WEB REVIEW – Rising preference for non-surgical treatment

According to a new report by Global Industry Analysts, cancer patient show a rising preference for radiation therapy over surgical treatment options.

Radiation therapy involves the use of high-energy radioactive particles or electromagnetic waves to destroy cancer cells, shrink tumors and repair physiological abnormalities.

The growth in the radiation therapy equipment market is primarily driven by rising incidence of cancer (due to aging population, lifestyle changes, dietary habits, and high smoking rates), but is also fueled by technological improvements in molecular and biological imaging techniques and tumor markers which allow radiotherapy to be increasingly personalized.

The United States is the largest market worldwide. Growth in the country is driven by aging population vulnerable to cancer, increasing preference for non-surgical options, and faster adoption of novel therapies.

Over the past few decades, radiotherapy has witnessed a paradigm shift due to significant advancements in medical technologies. There has been a gradual transition from traditional technologies to highly complex, resource intensive treatment procedures (4D imaging, intensity-modulated radiotherapy (IMRT), proton therapy, stereotactic body radiation therapy), facilitating clinicians in improving the accuracy and precision of radiotherapy.

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WEB REVIEW – Proton Therapy : safest radiation treatment for pediatric tumors

If your child was diagnosed with cancer, you would want to find the best, smartest and most pain-free treatment available. For a growing number of pediatric patients and their parents, it is clear that proton beam radiation may be the most desirable course of action to pursue. But sadly, that too many patients and their doctors remain unfamiliar with proton therapy and its documented benefits.

This unawareness is partly due to the fact that there are only 12 proton therapy centers in the US. Combined, these centers treat approximately 10,000 patients a year, or less than 1% of all patients diagnosed with cancer. However, far from experimental, proton therapy has been greatly refined over the past two decades, and medical literature testifies to the efficacy of proton therapy for both adults and children and shows the lower incidence of secondary malignancies compared with photon therapy.

Conventional radiation therapy delivers large doses to ensure harm to all the cancer cells, but some undesirable energy finds its way beyond the tumor and causes unnecessary damage in healthy tissues. Children are more sensitive to radiation, and standard X-rays are often avoided, specifically under 3 years old because it can affect  growth and development.

In contrast, proton beams are specifically programmed to reach the exact depth needed to release their maximum energy. As a result, the treatment benefits are significantly maximized while unwanted side effects are greatly reduced. In short, because of the proton beam’s characteristics, we can increase the dose to target tumors in children while reducing the impact on surrounding normal tissues, which increases the likelihood of effective tumor control.

Most specifically, proton therapy has been particularly effective in treating three different types of pediatric cancers: brain tumors (i.e. the most common pediatric cancer), pediatric eye cancer and pediatric tumors at the base of the skull and along the spine : proton therapy minimizes the potentially damaging effects of radiation on the neighboring structures, which is crucial for tumors near critical vital organs.

Proton therapy treatment also has the added advantage of being both non-invasive and painless. The patient even enjoys a better quality of life after the treatment as compared to conventional X-rays (less side effects, etc.).

For more than two decades, proton therapy has been making a difference in the lives of people with many different types of cancers – from prostate to breast to lung. Now is the time to embrace this modality as a powerful tool to fight cancer in children.

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WEB REVIEW – Little Shaun with brain cancer is struggling for life

Shaun Currie’s parents learned last month that their four-year-old son was suffering from a terminal brain tumor. The little Scottish boy has spent the past few days in Yorkhill Children’s Hospital, in Glasgow, and the nearby Beatson cancer center.

Shaun’s parents first realized something was wrong with Shaun when he felt poorly and became unsteady on his feet. His doctor sent him to the hospital, where he was diagnosed with a brain infection and scheduled for further scans. The seriousness of his condition was then revealed.

Shaun is due to start radiotherapy before Christmas but the effort to beat the tumour has already left him exhausted. It is affecting his speech and balance and he might need a wheelchair soon.

Shaun’s grandmother said: “We’ve been told the tumour can’t be treated. It is inoperable. He should see Christmas and if we are lucky his birthday so every moment we have him is an extra precious one.”

Despite the sad prediction that Shaun is unlikely to see his fifth birthday in April, his mother Elaine and father Bruce are desperately seeking a treatment to buy the family more time together and launched a fundraising campaign. They are currently waiting to hear back from a clinic in the United States that offers proton therapy, a state-of-the-art type of radiation therapy: “People have already been very generous and we really do want to get any help we can, even if it means going abroad. We’ve been in touch with a clinic in the USA and are hoping to hear back soon. But we are too scared to hope too much”, they said.

Friends of the family started a fundraising campaign immediately after Shaun’s diagnosis on November 21. The plan is to give the family as many memories together as possible, including a holiday to Legoland, before he becomes too ill to travel.

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Secondary and recurrent cancers may be good candidates for protons

For cancer survivors, cancer’s return can be a sudden, agonizing punch to the gut.

And that’s especially true for patients whose cancer develops in the same area where the first cancer had been successfully treated with radiation.

Physicians have a harder time using photon treatments a second time. They don’t want inadvertent radiation to re-injure adjacent tissues and organs — over and above the unintentional radiation experienced during photon treatments for the first cancer.

And if chemotherapy and surgery are poor treatment options, surviving the second cancer is more challenging.

But targeted proton beams offer an alternative radiation option that may increase the odds of surviving these locally recurring cancers and local secondary cancers.

Protons can provide effective cancer-killing power, with less collateral damage to adjacent tissues and organs, particularly those that have already been affected by inadvertent radiation during the first cancer treatment, said Anita Mahajan, MD, medical director of the MD Anderson Proton Therapy Center in Houston, Texas. “Protons are very strategic that way,” she said.

“When you treat a person for breast cancer with photons, you’re treating the whole anterior chest wall,” Mahajan said. “Sometimes, the heart gets some radiation dose. Years later, should that patient develop lung cancer, you can use protons to treat the cancer and avoid additional radiation to the heart. With protons, you can come in from the back and side and around the front part of the chest. You can actually think about ways to avoid radiation to areas where you don’t want radiation.”

Mahajan said she currently has four “re-radiation patients” receiving treatment at MD Anderson. Some were treated with photon radiation therapy 15 or 20 years ago and recently developed a second cancer in the same area.

Re-radiation cases include a patient treated successfully for Hodgkin’s Lymphoma who now has breast cancer and a patient treated successfully for breast cancer who has since developed lung cancer. “We have a 23-year-old woman with rhabdomyosarcoma,” Mahajan added. “She had chemotherapy and radiation four years ago. This time, she had surgery, chemotherapy and proton radiation.”

Radiation oncologists are very aware of the unintentional harm of photon radiation treatments, Mahajan said. “With tissue, there is a certain memory that occurs with radiation,” she said. “It goes through changes that make it much less tolerant to more radiation. If you talk to surgeons, they can tell the tissue that’s been irradiated years ago. It’s different. They can tell by feel and color. The tissue is not as pink and happy.”

Mahajan cautioned not to presume that all local secondary cancers or locally recurring cancers are caused by photon radiation.

“There are certain rules that need to be checked off before we can call it a radiation-associated tumor,” Mahajan noted. “It has to be in an area that received radiation therapy. It has to be a different type of tumor than the initial tumor treated. And it has to have occurred in the right timeframe. If a tumor develops a year or so after, it’s very, very unlikely it’s associated with radiation therapy. Usually, the secondary tumor develops at least five to seven years after.”

WEB REVIEW – The fight of a 55-year-old with prostate cancer

55-year-old Chicago resident Rick Kasprzak has been on an emotional two-year roller-coaster that, not a minute too soon, is finally slowing down.

In summer 2011, Rick saw his primary care physician for an annual physical exam, including a blood test for prostate cancer. The results were higher than normal. However, the situation was not critical, just something that needed to be monitored.

In summer of 2012, Rick was back at his doctor’s office for his annual exam. This time, he was told he should see a urologist for further evaluation. A biopsy was made and last December, he learned he was tested positive for prostate cancer.

“It was one of those events in your life where everything just kind of stops,” said Kasprzak, who lives in Chicago with his partner Jim Lawless. “I had no symptoms; nothing felt different at all. … I just had a lot of unanswered questions.”

Days later, Kasprzak went to a specialist who suggested a few treatment options, including surgery and radiation. Since it was not at the critical phase, Kasprzak sought additional input and ideas, especially from non-medical personnel. “I wanted to talk to another man who has had this,” he said. He talked about treatment options with several and learned about potential after-effects, including impotence.

Rick was suggested to consider female hormone therapy, which would last for eight months, and side-affects would be similar to a women in menopause, including hot flashes, weight gain, tender breasts, mood swings, and more. “I thought my options sucked”, Rick said.

After a while, Rick was lucky enough to meet a man who underwent the same thing. He told him all about his proton radiation therapy and a treatment center in Warrenville, one of only 10 such centers in the U.S. Rick ultimately picked that plan and started the 44-day treatment at the end of March.

He finished his treatment in May, and had his first three-month, post-treatment exam on August 19. He’s improving. “I don’t think I could be any more pleased with the outcome than I am right now. Is it fate? Absolutely!” Rick said. He is now willing and interested in serving as a resource and advocate for others in need, with questions. “I want to be an advocate for gay men with prostate cancer.”

Source : http://www.windycitymediagroup.com/lgbt/Chicagoan-recalls-battle-with-cancer/45286.html

Proton Therapy giving hope to patients affected by rare cancers

Complex cases coupled with limited treatment options have historically translated into a bleak prognosis for many patients diagnosed with a rare cancer. Now, however, novel therapies developed in recent years at The University of Texas MD Anderson Cancer Center are enabling clinicians to successfully treat a range of uncommon tumors offering increasing numbers of patients new hope. Proton therapy is one such tool advanced by specialists at MD Anderson’s Proton Therapy Center.

Proton therapy is often used to treat rare cancers such as sarcomas and pediatric malignancies and tumors in sensitive areas of the body including the head and neck and liver. These and other rare cancers benefit from proton therapy’s ability to deliver radiation precisely to the tumor — destroying cancer cells while sparing surrounding healthy tissue from damage. As a result, proton therapy patients can receive a stronger, more effective radiation dose, while simultaneously protecting vital quality of life functions such as neurocognitive function, vision, swallowing, taste and speech.

Proton therapy’s advantage is often realized in treating uncommon or inoperable cancers or tumors that are unresponsive to standard radiation and chemotherapy. Ongoing MD Anderson research studies are comparing long-term survival benefit for patients whose rare cancers are treated with proton therapy versus other non-operative therapies (see sidebar an example with liver cancer).

“Individually, rare diseases affect too few patients to benefit from research funding and major clinical trial advances,” said Christopher Crane, M.D., professor of Radiation Oncology and Gastrointestinal Section Chief at MD Anderson. “MD Anderson is standardizing proton therapy as an effective treatment for not just one, but a variety of rare cancer types where viable options are limited. While our goal is always to provide the optimal treatment solution for every patient, we have the opportunity to impact rare cancers as a whole.”

When combined, rare cancers account for more than 50% of all cancer diagnoses in the U.S. Specialists at MD Anderson continue to evolve innovative treatments, like proton therapy, to rare disease-sites, offering new options for these patients.

A significant portion of the 30,640* patients diagnosed with liver cancer in the U.S. each year are not candidates for aggressive surgery and traditional radiation therapy that offers limited therapeutic benefit. In these cases, as well as scenarios where the disease has spread or there is cirrhosis of the liver, the best treatment option, though not always available, is transplanting a new liver.MD Anderson estimates that 30% of its patients diagnosed with liver cancer may benefit from proton therapy. The MD Anderson Proton Therapy Center is one of two proton centers in the U.S. with the technological capability to treat liver cancer with high-powered doses of proton therapy, precisely targeting the tumor and limiting radiation exposure to the healthy liver tissue and surrounding organs (such as the gallbladder and pancreas). This regimen has resulted in tumor control and long-term survival in individual cases documented at MD Anderson Proton Therapy Center.MD Anderson is currently leading a clinical trial of 50 liver cancer patients in cooperation with the Massachusetts General Hospital Francis H. Burr Proton Therapy Center in Boston. This study, the only one of its kind done in the U.S., has yielded impressive preliminary results with median survival rates of over 30 months among patients treated with proton therapy in comparison with 12 months for patients treated with other non-operative therapies. MD Anderson hopes to design and conduct a national randomized trial based on these results.Listen to Christopher Crane, M.D., professor of Radiation Oncology and Gastrointestinal Section Chief at MD Anderson, discussing proton therapy for liver cancer patients in this podcast.

Prostate cancer and protons forge lasting brotherhood

Proton therapy advocate Bob Marckini calls it the “Brotherhood of the Balloon.” It’s the lasting bond of fellowship forged among men who, day after day, come to know one another as they wait their turn to have their prostate cancer zapped by protons.

Wisconsin resident Bill Friedlander found the camaraderie among prostate cancer patients one of the most rewarding aspects of his proton treatments earlier this year at CDH Proton Center, A ProCure Center, in Warrenville, Illinois.

“Marckini reflected this in the book he wrote,” Friedlander recalled. “The social aspects of treatment play a tremendous role in your everyday well-being.”

Their shared cancer and the rather immodest patient preparation that all prostate patients endure instantly erased any distinctions of status, education and economic class, observed Friedlander. “You were among people from all walks of life, from guys who drive trucks to farmers to company executives. Prostate cancer and proton therapy were the great equalizers.”

Everyone goes through the same routine, Friedlander noted. Each man drinks 24 ounces of water — just enough water to fill his bladder and hold it still during treatment. They visit the changing room to shed their street clothes and don an open-backed patient gown and comfortable robe.

In the treatment room, each patient lies on his back on a treatment table. A balloon is inserted into his rectum and inflated with 120 cubic centimeters of water. An X-ray is taken. Three tiny gold coils, planted into the prostate during pre-treatment preparation, read white on the X-ray. They provide visual reference points to help the radiation technician nudge the patient on the treatment table to within 2 millimeters of where the beam will be targeted in the prostate.

Prep for treatment takes about 30 minutes. “And there is no modesty,” Friedlander said with a chuckle. In a nod to Danté’s Divine Comedy, Friedlander said an appropriate sign above the proton treatment room doorway could announce, “Abandon modesty, all ye who enter here.”

“There was all sorts of jocularity and fun and truly getting to know one another,” he recalled fondly. “Every day. Five days a week. It was kind of a fraternity in that sense.”

Friedlander and his spouse were greeted by about a half dozen men and their wives when he started treatment in late April 2013. They welcomed the newcomers with warmth and good humor, each offering their own views of the daily treatment routine, the technicians they liked and where to eat in the Chicago suburbs.

As the morning routines commenced, the group of men grew to 10 or 12. Over the next nine weeks of his own proton beam therapy, Friedlander saw newfound friends rotate out of the group, having completed their 44 rounds of therapy, and a new set of patients — and soon to be friends — rotate in. With no television to distract them, conversation among the patients and their wives was sincere and spontaneous.

“One of the first things you say to one another is, ‘What number [treatment] are you on?’” Friedlander said. Early on, patients with treatments in the double-digits played mentor to the new prostate patient from Wisconsin. Later, Friedlander offered supportive guidance to the newly arrived patients.

“You feel a little superior because you’ve had your 35 treatments and you have only 9 to go,” Friedlander observed with a laugh. “Seriously though, you try to counsel the new people, ‘You’ll be settling into a routine. You’ll be amazed how fast it goes.’”

The word “cancer” was never spoken. “It was always, ‘What’s your Gleason?’ or ‘What’s your PSA?’” he said.

Every week, CDH Proton Center holds a graduation ceremony for all cancer patients who have just completed their treatments.

“At my graduation, there were 11 of us,” Friedlander said. “They give all the graduates a chance to speak. But 90 percent of the guys couldn’t finish. They were so emotional. I think a lot of these fellows really thought they were going to die when they were first diagnosed. And they were overcome with emotion over the friendships they had formed and that they were all cancer survivors.”

WEB REVIEW – Proton Therapy, a new way of fighting cancer

When Mike Buettner learned he had prostate cancer, it was a scary shock. As a pastor, he had presided many cancer patients’ funerals. Now he’s cancer-free, after undergoing a newer kind of radiation therapy in an Oklahoma City clinic.

He now wants to get the word out about being aware of prostate cancer. And he is an advocate for the treatment he received : proton therapy.

Buettner’s story began with an annual physical. His blood showed elevated PSA levels (a test that measures proteins produced by the prostate gland). Levels continued to rise during the next months, indicating an aggressive cancer. A biopsy confirmed it.

Although 67, Buettner is active, with eight adopted children. He was very concerned about being slowed down by possible side effects of treatment or the aftermath.

He and his wife began researching treatment options. A younger brother, who lives in Oklahoma City, suggested to look into ProCure, a cancer treatment center that offers a newer form of radiation therapy with fewer side effects.

Buettner said he was thankful that his family physician discovered the illness and for diagnosis and advice he got from his cancer doctors in Kansas City, who could have treated him with other radiation techniques. But he also thinks patients should take an active role deciding on what’s their particular best option.

Buettner was fortunate that he could live with his brother in Oklahoma City for nine-weeks of daily treatment, otherwise he could not have afforded that option. He had good insurance to cover the medical costs. His church gave him medical leave.

He said he was determined to avoid incontinence. He finished his treatments last week without experiencing those problems.

While undergoing treatment, he was even able to be a guest preacher in Oklahoma and help with a revival. “I wanted to know what we can do to have the best results without any side effects,” Buettner said. “Each one of us should be in control of their life.”

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Study compares organ-sparing properties of protons with other breast cancer treatments

A recent study showed proton therapy to be superior to three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and helical tomotherapy (HT) in sparing the heart and coronary arteries from unintended radiation when treating Stage III breast cancer.

“The study validates what we had hypothesized, which is that with the use of proton therapy, we can greatly reduce radiation exposure to the heart, lung and contralateral [opposite] breast,” said L. Christine Fang, M.D., one of the study investigators and a physician at Seattle Cancer Care Alliance Proton Therapy, A ProCure Center.

Because more normal tissue can be spared from unintended radiation with proton therapy, using it with breast cancer patients allows delivery of a more optimal dose. “When we are designing very complicated treatment plans with conventional 3D conformal therapy, we have to compromise on how much dose is delivered to the areas we care about — the chest wall, the lymph nodes — because the dose to the heart and the lung would otherwise be excessive,” said Dr. Fang. “For example, in order to get a certain dose to the lymph nodes, the lung or heart may receive unacceptably high doses, so we make the decision to lower the dose to the lymph nodes.

“With proton therapy, because we’re able to decrease exposure to the normal tissue, we will not need to make that hard decision to compromise on the dose to the chest wall and lymph nodes. That’s the great thing. When we run plan comparisons, not only do we look at the difference between doses to the heart, lung and contralateral breast, but we also look at how well the target areas are covered by the radiation dose. Proton plans more adequately cover the target than the other modalities.”

Presented at the 2013 American Society for Radiation Oncology Annual Meeting, the study involved 10 women ranging in age from their early 30s to their early 70s. All had had a left mastectomy and had received conventional 3D-CRT with photons. Then, proton, IMRT and HT treatment plans were prepared for each patient, after which important metrics for dose levels of unintended radiation exposure to heart, lung and opposite breast were compared.

In the study, 3D-CRT, IMRT and HT delivered an average radiation dose to the heart that was seven to 10 times higher than the dose delivered by proton therapy. The dose delivered to the contralateral breast was eight to 30 times higher for the other three modalities than with protons. Lung dose was also higher with 3D-CRT, IMRT and HT than with protons, said Dr. Fang.

A Phase II study of postsurgical, cardiac-sparing proton radiotherapy for women with Stage III breast cancer is now under way at ProCure Proton Therapy Centers in Warrenville, Illinois, and Somerset, New Jersey. Click on either link, then on Clinical Trials for more information on these studies and to see if you are eligible, or click here. In 2014, a similar study will be opened at the SCCA Proton Therapy center in Seattle, Dr. Fang noted.

WEB REVIEW – Funds sought for brain cancer boy

Jamie Green, a 13-year-old boy, has been diagnosed with a highly aggressive type of cancer called medulloblastoma, which may have spread to his spine. His family are trying to raise 250.000 pounds for treatment in the US.

Jamie was diagnosed in July and had immediate surgery in Oxford to remove the tumor, which was more than 4cm in size. Now, he needs state-of-the-art proton therapy, a type of treatment that targets cancerous cells more precisely than traditional radiotherapy, causing less damage to surrounding tissue and fewer side effects. Some very rare cancers including tumors affecting the base of skull or spine can especially benefit from it.

Jamie’s mother, Anita Green, 40, and father, Steve Purvey, 44, are now trying to raise £250,000 to get him proton therapy in America, as the treatment plan has been refused by the NHS. An appeal was made directly to the funding panel at NHS England by the charity Kids ‘n’ Cancer but they have also been told the tumor type does not meet the criteria.

To help raise the money, Jamie’s godfather has organized a comedy and sporting event, and Mr Birchmore and Rob Dore of the charity Boys Beating Cancer have organized Jamie’s Sporting Chance black tie dinner. Mr Birchmore said: “We so urgently need to raise money to give Jamie the very best chance of beating this vicious brain tumor. We have had a tremendous amount of support from friends, family and strangers but we need more.”

The UK Government announced earlier this year that £250 million is being committed to hospitals in Manchester and London to deliver proton beam therapy. From 2018, it will be offered to up to 1,500 cancer patients per year at the Christie NHS Foundation Trust in Manchester and University College London Hospitals NHS Foundation Trust.

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