proton therapy for breast cancer treatment

Proton Therapy for breast cancer treatment ‘safe and effective’ concludes new study

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Proton therapy for breast cancer treatment is “safe and effective.” That’s the conclusion of a new study released in the Journal of Clinical Oncology, which highlighted proton therapy’s ability to control cancer cells with much less toxicity in the heart and lungs as compared to conventional (x-ray) radiation therapy.

“In our prospective trial of women with locally advanced breast cancer who required treatment of the internal mammary nodes, proton beam radiation therapy was safe and effective,” says Shannon M. MacDonald, MD, of Massachusetts General Hospital in Boston, and colleagues.

Breast cancer tumors usually occur in the lobules and ducts of the breast, which are used in the production and delivery of breast milk. Breast cancer is the most common cancer among women aside from skin cancer. Men are also susceptible to breast cancer, although the disease is rare among males.

As with other cancers, the best possible outcomes for breast cancer treatment come through early breast cancer care. Proton therapy has unique attributes that reduce radiation exposure to normal, healthy organs3,4. This is especially important in left-sided, node positive breast cancer patients (those who need the internal mammary nodes irradiated), as the cancer is close to critical organs such as the heart and the lungs.

How Massachusetts General Hospital conducted the study

Researchers enrolled 70 prospective patients with nonmetastatic breast cancer who required radiation therapy to the chest wall and regional lymph nodes. The average age of enrollees was 45, with patients ranging from 24 to 70 years old. The vast majority (91%) of evaluable patients had left-side breast cancer, and all but four patients had stage II-III disease. Only one patient did not receive chemotherapy in conjunction with proton radiation therapy.

The study, which lasted from 2011 to 2016, specifically chose patients whose treatment would include irradiation of the internal mammary nodes (IMNs). This made them suboptimal candidates for conventional radiation therapy, since exposure to the IMNs would also increase radiation to the heart and lungs. According to the study’s authors, that has been associated with an increased risk of cardiac events.

The benefits of proton therapy, however, significantly reduce exposure to the heart and lungs. It’s an advanced form of radiation therapy that precisely targets a tumor using a single beam of high-energy protons to kill cancer cells. Unlike conventional photons, which have almost no mass and extend beyond a tumor through the body, protons are relatively heavy and will hit their target – then stop. This spares nearby healthy tissues and organs from receiving unnecessary radiation.

Summary of the study’s results

Proton therapy for breast cancer treatment received high marks from this study. Of the 69 evaluable patients, the 5-year cancer recurrence rate was just 1.5% and the 5-year overall survival rate was 91%. Those positive results go hand-in-hand with low rates of severe side effects. Study authors reported no patient developed grade 3 pneumonitis (inflammation of the lungs) or grade 4 or higher toxicity in the lungs. They also reported no significant changes in cardiac function or key cardiac biomarkers.

Dr. MacDonald and colleagues concluded that “Proton beam radiation therapy (RT) for breast cancer has low toxicity rates and similar rates of disease control compared with historical data of conventional RT.”

Dr. Ben Wilkinson, MD, FACRO, Radiation Oncologist and Medical Director at Provision CARES Proton Therapy Knoxville says the findings of this study support the success he’s seen at Provision.

“Among mostly young women with left-sided breast cancer receiving regional nodal irradiation, proton therapy produces excellent target coverage with miniscule cardiac doses and low rates of lung toxicity,” Dr. Wilkinson says about the study’s conclusion. “When we treat breast cancer, those lymph nodes run very close to the heart. Proton therapy allows us to deliver the dose to the tumor site and spare the surrounding area – the heart, lung, chest wall, and even the esophagus.”

What’s next for proton therapy research?

The authors of the study from Massachusetts General Hospital say their findings open the door for more extensive studies in the future. “No early cardiac changes were observed,” they note, “Which paves the way for randomized studies to compare proton beam radiation therapy with standard radiation therapy.”

In fact, the results of the study bode well for a more comprehensive trial already underway to compare proton therapy with conventional x-ray therapy. The Radiotherapy Comparative Effectiveness (RADCOMP) Consortium Trial, which began in 2016 and will continue until at least 2022, is being conducted by the University of Pennsylvania, in conjunction with the Patient-Centered Outcomes Research Institute.

According to the U.S. National Library of Medicine, it is a pragmatic randomized clinical trial of patients with locally advanced breast cancer. More than 1,000 patients will be randomly assigned to receive either proton therapy or x-ray therapy. Each patient will have a 50-50 chance of getting into either treatment group. Both groups will be followed for at least 10 years after completing radiation therapy. The trial’s ultimate goal to is to study the patients’ quality of life outcome to help decide which is the best treatment option for future patients with breast cancer – proton therapy or x-ray therapy.

The Benefits of Proton Therapy for Breast Cancer Treatment

Proton therapy shows remarkable promise and advantages over conventional therapy in the treatment of breast cancer. It is a type of radiation that stops at a very specific point in the targeted tissue; conventional radiation continues beyond the tumor. In breast cancer, this means on average no radiation to the heart and on average 50% less radiation to the lung5 as compared with conventional radiation.

Proton therapy is extremely precise and therefore more effective at targeting cancerous cells without causing damage to surrounding breast tissue. It is not a substitute for a lumpectomy. Rather, it is used as an alternative to conventional radiation therapy. After surgery a breast cancer patient may receive 2-6 weeks of proton therapy.

Sources:

  1. Phase II Study of Proton Beam Radiation Therapy for Patients with Breast Cancer Requiring Nodal Irradiation. Journal of Medical Oncology
  2. Pragmatic Randomized Trial of Proton vs. Photon Therapy for Patients with Non-Metastatic Breast Cancer: A Radiotherapy Comparative Effectiveness (RADCOMP) Consortium Trial. ClinicalTrials.gov
  3. MacDonald S, Specht M, Isakoff S, et al. Prospective pilot study of proton radiation therapy for invasive carcinoma of the breast following mastectomy in patients with unfavorable anatomy – first reported clinical experience. Int J Radiat Oncol. 2012;84(Suppl 3):S113-S114. Abstract 281
  4. Moon SH, Shin KH, Kim TH, et al. Dosimetric comparison of four different external beam partial breast irradiation techniques: three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, helical tomotherapy, and proton beam therapy. Radiother Oncol. 2009;90:66-73.
  5. Early Toxicity in Patients Treated with Postoperative Proton Therapy for Locally Advanced Breast Cancer. U.S. National Library of Medicine, National Institutes of Health

 

Upcoming Event: Prostate Cancer 101: Understanding the Journey Diagnosis, Treatment, and Survival

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Join us for a free presentation to learn more about the latest developments in prostate cancer. Dr. Wilkinson will discuss the most advanced diagnostic tools and current trends in treatment including multiparametric MRI, genomic classification, when to use active surveillance, and how to preserve quality of life after a prostate diagnosis.

Friday, September 20th from  930-11a

Hosted by: Provision CARES Proton Therapy Knoxville, 6450 Provision CARES Way, Knoxville, TN 37909

RSVP: To reserve your seat, please RSVP to Jenni Turner at 865.321.4539 or jenni.turner@provisionhp.com

Upcoming Events: Prostate Cancer 101: Understanding the Journey Diagnosis, Treatment, and Survival

By

Join us for a free presentation to learn more about the latest developments in prostate cancer. Dr. Wilkinson will discuss the most advanced diagnostic tools and current trends in treatment including multiparametric MRI, genomic classification, when to use active surveillance, and how to preserve quality of life after a prostate diagnosis.

Friday, July 26th from 930-11a and Friday August 23rd from 930-11a

Hosted by: Provision CARES Proton Therapy Knoxville, 6450 Provision CARES Way, Knoxville, TN 37909

RSVP: To reserve your seat, please RSVP to Jenni Turner at 865.321.4539 or jenni.turner@provisionhp.com

Prostate Cancer 101: Understanding the Journey Diagnosis, Treatment, and Survival

By

Join us for a free presentation to learn more about the latest developments in prostate cancer. Dr. Wilkinson will discuss the most advanced diagnostic tools and current trends in treatment including multiparametric MRI, genomic classification, when to use active surveillance, and how to preserve quality of life after a prostate diagnosis.

Thursday, May 9th at 6:30pm or Friday, May 17th at 9:30am

Hosted by: Provision CARES Proton Therapy Knoxville, 6450 Provision CARES Way, Knoxville, TN 37909

RSVP: To reserve your seat, please RSVP to Jenni Turner at 865.321.4539 or jenni.turner@provisionhp.com

Provision Team Members Participate in the National Association of Proton Therapy Convention

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The National Association for Proton Therapy (NAPT) held its seventh annual proton conference March 24-27, 2019, at The Biltmore Miami – Coral Gables, in Miami, Florida.  Founded in 1990, the National Association for Proton Therapy is a nonprofit organization whose mission is to work collaboratively to: (i) raise awareness of the therapeutic benefits of proton therapy among patients, providers, payers, policymakers, and other stakeholders, (ii) ensure patient choice and access to affordable proton therapy, and (iii) encourage cooperative research and innovation to advance the appropriate and cost-effective utilization of proton therapy. The annual conference allows proton centers from across the Unites States to convene and discuss how to advance awareness of the clinical benefits of proton therapy for cancer patients, provide education, and advocate for insurance coverage.

This year, almost 300 physicians, nurses, therapists, proton therapy directors, managers and others involved with or interested in learning more about the cutting-edge therapy attended the conference.  The 2019 program covered a variety of interesting and informative topics including: pediatrics, marketing, legislation, insurance and appeals, and clinical updates. Keynote speaker Barbara L. McAneny, MD, President of the American Medical Association, Anne Hubbard, Director of Health Policy for the American Society for Radiation Oncology, and guest speaker Senator Marco Rubio, all described the important role and impact of proton therapy in cancer care and the medical field at large from perspectives beyond those of proton providers. It was encouraging to hear proton therapy is gaining powerful advocacy and allies in positions within the medical field as well as in the upper levels of government.

Provision entities were represented by twelve attendees. Provision representatives participated as presenters and facilitators for several of the conference breakout sessions. Rebecca Bergeron, Dr. Ben Wilkinson, Jenni Turner, Elizabeth Vanzo, Nancy Howard, Niek Schroeder, and Laddie Derenchuk were all members of panel discussions and gave presentations on topics ranging from legislation and technical developments, to clinical best practices, patient interactions, and collaboration. This level of participation by Provision representatives further demonstrates Provision’s place as an industry leader.

In addition to the presentations, discussions, and panels, George Laramore, MD, PhD, FACR, FASTRO, of the Seattle Cancer Care Alliance Proton Therapy Center and the University of Washington, was awarded the 2019 NAPT Lifetime Achievement Award in recognition of his decades of pioneering work in the field of particle therapy. In announcing the award, NAPT Executive Director, Scott Warwick, stated “Dr. Laramore has brought honor and distinction to the field of particle therapy and we are grateful for the opportunity to award him for his endless dedication and perseverance to serve cancer patients across the country and the world.”

The NAPT announced that the 2020 National Proton Therapy Conference will be held April 25-29 in Nashville, TN at The Renaissance Hotel. Provision CARES Proton Therapy Nashville will host a Reception and Tour April 27th.  Nancy Howard, Vice President Marketing & Public Relations of Provision Solutions, will act as the 2020 Conference Chair.

The National Association for Proton Therapy is the voice for the proton community. As there are now 31 Proton centers in operation and 35 centers under construction or in development, it is important for all proton centers to form a strong alliance to advocate for patient access to proton therapy.   NAPT is the vehicle that will lead our alliance forward.

Provision Healthcare Introduces a Major Advancement in the Care of Cancer Patients and Treats First Patients at the Provision CARES Cancer Center Using ProNova’s Innovative Proton Therapy System

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Provision Healthcare, an industry leading innovator in comprehensive, collaborative cancer solutions, is pleased to announce successfully treating the first patients on Provision’s newly developed ProNova SC360 proton therapy system at the Provision CARES Cancer Center in Knoxville, Tennessee.  (more…)

Provision Culture of Safety

Provision’s Culture of Safety

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At Provision CARES Proton Therapy, we are dedicated to providing a safe workplace for our employees and a safe treatment environment for our patients. Just this month, our Provision CARES Cancer Center team in Knoxville received the official Accreditation Certificate issued by ASTRO (“Accreditation Certificate”). To receive this accreditation, the team was required to focus on five pillars of patient care. One of the five pillars of patient care is safety. The team demonstrated and committed to the highest standards of safety through daily processes and procedures. To read more about the Accreditation process and this achievement see our previous blog here. (more…)

Provision is first in Knoxville and the state of Tennessee to achieve ASTRO’s APEx Accreditation Certificate

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After months of preparing and a thorough review process, we are proud to announce Provision CARES Proton Therapy-Knoxville is the first radiation facility in the state of Tennessee and the first private practice proton center to receive the official certificate of ASTRO’s Accreditation Program for Excellence (“APEx”).  APEx is an independent radiation oncology practice accreditation program developed by ASTRO, American Society for Therapeutic Radiology and Oncology, based on a comprehensive set of sixteen evidence-based standards of radiation oncology practice.

(more…)

New proton therapy cancer center to open across from Williamson Medical Center

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A cancer treatment center specializing in proton therapy, an increasingly popular treatment, is set to open in the summer of 2018.

Provision Healthcare, a clinical provider and developer of cancer treatments, will open a Provision CARES Cancer Center on Carothers Parkway, across from Williamson Medical Center, said Dr. Terry Douglass, Ph.D., the executive chair of Provision.

Proton therapy, said Douglass, is a form of advanced radiation technology that impairs the DNA of cancer cells and causes them to die.

Unlike traditional radiation methods, a machine called a cyclotron is used to pinpoint cancer cells, targeting diseased cells while minimizing damage to surrounding tissue.

“It’s like using a rifle compared to a shotgun,” Douglass said of the therapy.

“We developed a new technology that is a lower cost, that uses smaller and lighter technology,” Douglass said of the 200-ton machine which is used to treat cancer.

In traditional chemotherapy or radiation techniques, side effects are common. But with proton therapy, Douglass said side effects are less pronounced; he also said numerous data support the use of proton therapy, including better long-term outcomes for patients.

The treatment is becoming more common for illnesses like prostate cancer, but studies show mixed results, not conclusively supporting the treatment as better than traditional radiation.

Proton therapy centers are popping up across the country. According to the National Association of Proton Therapy, there are currently 26 proton therapy centers in operation with 11 under construction or in development.

The Franklin location will be the company’s second center in Tennessee. The original campus opened in January of 2014 in Knoxville. Planned expansions in Fort Lauderdale and Orlando, Florida, are in the works, said Douglass.

Of the decision to be based in Franklin, Douglass said the surrounding health care centers and climate of technological innovation made it a good choice, noting Tennessee Oncology and Vanderbilt as two top-notch cancer treatment centers.

Douglass said the spot on Carothers Parkway, in a central location with easy access to the interstate, would make it easy for patients from Tennessee, as well as Kentucky and Alabama, to reach the center.

“These patients are here from four to eight weeks. They get five treatments Monday through Friday, then they have the weekend off,” he said. “We were looking for a site that would be amenable to the patients.”

“Being near the Williamson County Medical Center was very important to us as well,” he continued. “Franklin has just become a hub of healthcare services.”

In addition to the center, the company will build 72,000 square feet of office space, which Douglass said will house medical companies including Tennessee Oncology and drug discovery and trials for the Sarah Cannon Cancer Center.

Mary Lou DuBois, the president of Provision Health Partners, said the location will open some time this summer, and will hire 75 to 80 employees to staff the center.

“We’re about developing a culture of care that is totally focused on the patient and walking through and with them as they’re on their journey,” she said of center’s mission.

In 2005, Provision Healthcare was founded by Douglass in Knoxville. The organization operates as a for-profit healthcare solutions company, while both the Knoxville and Franklin cancer centers are non-profits.

“New proton therapy cancer center to open across from Williamson Medical Center.” Brooke Wanser, Brentwood HomePage