

Proton therapy is among the treatments listed. Although little used so far, proton therapy is currently breaking new ground in the treatment of breast cancer, allowing to better spare healthy vital organs close to the tumor, such as the heart and lungs.

If you want to know more on how proton therapy can help women fight against breast cancer.

Stay tuned! We will publish a series of reviews and articles over the next ten days.

Share if you care!

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Proton system engineer sees beam from new vantage point

For more than two decades, Mike Notarus has helped guide the design and construction of 17 proton treatment centers around the world.

Last April, he saw protons from a very different vantage point — laying on the treatment couch.

Diagnosed with prostate cancer by his physicians at the LAC+USC Medical Center in Los Angeles, California, Mike knew exactly which treatment he would pursue. And he knew where he would be treated.

Still, as is customary, his Los Angeles oncologist walked him through the various treatment options available for his prostate cancer, their risks and their benefits.

“‘No,’ I said, ‘I’ve been helping build proton therapy centers for 24 years, I’ll do protons and I’ll go to Jacksonville for treatment,’” he recalled. “I was never distressed. I knew I would be treated successfully.”

Mike’s confidence in protons goes back to the mid-1980s and the first center he worked on in Loma Linda, California.

Loma Linda University Medical Center was planning to build its proton therapy center and sought the advice of scientists at the US Department of Energy. Mike was employed by the department’s Enrico Fermi National Laboratory in Batavia, Illinois. FermiLab is home to a particle accelerator that generates proton beams. And Mike found himself advising the architects and construction managers to the Loma Linda proton center on the installation of the cyclotron and beam delivery system. IBA, the Belgium-based maker of proton systems, later hired Mike to provide architectural engineering expertise in preparation for IBA’s proton system installations around the world.

Mike takes pride in the strong working relationships he has developed with medical staff at all of the proton centers he’s helped design and build over the years. “They’re all incredibly knowledgeable, incredibly experienced,” Mike said. “But for some reason I just got to know the staff at the University of Florida so much more. And I just knew I would go there.”

The morning of Mike’s first proton treatment at UF Proton Therapy Institute, “I was super excited,” he recalled. “I laid down on the treatment couch and I looked up at that machine for the first time in a whole new way. And when I was done, I said, ‘Gee, there’s nothing to it.’”

Mike received 39 proton beam treatments in all. “And I worked every day,” he said. “I had no problems. There was never any fatigue. Never any loss of energy. Never any pain. Nothing prevents you from living a normal life. It was exactly as advertised.”

Mike and his wife brought two large cakes into the proton center to celebrate his final proton treatment with his medical team and with other patients undergoing proton therapy. But before they cut the cake, Mike hit the treatment couch for his last fraction of protons. His proton radiation therapists burst into laughter as they eyed two words temporarily tattooed to Mike’s buttocks: “Thank you.”

Mike’s PSA level was 7.1 prior to his first treatment. It dropped to 1.8 with his final treatment. His PSA level will be evaluated in October, and Mike has no doubt it will be lower.

Web review – Harvey stays positive thanks to proton therapy

Harvey Rector, 71-year-old former Springfield police officer, has completed his proton therapy treatment this summer. And to look on his smiling face today, one would never think he once was wrecked by pain caused by a cancerous growth on his tailbone.

First, doctors told him he would have to have the tailbone cut off and undergo radiation, and that he could be paralyzed from the waist down. But fortunately, an oncologist at Barnes Jewish Hospital in St. Louis directed him to ProCure, a health care company that provides cancer treatment through the use of proton therapy.

“They told me there was a unit in Oklahoma City where they could provide treatments that would help with the recovery time,” Harvey said. Indeed, the end result of proton therapy treatment, according to ProCure, is fewer side effects that leave patients feeling physically drained, allowing them to recover more quickly.

“I met many men down there being treated for prostate cancer with no pills or surgery,” he said. “We met one patient with brain tumors — she had a rare disease that forms tumors on the brain and spine — and they said she was cancer free after 50 treatments.”

It took Harvey 40 treatments before he was considered “cancer free;” he had his last treatment on June 10. There was “no pain to the treatment,” he said. “It’s unreal how they can direct a beam to a size of a hair to treat a tumor.”

Since his last treatment, he is slowly been getting back into his routine : “I have some bad days but normally I do good. Right now I’m just trying to make up for some lost time.”

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From our readers – Be Positive like the Protons

I am a 30 year survivor of a clival chordoma.  I was first diagnosed in September of 1983.  We found Mass General / Harvard Cyclotron by luck.

In 1983 nobody had any idea what a chordoma was let alone any medical protocols.  October 17, 1983 I had a transphenodial biopsy done at Mass General and then on October 31, 1983 I started my 7000 rads of experimental proton bean radiation therapy at the Harvard Cyclotron in Cambridge.

Over the 30 years I have terrible headaches every day, double vision, tinnitus and lately pituitary failure {hypopituitary}.  I have also worked every day, play golf (not great) and have a great family.  We found out that my wife was pregnant with our first child the first week of proton therapy.

I want everyone to know that we do not have an expiration date just because we have a brain tumor.  I was given less than a year to live; it is now 30 years later!

Good luck to everyone.  My thoughts and prayers are with each of you and your families.

Author: Jonathan Steinberg