February 15th is the the International Childhood Cancer Day. It gives us the opportunity to thank all individuals who devote their life to fighting pediatric cancers : medical staff, researchers, engineers, care givers, and families.
We love our young patients and we work tirelessly for them.
Proton Therapy is particularly recommended for children. The small bodies and organs of infants and children can be especially sensitive to rigorous cancer treatments and invasive surgical procedures, despite the best efforts of caring physicians and nurses.
Proton Therapy can aggressively treat the cancer while substantially reducing side effects that could impact the child’s quality of life. It has been proven to protect vital organs, important tissues, nerves, and glands during treatment, while also decreasing the estimated risk of secondary malignancies. Proton Therapy holds the promise of more aggressively fighting pediatric cancers while keeping infants and children feeling better during treatment.
Proton Therapy is now covered by some private insurance companies, without further review, for persons younger than 19 years of age. More and more governments also reimburse the cost of treatment for children and young adults, in country or overseas.
Cancer care is complex : at every stage of the disease, it requires many professionals who are experts in different areas of care.
In this ecosystem, everyone has a role to play and must play it perfectly !
Not every treatment is appropriate or necessary for each patient. This depends on both the characteristics of the tumor and the wishes of the patient over time. There are guidelines for the treatment of each cancer, but these leave room for patients’ own preferences.
SAH creates an environment of collaboration through regular tumor board meetings and updates on treatment modalities through the network of care.
Patient referrals help physicians identify optimal specialists based on patient needs and preferences, and the specialists decide through cross communication.
We foster an environment that is not driven by bottom lines, but by a high-quality continuum of care.
“The best care happens when everyone comes together.”
One year ago, we’ve launched our “Dr Proton” on social medias to share information about Proton Therapy.
Today, Dr Proton has built up a network of over 12,000 professionals around the world that not only include radiation oncologists, radiotherapists, medical oncologists, surgeons, physicians, physicists, nurses, patients and care givers, but also bankers, investors, manufacturers, public institutions, ministries, and private organizations.
Our aim is to consider all aspects of Proton Therapy, from physics to patients, through equipment and financing.
We want to leverage all resources to ensure we – together – provide the right treatment to the right patient at the right time, within a high-quality continuum of cancer care.
To spread the word even further, Dr Proton now has his own web site : Dr-Proton.com
Join our network, and let’s consider Proton Therapy !
“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, neurinomascraniopharyngiomaor recurrent pleomorphic adenomas.”
=> Proton therapy is an efficient alternative to photonic radiotherapy for the treatment of intra cranial or cervical benign tumors.
For these tumors, proton therapy could reduce neurocognitive impairment and risk of radio-induced secondary cancers.
Proton therapy achieves excellent local control with low toxicity rates.
Large randomized trials are still needed to assess proton therapy clinical advantages in comparison with radiosurgery or intensity modulated radiotherapy.
Radiotherapyis associated with serious treatment-related complications in patients with Idiopathic Pulmonary Fibrosis (IPF). Proton therapy may be helpful to reduce these acute and fatal pulmonary complications in these vulnerable patients. Currently, a phase 2 prospective trial with proton RT in patients with severely compromised pulmonary function and/or IPF is ongoing”
“Theresearchers point out that while IMPT could potentially benefit any patient receiving radiotherapy for malignant brain tumours, paediatric patients and patients with primary CNS malignancies (who have superior survival expectations compared with patients with metastatic disease) might receive the greatest benefit.” “The cognitive and quality-of-life benefits of hippocampal avoidance IMPT in paediatric patients could be substantial,” they wrote. “This increased dosimetric benefit to OAR may warrant inclusion of the IMPT modality as part of any upcoming clinical investigations into hippocampal avoidance for paediatric populations.” https://physicsworld.com/a/intensity-modulated-protons-reduce-side-effects-of-whole-brain-radiotherapy/
6 Jan 2019
Improved long‐term patient‐reported health and well‐being outcomes of early‐stage breast cancer treated with partial breast proton therapy
Sandra L. Teichmanet al.
« Patients’ responses suggest that PBPT is associated with improved overall Quality of Life compared to standard whole breast treatment. These self‐perceptions are reported by patients who are 5‐10 years post‐treatment, and that PBPT may enhance QoL in a multitude of interrelated ways »
Treatment outcomes of proton or carbon ion therapy for skull base chordoma: a retrospective study (Masaru Takagi, et al)
« The results of proton therapy and carbon ion therapy for skull base chordoma were both favourable regarding local control and late toxicities. Both showed the potential to become a standard therapy as opposed to XRT. To increase local control, surgery before particle therapy for tumour volume reduction and separation from OARs can be considered a viable alternative. »
Estimation of the risk for radiation-induced liver disease following photon- or proton-beam radiosurgery of liver metastases
Gracinda Mondlane, Ana Ureba, Michael Gubanski, P A Lind and Albert Siegbahn “Intensity-modulated Proton Therapy could provide a significant reduction of the risk for Radiation-induced liver disease for most of the patients studied”
Particletherapy(high-dose protons or carbonions) providea betterlocal control, survivaland allowlowerdoses to begivento normal tissues and should,therefore,beconsideredthe treatmentof choicein somecases.
(…) Protontherapy offers an alternative method of RT for patients for whom photon-based EBRT is suboptimal.Although IMRT is a highly conformal radiation technique, low to intermediate doses to surrounding non target organs is unavoidable. In contrastto photon-based EBRT, proton therapy deposits most of the radiation energy within the target area rather than the surrounding healthy tissues outside the target volume. Proton therapy is preferable for patients with recurrent tumors in previously irradiated areas and tumors near radiation-sensitive structures because of its physical properties, which allow for a sharp drop-off in dose in the surrounding healthy tissues, including radiosensitive OARs
(…) proton palliative RT can benefit those who cannot receive photon-based palliative RT because of tumor location or prior local radiation, and it provides benefit to patients who have had previous radiation through decreased cumulative dose to sensitive surrounding tissue . The proton quad shot regimen offers an alternative option for symptom palliation for patients not amenable to palliative photon RT.
(…) protontherapy offers the unique advantage of delivering a negligible radiation dose to healthy tissues behind the target volume.
It has finally been decided to establish proton therapy as a national treatment option in Norway, and there will be centres in Oslo and Bergen from2023. The majority of children and young adults who are to receive curative radiation therapy should be treated with proton therapy.
Particle therapy is used as a collective term for radiation therapy using heavy ions. In general, regular radiation therapy in Norway currently consists of photon therapy (high-voltage x-ray radiotherapy). The ion that is most commonly used in particle therapy is the proton, and of around 175 000 patients treated worldwide at the end of 2016, 150 000 were treated with proton therapy (1). The other ion in use today is the carbon ion, and globally a little more than 20 000 patients have received carbon ion therapy.
Although heavy ions have been used to a limited extent for therapeutic purposes since the 1950s, only in the last 20 years has this really become an intrinsic part of the cancer treatment programme. The number of patients treated has increased by a factor of almost ten in this period. The main advantageof proton and carbon ions in radiation therapy, compared with photons, is that the physical properties of the ions allow for a better radiation dose distribution for most tumours, so that they cause damage to the tumour rather than to normal tissue. This does not necessarily result in a higher cure rate, but in the adverse effects of radiation therapy (late effects) being less pronounced than is the case for current, regular photon therapy. This results in considerably improved quality of life for patients who live for many years after cancer treatment. A number of adverse effects may manifest themselves up to 15–20 years after radiation therapy, and therefore young patients, patients with a long life expectancy, and patient groups with major adverse radiation-related effects may derive most benefit from proton therapy.
The benefits of proton therapy
Throughout the years of assessment sin Norway, a great deal of discussion has taken place regarding the extent of the need for proton therapy, as well as the ethical aspects of the treatment(6–9).
The prevailing opinion based on our current knowledge is that the majority of children who are to receive radiation therapy with curative intent should be given proton therapy(6). It is known that reduced radiation to normal tissue reduces the risk of late effects and secondary cancer, and it is therefore highly probable that proton therapy is particularly advantageous for children(8). However, no randomised trials have been undertaken on children, as this is viewed as ethically problematic.
For adults the picture is more complex. Generally young adults with tumours in or near the central nervous system should be prioritised for the same reason as children. Chordomas, chondrosarcomas and ocular tumours that need external radiation therapy are considered to be relatively well-established indications for particle therapy (9, 10). In the case of sinonasal cancer, a number of studies have been undertaken that compared patient cohorts that have undergone particle and photon therapy .These studies have been included in a meta-analysis which concludes that particle therapy is beneficial for this diagnosis (11).
“The study identifies an area of cognition that is inadvertently impacted by standard treatment methods, which has real consequences for the quality of life of the survivors. The physicians’ ultimate goal is to allow their patients to survive and to live as well as possible, ” Sekeres said. “Although these treatments are often crucial in the effective management of the cancer, if the physicians and the family know there are these unintended side effects, that may be an additional factor to consider when exploring the treatment options.”
A small amount of lung tissue is irradiated when treating the breast, but the proportion of the total lung capacity is inconsequential– 2–3% at most.
The heart is another story. There is no radiation dose considered completely safe for the heart.
With modern treatment techniques, most Radiation Oncologists try to keep the mean dose below2 Gy*. But 20 yearF/U data on patients treated for left sided breast cancer shows a 7% increase in the likelihood of having a significant cardiac event (myocardial infarction, the development of cardiomyopathy, symptomatic coronary vascular disease, etc.) for every Gy mean heart dose given.
We can usually limit the heart dose to < 1–2 Gy for left sided breast cancer patients with standard x-ray radiation therapy techniques. Sometimes that includes having the patient hold their breath while the machine is treating, to bring the chest wall away from the heart. These techniques usually work unless we have to treat the lymph nodes, for more advanced cancers – especially the internal mammary lymph nodes, which lie immediately in front of the heart.
The only way to accomplish that is with Proton Beam Irradiation – which allows us to treat the breast and all the draining lymph nodes with essentially ZERO dose to the heart.
Proton BeamTherapy has the potential to be applicable to more complicated cases ineligible for X-ray therapy, such as those with a history of hepatic RT, vascular invasion of the tumor, extremely large tumor burden, and/or poor liver function.
Proton Beam Therapy has significant dosimetric advantages compared with X-ray therapy ,which has translated to significant differences in clinical outcomes for the treatment for hepatocellular carcinoma (HCC). The American Society for Radiation Oncologyi ncludes HCC in the “group I” indications for PBT, meaning that PBT is recognized as an effective and safe local modality for the treatment of HCC. Various studies comparing with other local modalities are ongoing, and we expect that PBT will become a main stay of local treatment of HCC in the near future.
According to one of the authors from the study, Dr. Curtiland Deville, “this review is compelling as it is the first in the medical literature to report that proton therapy can be safely and effectively delivered for prostate cancer patients undergoing radiation in the post-operative setting. Previous studies have all reported on patients with an intact prostate. This study is important in that patterns of care have shifted over time with less routine screening for prostate cancer, more low riskp atients being offered active surveillance, and more high-risk patients being offered surgery. These have all led to Radiation Oncologists now more often treating patients with adverse risk features in the post-prostatectomy setting. Thus, with my colleagues, we sought to treat and assess side effects and toxicity rates in prostate cancer patients requiring adjuvant or salvage radiation therapy using proton therapy. Patients in the study were treated using the RadiaDyne Endorectal balloon device to immobilize the prostatic fossa, provide reproducible anatomy, and spare the posterior rectal wall, which was critica lto reduce dose uncertainties since protons have a finite range and no exit dose unlike photons. Our experience demonstrates that it is both feasible and safe to use proton therapy in the post-prostatectomy setting.”
In recognition of National Sarcoma Awareness Month in July, the Alliance for Proton Therapy Access is underscoring the importance of patient access to proton radiation therapy, a clinically-effective treatment for patients diagnosed with sarcoma cancers. Proton therapy is an FDA-cleared treatment that allows physicians to precisely control and conform the bulk of its cancer-fighting proton energy field on the cancerous cells, thereby minimizing extraneous radiation dose to healthyt issues, preserving organ function, and potentially reducing harmful side effects. This makes the treatment ideal for some sarcoma cancer patients, as sarcoma tumors are often located near sensitive tissues. One study shows that high-dose proton therapy controls more than half of spinal chordomas and chondrosarcomas and compares favorably with historical traditional (photon) radiation data. “The successful treatment of my recurrent sarcoma cancer illustrates the power of proton therapy. I am living proof that proton therapy is a legitimate, safe, and effective cancer treatment,” said Cindy Lee, a cancer survivor and advocate. “I encourage others to join me in advocating for policies that ensure timely access to treatment for cancer patients in need of proton therapy.”
“Hadron therapy is indicated especially for tumors resistant to chemotherapy and radiotherapy, or inoperable due to their localization in vital organs : e.g., brain tumors, skull base, face or neck tumors, tumors close to the heart or the eye, and so on”
The National Cancer Center said it has reaped meaningfulr esults in proton therapyt o treat cancer during the pas t11 years, after introducing it to Korea for the first time in 2007. (…)
Proton therapy good in liver, pancreatic, eye, lung cancer NCC held a press conference at Goyang Aram Nuri in Goyang, Gyeonggi Province, on Friday to promote the proton therapy’s clinical effectiveness. The hospital also held an international symposium on “Clinical Evidence in Particle Therapy & Current Status of Particle Therapy in Asia-Oceania” at the NCC’s cancer prevention and examination center in Goyangon Friday and Saturday. The proton therapy was effective particularly for radiation-treated but recurrent cancers such as spinal cord chordoma and head and neck cancer, NCC said. “The proton therapy showed an excellent therapeutic effect in liver cancer and pancreatic carcinoma with low survival rate,” said Kim Tae-hyeon, head of the NCC’s proton therapy center. “In patients with liver cancer, patients who could not have surgery due to poor liver function with smaller than 8-centimeter tumor showed more than 90 percent of complete remission rate within one year. Their three-year survival rate was 74 percent.” Kim went on to say that a patient with locally advanced hepatocellular carcinoma who accompanied tumor thrombosis with a poor prognosis had a remarkable treatment result with the two-year survival rate exceeding 50 percent, in combination with other therapies. “In a pancreatic cancer patient who could not undergo surgery, the proton therapy showed a similar treatment result with those who had surgical resections,” Kim added. The proton treatment is also effective on eye cancer, as most other surgeries require the removal of the eyeball. The proton treatment precisely targets cancer cells only, preserving the eyeball and the sight. “In choroidal melanoma, the most common type of eye cancer, patients had a 95 percent local tumor control rate and a 100 percent three-year survival rate after the proton therapy,” said Moon Seong-ho, a specialist at the NCC’s proton therapy center. Another physician SeoYang-kwon at the center said first-stage lung cancer patients who could not have surgery had an 85.4 percent three-year local tumor control rate after the proton therapy. Those whose tumors were smaller than 3 centimeters had a 94 percent rate. “Patients in stage-1 esophageal cancer had a 90 percent local tumor control after the proton treatment, too,” he added.
Children with brain tumors who receive conventional photon radiation therapy are at risk for experiencing cognitive changes after treatment. That’s because the radiation not only treats the tumor but it can also impact the healthy tissue surrounding it. With proton beam radiation therapy, research suggests that these cognitive changes will be less severe. This technology allows radiation oncologists to more precisely apply radiation dose to the tumor so the child’s healthy brain tissue is not exposed to as much radiation and can continue growing and developing.
Oncologists recommend proton therapy to treat some brain cancer patients because it is more precise than traditional radiation, drastically lowering the risks of radiation to healthy tissue. With proton therapy, unnecessary radiation doses can be avoided in patients with brain cancer, resulting in significant improvement in quality of life during and after treatment. As a result, there is a lower risk of side effects and permanent brain damage.
Particle beam radiation therapy is preferred if the tumor is >18 mm in the largest diameter with any thickness, >10 mm in thickness with any diameter, or >8 mm with optic nerve involvement and any diameter, and Particle beam radiation is recommended for all tumor sizes.
Our results indicated that PBT monotherapy can be a beneficial treatment for localized PCa. Furthermore, it can preserve the quality of life of these patients. We believe that this study provides crucial hypotheses for further study and for establishing new treatment strategies.
Proton beam therapy (PBT) may be a better treatment option for pediatric patients with head and neck cancers than first-line therapy with traditional photon radiation, according to a new study published by PediatricBlood and Cancer. The authors found that PBT results in similar outcomes with less of a detrimental impact on quality of life.
“These data show proton therapy is not only effective, it is also more tolerable for patients,” Dr Hill-Kayser said. “ This study shows this treatment is safe and offers practice guidelines for delivering head and neck proton therapy in the pediatric population.”
A new study found that Hodgkin lymphoma patients treated with consolidative proton therapy afte rchemotherapy had “excellent” early relapse-free survival rates and no early grade 3 radiation-related toxicities.
Five-year results of a single-institution study show that proton beam radiotherapy given concurrently with chemotherapy offers promising clinical outcomes with good toxicity results compared with historical data.
The use of reirradiation with intensity-modulated proton therapy yielded strong overall survival with limited toxicity in patients with thoracic tumors, potentially offering a new option in this patient population.
CERN is the world’s largest particle physics research laboratory. Since it was established in 1954, it has made an outstanding contribution to our understanding of the fundamental particles and their interactions, and also to the technologies needed to analyse their properties and behaviour. The experimental challenges have pushed the performance of particlea ccelerator sand detectors to the limits of our technical capabilities, and these ground breaking technologies can also have a significant impact in applications beyond particle physics. In particular, the detectors developed for particle physics have le dto improved techniques for medical imaging, while accelerator technologies lie at the heart of the irradiation methods that are widely used for treating cancer.
Indeed, many important diagnostic and therapeutic techniques used by healthcare professionals are based either on basic physics principles or the technologies developedt o carry out physics research. Ever since the discovery of x-rays by Roentgen in 1895, physics has been instrumental in the developmen tof technologies in the biomedical domain, including the use of ionizing radiation for medical imaging and therapy. Some key examples that are explored in detail in this book include scanners based on positron emission tomography, as well as radiation therap yfor cancer treatment. Even the collaborative model of particle physics i sproving to be effective in catalysing multidisciplinary research for medical applications, ensuring that pioneering physics research is exploitedf or the benefit of all.
Cancer therapy is a multi-modality approach including surgery, systemic or targeted chemotherapy, radiation (external beam or radionuclide), and immunotherapy. Radiation is typically administered using external beam photon therapy. Proton therapy has been around for more than 60 years but was restricted to research laboratories until the 1990s. Since then clinical proton therapy has been growing rapidly with currently more than 50 facilities worldwide. The interest in proton therapy stems from the physical properties of protons allowing for advanced dose sculpting around the target and sparing of healthy tissue. This review first evaluates the basics of proton therapy physics and technology and then outlines someof the current physical, biological, and clinical challenges. Solving these will ultimately determine whether proton therapy will continue on its path to becoming mainstream.