Kevin’s Proton Therapy Experience

Proton Therapy Patients Experience

Kevin Holmes received proton therapy prostate cancer treatments at Hampton University Proton Therapy Institute (HUPTI) after being diagnosed at the age of 54. 

“I received the very best care ! The HUPTI staff became my Hampton Roads family while I was away from my own. My quality of life never changed, and I was routinely active – morning to night. The only physical issue was sun burning on my hips, which should soon fade. I can now let others know cancer is NOT a death sentence.”
– Kevin Holmes

“The treatment was much easier than I could have ever possibly imagined. It was as simple as getting an X-ray,” said Holmes. “I was in and out within 30 minutes of when I pulled into the parking lot and when I left.”

HUPTI Kevin Holmes

What is Proton Therapy ?

Proton therapy is a much more targeted version of radiation therapy. Oncologists can use specific frequencies to narrowly direct a radiation beam into a tumor, increasing the strength of the treatment and sparing a larger portion of healthy cells around the tumor.

A secondary benefit of more accurately targeted radiation is the decreased risk of secondary malignancies developing as a result of radiation exposure. The reduced risk to healthy tissue also allows physicians to increase the radiation strength per session, resulting in the need for fewer procedures to deliver the same level of radiation treatment.

As a result, patients experience fewer side effects and suffer significantly less discomfort during and after the procedure. Some patients may experience minor skin irritation or hair loss at the treatment site, which is a small price to pay when compared to the side effects of other cancer treatment methods.

Proton therapy is not an all-day experience. Proton therapy sessions take minutes, not hours, and most patients are able to return to work or their daily routine immediately following their procedure.

Proton Therapy Can Treat Many Types of Cancer

The cancer treatment specialists at HUPTI can use proton therapy to treat:

  • Prostate Cancer
  • Breast Cancer
  • Brain and Spine Cancers
  • Head and Neck Cancers
  • Lung Cancer
  • Gastrointestinal Cancers
  • Ocular Cancer
  • Pediatric Cancer

HUPTI is the brainchild of Hampton University President Dr. William R. Harvey. The facility’s team has treated more than 3,500 patients to date, and they’re ready to consult with you.

“Don’t let what your preconceived notions are stop you from going forth and asking questions with these people because these people made my life so simple with the process that I really didn’t feel like I was going through anything difficult”

– Kevin Holmes


International patients who recently received a cancer diagnosis and are looking for less invasive and disruptive options can talk to SAH Care to arrange consultation and treatment at HUPTI.

Hampton University Proton Therapy Institute 2021

Dr. Allan Thornton

Take a virtual tour of Hampton University Proton Therapy Institute and listen to Dr Allan Thornton explaining this cutting-edge cancer treatment.

2021 Virtual Tour of HUPTI

Because we use charged particles as our form of radiation, we can control the range of the beam. That results in treating about 70% less normal tissues than with any form of X-ray therapy currently practiced.

We treat a widening number of tumors. Essentially we treat any solid tumor that can be treated with conventional X-ray based therapy, but  with significantly less side effects to normal tissue.

We treat essentially all solid tumors that we normally treat with radiation therapy with proton therapy. Those are specifically : brain tumors – in particular brain tumors, posterior fossa tumors, medulloblastoma – we also treat a significant number of prostate patients, rectal cancer patients, lung cancer, women with breast cancer – particularly the left side of breast cancer where we can spare the heart -, and we even treat some skin tumors and lymph node tumors – lymphomas – more successfully and with much less side effects than with conventional therapy.

— Dr Allan Thornton

International patients can contact SAH Care to see if Proton Therapy is right for them.

Proton Therapy for breast cancer patients : Focused Treatment, Fewer Side Effects

Proton Therapy for Breast Cancer Patients

The Hampton University Proton Therapy Institute offers radiation therapy for breast cancer patients that often spares healthy tissue. 

Registered Nurse Donna Sternberg talked about why folks whose Oncologists have prescribed radiation should consider treatment at Hampton’s state-of-the-art center.

Proton Therapy is the most advanced method of radiation therapy used to destroy cancer cells. The team at Hampton Proton Therapy Institute (HUPTI) has made significant stride in using proton treatment for breast cancer. Breast cancer is a complicated and diverse disease. Some patients will receive first chemotherapy and/or surgery, and then external beam radiation therapy. Compared to other conventional external beam radiation technics, the proton beam can be programmed to reach a specified depth, and therefore not expose healthy tissues to unnecessary radiation. Treatment itself is a daily treatment. On an average there are 4 to 6 weeks of daily treatment, from Monday to Friday. We book patients every 15 minutes. The actual duration of the daily session is quite short. For breast cancer specifically, there are few side effects, if any. There is some skin irritation, as there will be with any radiation therapy. But in general our patients are able to continue their normal activities, with no interruption and no side effect.

How Proton Therapy Improves Breast Cancer Treatment

Proton Therapy has become a viable option for breast cancer patients because it limits radiation exposure. Traditional radiation therapy cannot be narrowly targeted and as a result, it carries the risk of damaging the lungs and heart, and causing secondary malignancies. It also commonly causes cosmetic damage, rib fractures and skin deterioration. Proton Therapy helps to avoid those risks by delivering powerful doses of radiation to an extremely precise treatment site. It is a powerful weapon in the battle against breast cancer, that is gentler for the patient and improves quality of life during treatment.

Breast Cancers Treated with Proton Therapy :

  • Early Stage Breast Cancer
  • Locally Advanced Breast Cancer (stage II and III)
  • Ductal carcinoma in-situ
  • Triple-negative Breast Cancer
  • Lobular Carcinoma

Read the latest scientific publications about Proton Therapy for Breast Cancer

Proton pencil beam scanning reduces secondary cancer risk in breast cancer patients with internal mammary chain involvement compared to photon radiotherapy

Cartechini et al.
👉 “Our work indicates a benefit from the use of Protontherapy (PT) in Breast Cancer (BC) patients with nodal involvement. When coupled with the lower normal tissue complication probability (NTCP) expected for distal Organs at Risk (i.e. heart, lung), this represents valuable information for the establishment of cost-effective patient selection criteria for BC treatment. Specifically, we show that the gain offered by PT is maximized when the target volume includes internal-mammary-nodes (IMN). In this setting and especially for younger patients, PT might be an alternative to VMAT irradiation.”

Feasibility study: spot-scanning proton arc therapy (SPArc) for left-sided whole breast radiotherapy

Sheng Chang et al.

👉 “Conventional protontherapy (IMPT or Passive-scattering) could reduce the dose of the heart and LAD in left-side breast cancer patients compared to the photon radiotherapy technique in the high cardiac doses sparing. This study found that the new proton treatment technique, SPArc, could further reduce the D1 of heart and LAD which might mitigate the probability of heart acute and late toxicities (…)
Our feasibility study finds that the technology of SPArc can substantially improve not only the heart and LAD sparing but also the lung sparing in comparison with vIMPT. Previous studies have confirmed that proton therapy can significantly reduce the V500(cGy) and V2000(cGy) of the ipsilateral lung by nearly 50% compared to traditional 3DCRT and IMRT. This study found that SPArc plans further reduced all dose-volume parameters while providing a reduced or similarly high-dose radiation volume with IMPT in left-sided WBRT”

Breast Cancer Survival Is Significantly Decreased Among Premenopausal Women Previously Treated With Radiation for Childhood or AYA Cancer

Jo Cavallo

👉 “Breast cancer–specific survival is significantly decreased among all survivors of childhood and AYA cancer treated with radiotherapy that develop a secondary breast cancer, including women with good prognostic features. Therefore, we may need to consider alternative and even more aggressive treatment in what were considered low-risk populations previously”

Second Cancer Risk After Primary Cancer Treatment With Three-Dimensional Conformal, Intensity-Modulated, or Proton Beam Radiation Therapy

Xiang M, Chng DT, Pollom EL

👉 “The risk of a second cancer diagnosis after primary cancer treatment was similar after intensity-modulated radiotherapy (IMRT) versus 3-dimensional conformal radiotherapy (3DCRT), while proton beam radiotherapy (PBRT) was correlated with a lower risk of second cancer diagnosis”

Proton Therapy in 2020: Where We Are and How We Got Here

Minesh Mehta

👉 “The precision and accuracy of protontherapy treatments have vastly improved by incorporating these technologies into the daily workflow. With normal tissue spared from unnecessary exposure to radiation doses, patients experience fewer short- and long-term side effects and can enjoy a better quality of life.”

The risk for developing a secondary cancer after breast radiation therapy: Comparison of photon and proton techniques

Paganetti et al.

👉 “Conventional (3DCRT) techniques led to the lowest estimated risks of, thyroid and esophageal secondary cancers while Protontherapy PBS demonstrated a benefit for secondary lung and contralateral breast cancer risks, with the highest risks overall associated with VMAT techniques.”

Proton Reirradiation: Expert Recommendations for Reducing Toxicities and Offering New Chances of Cure in Patients With Challenging Recurrence Malignancies

Simone et al.

👉 “The high conformality and lack of exit dose with protontherapy offer significant advantages for reirradiation. By decreasing dose to adjacent normal tissues, proton therapy can more safely deliver definitive instead of palliative doses of reirradiation, more safely dose escalate reirradiation treatment, and more safely allow for concurrent systemic therapy in the reirradiation setting. “

Cardiotoxicity and Radiation Therapy: A Review of Clinical Impact in Breast and Thoracic Malignancies

Elizabeth M. Nichols et al.

👉 “All radiation oncologists should be aware of Radiation-Induced Cardiotoxicity (RIC), with a call to action to support advanced delivery techniques”

👉 “Based on available data, a clear relationship exists between whole-heart dose and risk of cardiac events following RT for breast cancer with a significant increase in risk for left-sided breast cancer patients (…) Patients, with a particular focus on those with left-sided disease, should be evaluated for cardiac-sparing techniques, including but not limited to deep-inspiration breath hold (DIBH), gating, prone positioning, and/or proton therapy, to achieve the lowest dose possible.”

April 2020 : what did we learn ?

Last month, the impact of Covid-19 on cancer treatment has been discussed in many articles. Several more studies have also been published showing the benefits of Proton Therapy for Pediatric Ewing Sarcoma, Head & Neck, Oropharyngeal, Breast, Lung, Esophageal, and Prostate cancers, and for re-irradiation.

Read our selection.

COVID-19 : global consequences for oncology

This pandemic will undoubtedly change the way we work. But the oncology community is relentlessly devoted to the patients, and we will certainly weather this unprecedented storm !

Editorial| Volume 21, ISSUE 4, P467, April 01, 2020

COVID-19: global consequences for oncology
The Lancet Oncology

Challenges posed by COVID-19 to children with cancer

⚠️ Let’s get ready !
Let’s work all together and let’s optimize all our resources to make sure our young patients receive the right treatment at the right time !
👉 “The coming months will pose many further challenges, which might include accessibility to scarce resources, effects on drug manufacture and supply, and the effect on care of children with cancer from low-income and middle-income countries. Continued collaboration among the international pediatric oncology community is required to get through such uncertain times.”

Rishi S Kotecha

Treating childhood cancer : a necessity not a choice

“Inadequate access to care, late diagnosis, financial toxicity, and poor-quality care are ubiquitous barriers for children with cancer worldwide and have a crucial impact on survival outcomes. Owing to population growth and inequitable access to cancer care, 80% of the global cancer burden–in terms of both incidence and mortality is estimated to fall on children in low-income and middle-income countries (LMICs)—a humanitarian situation that demands immediate attention.”

Allison Landman
David Collingridge

Pediatric Ewing Sarcoma : Depending on the chest wall subregion, proton treatment has the potential to minimize pulmonary, cardiac, renal, and hepatic toxicity, as well as second malignancies.

👉 Target conformity and homogeneity indices are generally better for the IMPT plans with beam aperture.
👉 Doses to the lung, heart, and liver for all patients are substantially lower with the 3DPT and IMPT plans than those of IMRT plans.
👉 In the IMPT plans with large spot without beam aperture, some OAR doses are higher than those of 3DCPT plans. The integral dose of each photon IMRT plan ranged from 2 to 4.3 times of proton plans.
👉 Compared to IMRT, proton therapy delivers significant lower dose to almost all OARs and much lower healthy tissue integral dose. Compared to 3DCPT, IMPT with small beam spot size or using beam aperture has better dose conformity to the target.
👉 Treatment plan using the smaller beam spot with beam apertures provided the best combination of target coverage and OAR sparing.

Impact of different treatment techniques for pediatric Ewing sarcoma of the chest wall: IMRT, 3DCPT, and IMPT with/without beam aperture
Zhong Su et al.

For patients with HPV-positive oropharyngeal cancer, the predicted risk of secondary malignant neoplasms (SMN) is significantly reduced statistically for treatment with Intensity Modulated Proton Therapy (IMPT) compared with Intensity Modulated photon Radiation Therapy (IMRT).

👉 Although both modalities afforded good target coverage, IMPT plans were able to achieve improved healthy-tissue sparing : significant reductions in mean mandible, contralateral parotid, lung and skin organ equivalent doses with IMPT compared with IMRT plans (P < .001).
👉 This reduction in integral dose led to a predicted decrease of 436 additional cases of SMNs for every 10 000 patients/y (or 4 per 100 patients/y) for treatment with protons instead of photons

Predicted Secondary Malignancies following Proton versus Photon Radiation for Oropharyngeal Cancers – Jain et al

Oropharyngeal cancer : proton therapy improves Patient-reported outcomes

👉 Intensity Modulated Proton Therapy is associated with improved Patient-reported outcomes, reduced percutaneous endoscopic gastrostomy -tube placement, hospitalization, and narcotic requirements.
👉 Mucositis, dysphagia, and pain were decreased with IMPT.
👉 Benefits were predominantly seen in patients treated definitively or with chemoradiotherapy.

Comparative analysis of acute toxicities and patient reported outcomes between intensity-modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) for the treatment of oropharyngeal cancer
Manzar et al.

Particle therapies, such as proton therapy or carbon ion therapy, proposed to reduce the burden of xerostomia in patients following chemoradiotherapy for HNSCC

👉 Particle therapies are especially able to reduce moderate to low dose exposure to the oral cavity (minor salivary glands), submandibular glands, and parotid glands with similar target coverage based on the physical properties of the Bragg peak energy deposition of these approaches.

Sticky stuff: xerostomia in patients undergoing head and neck radiotherapy-prevalence, prevention, and palliative care.
Snider JW 3rd, Paine CC 2nd Annals of Palliative Medicine, 25 Mar 2020 10.21037/apm.2020.02.36

Be aware of Radiation-Induced Cardiotoxicity (RIC), and support advanced delivery techniques

👉 Breast cancer
Based on available data, a clear relationship exists between whole-heart dose and risk of cardiac events following Radiotherapy for breast cancer with a significant increase in risk for left-sided breast cancer patients (…) Patients, with a particular focus on those with left-sided disease, should be evaluated for cardiac-sparing techniques, including but not limited to deep-inspiration breath hold (DIBH), gating, prone positioning, and/or proton therapy, to achieve the lowest dose possible.
👉 Thoracic Malignancies (Lung and Esophageal cancers)
Because of the anatomic proximity of these cancers to the heart, however, radiomodulatory techniques such as DIBH or gating may not be as helpful in reducing heart dose; thus, other techniques, such as proton therapy, may be needed.

Nichols et al.
Cardiotoxicity and Radiation Therapy: A Review of Clinical Impact in Breast and Thoracic Malignancies

For locally advanced esophageal cancer, ProtonTherapy (PBT) reduced the risk and severity of Adverse Eventss compared with IMRT while maintaining similar progression-free survival (PFS)

👉 The posterior mean total toxicity burden (TTB) was 2.3 times higher for IMRT (39.9; 95% highest posterior density interval, 26.2-54.9) than (PBT) (17.4; 10.5-25.0).
👉 The mean postoperative complications (POCs) score was 7.6 times higher for IMRT (19.1; 7.3-32.3) versus PBT (2.5; 0.3-5.2).
👉 The posterior probability that mean TTB was lower for PBT compared with IMRT was 0.9989, which exceeded the trial’s stopping boundary of 0.9942 at the 67% interim analysis.
👉 The 3-year PFS rate (50.8% v 51.2%) and 3-year overall survival rates (44.5% v 44.5%) were similar.

Randomized Phase IIB Trial of Proton Beam Therapy Versus Intensity-Modulated Radiation Therapy for Locally Advanced Esophageal Cancer
Lin SH, et al. J Clin Oncol. 2020;doi:10.1200/JCO.19.02503.

Re-irradiation with proton therapy is a safe and effective treatment in patients with recurrent glioblastoma

Proton therapy does not negatively effect on health-related quality of life (HRQOL), but rather it seems to preserve HRQOL until the time of disease progression :
👉 The treatment was associated with improvement or stability in most of the preselected HRQOL domains.
👉 Global health improved over time with a maximum difference of six points between baseline and 3-months follow-up.
👉 Social functioning and motor dysfunction improved over time with a maximum difference of eight and two points, respectively.
👉 Non-significant decrease in cognitive and emotional functioning.
👉 Fatigue remained stable during the analysis such as the other preselected domains.

Proton therapy re-irradiation preserves health-related quality of life in large recurrent glioblastoma
Scartoni et al.

The high conformality and lack of exit dose with proton therapy offer significant advantages for reirradiation

👉 By decreasing dose to adjacent normal tissues, proton therapy can more safely deliver definitive instead of palliative doses of reirradiation, more safely dose escalate reirradiation treatment, and more safely allow for concurrent systemic therapy in the reirradiation setting.

Proton Reirradiation: Expert Recommendations for Reducing Toxicities and Offering New Chances of Cure in Patients With Challenging Recurrence Malignancies
Simone et al.

Rectal Hydrogel Spacer Improves Late Gastrointestinal Toxicity

👉 compared with rectal balloon immobilization, treatment with the hydrogel spacer significantly reduced the risk of clinically relevant (grade 2+), late rectal bleeding and was associated with a significantly lower decrease in patient-reported bowel quality of life
👉 “the rectal-sparing benefit of the hydrogel spacer, particularly for reducing late rectal bleeding, was even greater than expected. These findings can hold interest for urologists who counsel patients about their treatment options for localized prostate cancer,” added Dr. Ellis, professor and vice-chair of urology, University of Washington, Seattle.

Dinh TT et al.
Rectal Hydrogel Spacer Improves Late Gastrointestinal Toxicity Compared to Rectal Balloon Immobilization After Proton Beam Radiation Therapy for Localized Prostate Cancer: A Retrospective Observational Study.

Prostate cancer : Hydrogel spacer reduce the rectal dose

👉 Significant rectal dose reduction (P < 0.001) between the treatment plans on pre- and post-CT images were achieved for all modalities for D50%, D20% and D2%.
👉 In particular, the dose reduction of high-dose (D2%) ranges were : −40.61 ± 11.19 for proton therapy −32.44 ± 5.51 for CK −25.90 ± 9.89 for HT −13.63 ± 8.27 for VMAT −8.06 ± 4.19% for 3DCRT
👉 The results of this study demonstrated that all external radiotherapy modalities with hydrogel spacer could reduce the rectal dose.”

Comparison of rectal dose reduction by a hydrogel spacer among 3D conformal radiotherapy (3DCRT), volumetric-modulated arc therapy (VMAT), helical tomotherapy (HT), CyberKnife (CK) and proton therapy – Saito et al.
Journal of Radiation Research, rraa013,

Figure : Typical dose distribution of SO(−) and SO(+) and the results of five modalities: (a) 3DCRT, (b) VMAT, (c) HT, (d) CK and (e) proton. The contour of the orange color illustrates the rectum.

Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement


Background: Different modern radiation therapy treatment solutions for breast cancer (BC) and regional nodal irradiation (RNI) have been proposed. In this study, we evaluate the potential reduction in radiation-induced skin morbidity obtained by intensity modulated proton therapy (IMPT) compared with intensity modulated photon therapy (IMXT) for left-side BC and RNI.

Material and Methods: Using CT scans from 10 left-side BC patients, treatment plans were generated using IMXT and IMPT techniques. A dose of 50 Gy (or Gy [RBE] for IMPT) was prescribed to the target volume (involved breast, the internal mammary, supraclavicular, and infraclavicular nodes). Two single filed optimization IMPT (IMPT1 and IMPT2) plans were calculated without and with skin optimization. For each technique, skin dose-metrics were extracted and normal tissue complication probability (NTCP) models from the literature were employed to estimate the risk of radiation-induced skin morbidity. NTCPs for relevant organs-at-risk (OARs) were also considered for reference. The non-parametric Anova (Friedman matched-pairs signed-rank test) was used for comparative analyses.

Results: IMPT improved target coverage and dose homogeneity even if the skin was included into optimization strategy (HIIMPT2 = 0.11 vs. HIIMXT = 0.22 and CIIMPT2 = 0.96 vs. CIIMXT = 0.82, p < .05). A significant relative skin risk reduction (RR = NTCPIMPT/NTCPIMXT) was obtained with IMPT2 including the skin in the optimization with a RR reduction ranging from 0.3 to 0.9 depending on the analyzed skin toxicity endpoint/model. Both IMPT plans attained significant OARs dose sparing compared with IMXT. As expected, the heart and lung doses were significantly reduced using IMPT. Accordingly, IMPT always provided lower NTCP values.

Conclusions: IMPT guarantees optimal target coverage, OARs sparing, and simultaneously minimizes the risk of skin morbidity. The applied model-based approach supports the potential clinical relevance of IMPT for left-side BC and RNI and might be relevant for the setup of cost-effectiveness evaluation strategies based on NTCP predictions, as well as for establishing patient selection criteria.

Francesco Fellin, Martina Iacco, Vittoria D’Avino, Francesco Tommasino, Paolo Farace, Giuseppe Palma, Manuel Conson, Irene Giacomelli, Claudio Zucchetti, Lorenzo Falcinelli, Maurizio Amichetti, Cynthia Aristei & Laura Cella(2019) Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement, Acta Oncologica, DOI: 10.1080/0284186X.2019.1591638

Cardiotoxicity Associated with Radiation for Breast Cancer

Leonard K.L., Wazer D.E. (2019). In: Wright J. (eds) Toxicities of Radiation Treatment for Breast Cancer. Springer, Cham

“Strategies to reduce cardiac dose, including deep inspiration breath hold, prone positioning, partial breast irradiation, and proton therapy should be considered, particularly in women at high risk for cardiotoxicity. Based on available data, most current protocols recommend limiting mean cardiac dose and the dose to 5% and 10% of the cardiac volume.”

The relationship between radiation doses to coronary arteries and location of coronary stenosis requiring intervention in breast cancer survivors

Anna-Karin Wennstig, Hans Garmo, Ulf Isacsson, Giovanna Gagliardi, Niina Rintelä, Bo Lagerqvist, Lars Holmberg, Carl Blomqvist, Malin Sund and Greger Nilsson

Radiation Oncology201914:40

This study assessed the relationship between radiation doses to the coronary arteries (CAs) and location of a coronary stenosis that required intervention after three-dimensional conformal radiotherapy (3DCRT) for breast cancer (BC).

In women receiving conventional 3D Conformal RadioTherapy for Breast Cancer between 1992 and 2012, radiation doses to the Left Anterior Descending Artery (LAD) remained high and were associated with an increased requirement of coronary intervention in mid LAD. The results support that the LAD radiation dose should be considered in RT treatment planning and that the dose should be kept as low as possible.

Reducing the dose to LAD, and implementation of heart-sparing RT techniques is of importance, since minimising the dose to LAD is expected to diminish the risk of later radiation-induced stenosis.