News and Blog

Mar

A message from Provision leadership regarding COVID-19 (coronavirus)

In response to the presence of COVID-19 (coronavirus) in Tennessee, effective Friday, March 13, Provision is taking the following preventative measures to protect the health of our patients, employees, and visitors:

All patients are asked to bring no more than one visitor or caregiver with them to our center.

Upon arrival at any of our centers, patients and visitors will be asked to complete a brief COVID-19 screening questionnaire.

Visitors and/or caregivers that are experiencing any symptoms associated with COVID-19 or have traveled to/from any area that has been significantly impacted by COVID-19 will be asked to leave the building.

All non-essential gatherings have been discontinued for the foreseeable future, including chat sessions, patient luncheons, and facility tours.

More comprehensive cleaning and disinfection procedures have been implemented at all of our facilities.

All patients, visitors, and employees are being asked to wash their hands often, maintain physical distance of at least three feet from others, and follow good cough/sneeze etiquette.

All employees are screened daily for symptoms associated with COVID-19 to determine whether they may continue providing care at the Center.

All patients are screened daily for symptoms associated with COVID-19 and, depending on the outcome of the screening, may be asked to postpone their appointment until they have been tested for the virus.

If you have questions or concerns regarding COVID-19, please visit our COVID-19 FAQ section to learn more about the steps we are taking to ensure your cancer treatment does not get delayed.

Mar

Provision doctor diagnosed with cancer, chooses proton therapy for his own treatment

By Provision CARES Proton Therapy

This story starts the way a lot of cancer stories start. A visit to the doctor for an unrelated issue. A few tests. And then, while trying to solve one problem, the doctor discovers another – a red flag.

That discovery sparks a journey down a road far too many have traveled. First, more trips to the doctor. Then more tests. And then the waiting. Waiting with fear and uncertainty – hoping for the best, but preparing for the worst. Until eventually, the wait is over and the news is in…

It’s cancer.

And from there, this story continues down a common path. Mulling over questions like “How bad is it?” and “How do I deal with this?” Determining the options and choosing a treatment. And of course, fighting the cancer.

There’s something uncommon about this story, though – the person making the journey. Because he’s literally been down this road hundreds of times before. He knows the roadmap better than most, because he’s guided people through it for decades.

The only difference this time? He’s no longer the guide. This is his journey.

FROM DOCTOR TO PATIENT

Dr. James Gray is a board-certified Radiation Oncologist and the Medical Director at Provision CARES Proton Therapy Nashville. His career includes work with the National Naval Medical Center and the National Cancer Institute. He began practicing radiation oncology in Nashville in the mid-1990s, including membership in Tennessee Oncology, one of the largest privately-held physician groups in the country. He has established his reputation as a pioneer in the industry, performing many advanced procedures never-before-seen in the region.

Accomplishments and accolades, aside, it’s Dr. Gray’s passion and commitment to his patients that define him. He’s spent 30 years studying cancer and helping patients navigate the difficult path of fighting it.

“I get to work with patients in a time of dire need for them. They undergo a diagnosis of cancer, and this is terribly frightening for most people to accept and move forward,” says Dr. Gray. “Helping someone move through that. Counseling them. Making them understand their disease. That’s what brings joy to me – the actual effort of bringing this understanding to those patients and then bringing the best possible care to them. That drives me every day.”

Then, in 2019, he visited a physician to check out a minor health issue. During that visit, Dr. Gray underwent a PSA level screening. Much to his surprise, the levels came back slightly elevated – a possible indication of prostate cancer.

“I realized with that PSA level, I needed to pursue this, and I went to see another physician – an outstanding urologist – and he proceeded with a diagnostic work up. That led to some other lab tests, an examination and then a biopsy.”

Dr. Gray recalled the anxiety he felt during the days following the biopsy. “You’ve got to wait maybe 3 or 4 days to get the pathology results back. I got to live firsthand that trepidation – that worry of, ‘Oh gosh. I hope it’s not cancer.’”

Unfortunately, though, it was cancer. Prostate cancer.

“It put me in a unique position where I’ve actually counseled patients who’ve just gotten this news. I’ve counseled probably more patients in this setting than anybody else in the area. All of a sudden, I’m counseling myself. Now, I’m the patient.”

WEIGHING THE OPTIONS

After receiving the news of his cancer diagnosis, Dr. Gray says he had a 30-year head start on the typical patient. As an established Nashville oncologist, he already had a strong grasp on the answers to questions like, “What does this mean for my life?” and “Am I going to die from this?” However, it was still important for him to remain objective, gather information about the severity of his cancer, then step back and make a clear treatment decision.

The initial decision for most prostate cancer patients is to determine whether the cancer is actually worthy of treatment, or if it would be more appropriate to observe it through active surveillance. In Dr. Gray’s case, he felt the cancer was threatening enough to treat immediately.

The next big divide – the “fork in the road,” as Dr. Gray calls it – is to decide whether to remove the prostate surgically or treat the tumor with radiation therapy.

“For me, that was not a difficult decision,” he says. “Knowing what I know about the likelihood of getting rid of the disease and the likelihood of having any kind of consequences from the treatment itself, I knew pretty quickly that I wanted to have radiation.”

That led to his next decision – choosing a radiation therapy method. There are many options for prostate cancer patients, including traditional x-ray radiation, radioactive seed implants (brachytherapy) and proton therapy.

For Dr. Gray, this was another easy decision. “One of the key advantages of proton therapy is that we’re putting (radiation) into the tumor with as little unnecessary dose to other tissues as possible. That inherently reduces the possibility of side effects – fatigue, difficulty with urination or bowels in my circumstance. So statistically, I am convinced. I’ve seen the data. I know what I consider to be the best treatment for prostate cancer, in my particular setting, was a proton therapy treatment system.”

“And fortunately, I happen to work at a proton system.”

WORK-LIFE BALANCE

They say it’s important to have a good work-life balance in your career. In Dr. Gray’s case, those two worlds collided as soon as the radiation oncologist began his proton therapy treatment in Nashville.

“I could actually go to work every day and receive a treatment – close to six weeks of treatment – but I was just going to work. And for 20 or 30 minutes, I stepped into the patient role, had my treatment, then went back into the doctor role.”

Dr. Gray remembers the transition from doctor to patient being fairly easy, mainly because of the trust he had in the treatment itself, as well as the Provision CARES team performing the treatment.

“For a lot of patients, they have to slowly gain the trust in me as their physician. They have to gain the trust in the people that are going to do their treatment. They have to gain the trust in the technology,” notes Dr. Gray. “I didn’t have those misgivings. I knew that when I was being treated, very bright people were watching over the treatment and making sure it was done right. I know how competent, outstanding and professional those people are, so I didn’t have any qualms about that.”

In fact, Dr. Gray’s positive attitude during his treatment actually helped the other staff members deal with a situation in which their colleague, friend and mentor was battling cancer – and they happened to be the ones treating it.

“I’ve never been in that situation before where you’re treating someone that you know so closely,” remembers Justin Pigg, Radiation Therapy Manager at Provision Nashville. “But to Dr. Gray, he just wanted to be treated like any other patient. He wanted the patient experience.”

“He was really calm and really strong through it, and I think that helped everybody else be calm, as well,” says Valerie Bohannon, the proton center’s Patient Concierge.

That sense of calm among the team was critical, as just about everyone at Provision Nashville had some role in Dr. Gray’s treatment.

“It’s all the way from the top to the bottom,” Dr. Gray says. “Every member of this staff had something to do with making sure my treatment went well. They all wished me well. They all asked me how I was doing. They were genuinely concerned about this.”

And that concern – that culture of care – is what Provision is all about. Dr. Gray hears it from his patients all the time.

“They will tell me how impressed they are from the moment they walk in the door to the time they’re leaving the center. They felt like they’ve been enveloped in care. And I felt the exact same way. It was obvious to me that I was brought into that care – that love – that people wanted me to do well.”

WALKING IN THE PATIENT’S SHOES

Dr. Gray successfully completed proton therapy in January 2020, placing him in a rare category of radiation oncologists who’ve actually been through the very cancer treatment in which they specialize. He says the entire experience impacted the way he’ll approach his role as a doctor going forward.

“It was enlightening. Going through the treatment myself gave me quite a bit of a different perspective. It’s important for me to understand that my personal experience can be translated only some degree to my patients, but at least having a taste of it allowed me to understand a bit more how they see it – how they experience the whole treatment process.”

That “taste” of proton therapy, as he calls it, will now be another tool for a Nashville oncologist who is passionate about making this effective and successful treatment available to as many people as possible.

“Some people suggested I had to choose proton therapy because I work at a proton therapy center. No, not necessarily. I’m not going to compromise my own good health just to make a point in my professional career. I wanted to have the best outcome, and I genuinely believe my best outcome would be achieved through the use of proton therapy.”

And with 36 operating proton centers across the country, why did he choose to be treated at Provision CARES Proton Therapy Nashville? He says that was another easy decision.

“Why would I leave here when I know I’ve got great people here to treat me. I can get world class treatment by world class people just downstairs from my office. Why wouldn’t I take advantage of that?”

Dec

2019 Year in Review at Provision CARES Proton Therapy

Year in Review: 2019 at Provision CARES Proton Therapy

By Provision CARES Proton Therapy

Major milestones. Community outreach. Inspirational moments.

Those are some of the recurring themes we noticed as we looked back on the highlights of 2019 at Provision CARES Proton Therapy. It was a year marked by plenty of “firsts,” as well as a concerted effort to be an innovative leader in cancer treatment, and a commitment to our mission of making proton therapy more accessible to patients around the world.

Here are some of Provision’s key moments from 2019.

DR. LAVEY JOINS PROVISION
2019 started out with an exciting addition to our expert team of Board-Certified Radiation Oncologists, as Robert Lavey, MD, MPH joined Provision CARES Proton Therapy Knoxville. Dr. Lavey has vast experience in treating all types of cancers and is an internationally recognized expert in pediatric malignancies.

He is also passionate about serving and educating the community to decrease the chance of developing cancer, improve care and ease the journey during and after treatment. To read more about Dr. Lavey’s career, family and other interests, visit this blog post from January.

KNOXVILLE CELEBRATES 5^TH ANNIVERSARY
Our Knoxville center opened its doors to patients on January 20, 2014. Since then, we have treated nearly 3,000 patients from dozens of states and even a number of different countries. It’s taken just five years for the Knoxville campus to grow into a comprehensive cancer treatment location. In addition to the Proton Therapy Center, the campus is also home to services for oncology, surgery, immunotherapy, traditional radiation, clinical trials, health and fitness, physical therapy, imaging and more.

NATIONAL PROTON CONFERENCE
In March, Provision was proudly represented at the National Proton Conference in Miami. We strive to be experts in the industry so we can provide our patients with the highest level of treatment. This conference, hosted by the National Association for Proton Therapy (NAPT), is an excellent opportunity to learn about a wide range of topics, including clinical and business operations, patient advocacy, research and advances in proton therapy technology.

Not only did a number of Provision team members attend this event, they also made valuable contributions. Our speakers served on a number of panels and spoke at sessions on topics such as patient experience and proton therapy education.

CHIEF MEDICAL PHYSICIST SPEAKS AT CIRMS
In April, Our VP and Chief Medical Physicist, Niek Schreuder, traveled to Maryland to join a group of leading industry experts at the Council on Ionizing Radiation Measurements & Standards (CIRMS). The 27^th annual meeting of CIRMS focused on “Strengthening the Economy and Homeland Security with Radiation Measurements and Standards.” As a worldwide leader in his field, Mr. Schreuder had the opportunity to present a lecture on the Economics of Particle Therapy.

NASHVILLE TREATS 1^ST PATIENT WITH PRONOVA SC360 SYSTEM
On April 29, Provision CARES Proton Therapy Nashville successfully treated the first patient on its ProNova SC360 proton therapy system. This milestone established a new standard of excellence with the world’s smallest 360-degree superconducting compact gantry for protons.

The ProNova SC360 Proton Therapy System, manufactured at Provision’s ProNova Solutions in Maryville, Tenn., includes state-of-the-art features like pencil beam scanning and advanced imaging with cone-beam computer tomography (CBCT) for adaptive treatment, all in a compact design.

The size, cost and capabilities of the SC360 make it the smallest, most economical and most operationally flexible unit in the pipeline today. “This is a no-compromise solution,” said Terry Douglass, Chairman of Provision Healthcare. “It delivers not only reduced cost and compelling economics, but greater clinical capabilities than other proton therapy system suppliers.”

COMMUNITY RALLIES AROUND TEEN FIGHTING BRAIN CANCER
May marked an important graduation at our Knoxville center. Mason, a high school student from Cleveland, Tenn., rang the victory bell after completing proton therapy treatment for a rare form of brain cancer. It was incredible to see the support from the Chattanooga and Cleveland communities throughout Mason’s journey. His story was featured in the Cleveland Banner, on News Channel 9 and other radio stations and media outlets in the area.

In a post on the “Team Mason Strong” Facebook page, his mother said, “It is such a blessing that Provision Proton Radiation Therapy is in Knoxville. So thankful we get to do treatment so close to home.” To read more about Mason’s story and see why Provision is proud to be on #TeamMasonStrong, visit this blog post from May.

PROSTATE CANCER 101 LAUNCHES
As part of our community outreach efforts, Provision launched a free community information session called “Prostate Cancer 101: Understanding the Journey, Diagnosis, Treatment and Survival.” Ben Wilkinson, MD, FACRO, the Medical Director and Radiation Oncologist at Provision CARES Proton Therapy Knoxville, delivered presentations throughout the year about the latest developments in prostate cancer.

Community members who attended had the opportunity to visit our Knoxville center and learn about 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.

NASHVILLE CELEBRATES 100^TH PATIENT GRADUATION
Shortly after opening its second treatment room, Provision CARES Proton Therapy Nashville celebrated its 100^th patient graduation. Patients, ambassadors and staff gathered to watch James ring the victory bell. It was certainly a momentous occasion for our Nashville center!

FROM EMPLOYEE TO PATIENT: CASEY’S STORY
As a Care Coordinator at our Knoxville center, Casey spends her day at work talking with patients and answering their questions. However, she now has the unique perspective of being on the other side of those calls, as well.

Late in 2018, she was diagnosed with breast cancer for the second time in her life. After finishing her breast cancer treatment at Provision’s Knoxville Center earlier this year, Casey decided she wanted to share her story to help others navigate their cancer journey.

Being both a former patient and a Care Coordinator allowed Casey to write a blog series to help guide patients through diagnosis, treatment and recovery. Her story was also featured on WBIR’s Buddy Check 10 earlier this year. To read more about Casey’s story, visit these blog posts:

Surviving Breast Cancer (Part 1) – Learning she has cancer for a second time
Surviving Breast Cancer (Part 2) – Preparing for treatment
Surviving Breast Cancer (Part 3) – Starting treatment
Surviving Breast Cancer (Part 4) – Ringing the bell

A MONTH OF ‘FIRSTS’ FOR NASHVILLE
With the 360-degree gantry up and running, things really began to pick up at our Nashville center this summer, making July a month of milestones for the center. They treated their first breast cancer patient on July 9, followed by the first treatments of esophageal, lung and central nervous system cancer.

EDDIE CHECK BREAKS RECORD
Each year during Prostate Cancer Awareness Month, Provision partners with Nisus Corporation and Medic Regional Blood Center for Eddie Check, a two-day event offering free PSA screenings. In 2019, Eddie Check broke a record with 1,420 screenings. That’s more than 300 more than last year, and 140 more than the previous record!

In addition to the screenings, Medic received 845 blood donations over the two-day period, which is more than double their daily average. It was an amazing turn out and we’re proud to be a part of an effort in which more than 1,400 men took the potentially life-saving steps for early detection of prostate cancer.

PROVISION CARES PROTON THERAPY KANSAS CITY ANNOUNCED
In September, we announced another expansion to the Provision CARES Cancer Network with plans to develop a proton therapy center in Kansas City. Located in the Lenexa community, Provision CARES Proton Therapy Kansas City will serve patients in the surrounding region with advanced cancer care. Like Nashville, the Kansas City center will also use the ProNova SC360 Proton Therapy System to provide the most innovative treatment available.

ASTRO CONFERENCE
Our commitment to being leaders in the proton therapy field continued in September, as a group of Provision representatives traveled to Chicago for the 2019 American Society of Radiation Oncology (ASTRO) Annual Meeting. By participating in conferences like this, Provision is able to keep up with rapidly evolving technologies and methodologies of radiation therapy. The ASTRO meeting is also a great opportunity for global collaboration as we work to make proton therapy more accessible around the world.

NASHVILLE CELEBRATES 1^ST ANNIVERSARY
October marked one year since Provision CARES Proton Therapy Nashville treated its very first patient. Employees from our Nashville center gathered to celebrate the 1^st anniversary and give thanks for the team members, patients and families who helped make the first year a very fulfilling one. It was a journey founded on establishing new standards of excellence, curating Provision’s Culture of CARE and serving middle Tennesseans with the most advanced cancer care in the world.

AMBASSADORS REUNITE FOR HOMECOMING
One of the most exciting “firsts” of the year came in November, when dozens of Provision Ambassadors reunited at our first-ever Ambassador Homecoming. Provision graduates from eight different states joined us for a weekend that included a Homecoming Dinner Program, tours of our Knoxville center and ProNova Solutions, and plenty of free time to catch up with friends and staff members.

DEVELOPMENTAL MILESTONE FOR PROVISION CARES PROTON THERAPY ORLANDO
A crucial delivery was made in November, as Provision CARES Proton Therapy Orlando announced the arrival of its cyclotron. One of the key components to the proton therapy system, the cyclotron generates the protons that are used to destroy cancer cells. Upon delivery, the Provision team began the rigging and installation of the cyclotron into the new proton therapy center building.

This was a milestone event as we work to expand the Provision CARES Cancer Network and bring the latest advancement in proton therapy systems to central Florida.

DR. GRAY DELIVERS KEYNOTE SPEECH AT LUNG FORCE EXPO
We were honored to have the American Lung Association invite Dr. James Gray, Medical Director at Provision CARES Proton Therapy Nashville, to be the keynote speaker at this year’s LUNG FORCE Expo.

This annual event takes place during Lung Cancer Awareness Month. It was a great opportunity for Provision to help spread awareness of the latest trends, resources and research about radiation therapy for lung cancer.

As we reflect on the past year and remember all of these key moments, Provision is very excited to think about what lies ahead in 2020.

• Milestone events such as Knoxville’s 5^th anniversary, Nashville’s 100^th graduation and Orlando’s cyclotron installation
• Inspiring moments like #TeamMasonStrong and Casey’s story
• Community outreach initiatives like Eddie Check and Prostate Cancer 101

We are confident these accomplishments, combined with our commitment to being innovative leaders in proton therapy and serving patients through our Culture of CARE, will help propel Provision into a brand new decade.

Dec

Casey rings the victory bell after completing cancer treatment at Provision CARES Proton Therapy Knoxville

Surviving Breast Cancer (Part 4)

By Provision CARES Proton Therapy

Casey’s Story: Ringing the Bell

Casey is a two-time breast cancer survivor who is sharing her experience during her proton therapy treatments at Provision CARES Proton Therapy Knoxville. Catch up on her story first by reading parts one, two and three of her blog series.

There is something about ringing that bell at Provision CARES Proton Therapy Center.

After my final radiation therapy treatment, my friends, family and co-workers gathered around me as I rang the bell three times, symbolizing an end to treatment and a new beginning to a cancer-free life.

Victory. Celebration. Gratefulness.

It takes time to actually realize that the most difficult journey in my life is really going to be over soon and it will be time to be well again. I remember my brother Pete telling me at this exact time last year, “Winter never lasts forever and Spring never skips its turn.” I thought about his words every single day.

Something very valuable I learned during my journey: choose your providers very carefully. Do your research in every way possible. As a Care Coordinator, I would always tell a prospective patient that they owed it to themselves to learn about and evaluate several treatment facilities before choosing where they would receive their care. This thought process served me well during every step of my journey.

Without the care of Dr. Brig and his amazing staff at Brig Center for Cancer Care, my surgeon Dr. Danielle Duchini and the entire staff at Provision CARES Proton Therapy, I would not be where I am today. I am well on my way to health and wellness and beating breast cancer.

I will be forever grateful to so many people and hope to pay it forward for as long as I can.

Provision CARES Proton Therapy would like to thank Casey for sharing her story. Please visit our website to learn more about the benefits of proton therapy for breast cancer and read other patient success stories.

Dec

Benefits of proton therapy for liver cancer

Liver cancer patients may benefit from advantages of proton therapy

By Provision CARES Proton Therapy

Proton radiation therapy can improve the overall survival rate for liver cancer patients, according to a new study. The good news for proton advocates comes on the heels of another study identifying predictors to help reduce liver damage from radiation, which could give doctors better insight when determining a patient’s treatment plan.

In a news release from the American Society for Radiation Oncology (ASTRO), Laura Dawson, MD, President-elect of ASTRO and a professor of radiation oncology at the Princess Margaret Cancer Center in Toronto, remarked on the promise this shows for patients with hepatocellular carcinoma, an often fatal type of liver cancer. “There is hope for patients with liver cancer, with more treatments becoming available in recent years,” said Dawson. “These studies show that protons, like photons, may be used to treat patients with HCC with a high rate of tumor control and a reduced risk of adverse effects.”

About Liver Cancer

One of the largest organs in the body, the liver filters harmful substances from the blood, makes bile to help digest fats and stores sugar for energy.

In 2016, there were approximately 83,000 people living with liver cancer in the United States. While that makes it a relatively less common disease in the U.S., it is still the second leading cause of cancer death around the world. According to the National Cancer Institute, the 5-year survival rate is just 18.4%.¹ In comparison, more common cancers like breast (89.9%) and prostate (98%) have much higher survival rates.^2,3

The most common type of liver cancer is Hepatocellular carcinoma (HCC), a disease in which cancer cells form in the liver tissue. Treatment options for HCC include surgery, ablation therapy, immunotherapy, radiation therapy and others. While the American Cancer Society says surgery may be the best option to cure liver cancer, it’s not always possible. A partial hepatectomy, where the cancerous part of the liver is removed, might not be an option if the patient has other liver disease, like cirrhosis. A liver transplant is also difficult because it can take too long for a donor to become available.

“Surgery remains the gold standard,” noted Nina Sanford, MD and colleagues from Massachusetts General Hospital in Boston. “But donor livers are a scarce resource, and a large proportion of patients are either technically or medically inoperable.”

Traditional radiation therapy has had limited success historically, especially for patients with liver damage from hepatitis or cirrhosis. One of the most serious side effects is radiation-induced liver disease (RILD), which can be fatal. Since proton therapy avoids unnecessary radiation to healthy liver tissues, new research suggests it may reduce the risk of RILD.

Study 1: Protons vs. Photons for Liver Cancer

A clinical investigation spearheaded by Sanford and colleagues at Massachusetts General studied proton versus photon radiation therapy for HCC patients who were not candidates for surgery.

“In the United States, patients with HCC tend to have underlying liver disease, which could both preclude them from surgery and make radiation therapy more challenging as well. So, having therapy option that is less toxic could potentially help many patients,” said Dr. Sanford. The study’s authors also noted, “Although dosimetric studies have demonstrated a theoretical advantage using proton therapy,^4,5 there have been no clinical studies. We sought to compare outcomes of patients treated for HCC with either modality.”

Researchers followed 133 patients who were treated from 2008 to 2017. The average overall survival for those treated with proton therapy was 31 months, compared to just 14 months for patients treated by traditional radiation. After two years, the overall survival rate for proton patients was 59%, while traditional radiation only had a 28.6% rate.

Not only did the study observe improved survival rates, they also noticed a decrease in non-classic radiation-induced liver disease. Patients receiving proton therapy had a 26% lower risk of RILD, as compared with photon radiation (odds ratio, 0.26; P=.03;).⁶

Sanford and her colleagues concluded the improved overall survival time could be the result of lower occurrence of RILD, noting that their findings should lead to more research comparing proton and photon radiation for HCC.

“Proton radiation therapy delivers less radiation dose to normal tissues near the tumor, so for patients with HCC, this would mean less unwanted radiation dose impacting the part of the liver that isn’t being targeted,” said Dr. Sanford. “We believe this may lead to lower incidence of liver injury. Because many patients with HCC have underlying liver disease to begin with, it is possible that the lower rates of liver injury in the proton group are what translated to improved survival for those patients.”

Study 2: Identifying Predictors for Liver Damage

A second study sought to identify predictors that could help doctors determine proper proton radiation dosage, while minimizing the risk of RILD in patients with HCC. Led by Dr. Cheng-En Hsieh, MD and colleagues at Chang Gung Memorial Hospital in Taiwan and University of Texas MD Anderson Cancer Center in Houston, the study found that the ratio of unirradiated liver volume to standard liver volume is actually the most crucial RILD predictor. In other words, the volume of liver untouched by radiation is more important than the dose of radiation delivered.

“Our data indicate that if a sufficient volume of the liver is spared, ablative radiation can be safely delivered with minimal risk of RILD, regardless of dose,” said Dr. Hsieh.

This study looked at 136 patients with HCC and found a “volume-response” relationship between the liver radiation and RILD. Patients who had a higher volume of their liver exposed to radiation, regardless of dosage, had a higher risk of developing complications.

Identifying this predictor is significant because it allows doctors to better plan a patient’s treatment. Knowing how much of the liver will be exposed to radiation can help determine whether proton therapy is a good option. The study’s authors concluded that if a sufficient volume of the liver can be preserved, proton therapy is an effective treatment of locally advanced liver cancer and the risk of complications is minimal.

Personalizing Your Treatment

“Knowing which metrics predict a greater risk for liver damage can help guide radiation oncologists in determining how to balance the benefits and risks of treatment,” said ASTRO’s Dr. Dawson, stressing that both of these studies highlight the need for a personalized radiation therapy plan when treating liver cancer. “There is rationale for the use of protons for some patients, but the evidence to date is not sufficient for a general recommendation of protons above photon therapy for all HCC patients.”

At Provision CARES, patients will always receive personalized treatment. Our Cancer Care Experts can talk to you about your specific diagnosis and schedule you for a consultation with one of our Board-Certified Radiation Oncologists. Once it’s determined whether proton therapy is right for you, our team of radiation therapists, medical physicists, dosimetrists, oncologists and others will formulate an individual treatment plan designed to destroy the cancer cells, avoid unnecessary radiation to nearby healthy tissue and organs, and minimize the risk of side effects.

Sources

Cancer Stat Facts: Liver and Intraheptic Bile Duct Cancer. National Cancer Institute. Read More
Cancer Stat Facts: Female Breast Cancer. National Cancer Institute. Read More
Cancer State Facts: Prostate Cancer. National Cancer Institute. Read More
Gandhi SJ, Liang X, Ding X, et al. Clinical decision tool for optimal delivery of liver stereotactic body radiation therapy: Photons versus protons. Pract Radiat Oncol 2015;5:209-218.
Wang X, Krishnan S, Zhang X, et al. Proton radiotherapy for liver tumors: Dosimetric advantages over photon plans. Med Dosim 2008; 33:259-267.
Protons versus Photons for Unresectable Hepatocellular Carcinoma: Liver Decompensation and Overall Surival. International Journal of Radiation Oncology. Read More
Predictors of Radiation-Induced Liver Disease in Eastern and Western Patients with Hepatocellular Carcinoma Undergoing Proton Beam Therapy. International Journal of Radiation Oncology. Read More

Nov

Lung Cancer awareness efforts focus on smoking prevention

By Provision CARES Proton Therapy

Lung Cancer Awareness Month is dedicated to educating the public about the prevalence of the disease in the United States, and providing resources on prevention, screening and treatment.

According to the American Cancer Society (ACS), lung cancer will kill more than 140,000 people in 2019, making it by far the leading cause of cancer death among both men and women. It is the second most common cancer in both men and women (not counting skin cancer). For men, prostate cancer is the only cancer more common, while in women breast cancer is more common.

Smoking is the leading cause of lung cancer. The ACS reports 80% of lung cancer deaths are caused by smoking.¹ However, non-smokers can also develop the disease. This could be caused by exposure to radon, secondhand smoke, air pollution, asbestos, diesel exhaust or other chemicals.

PREVENTION IS KEY

With such a high percentage of lung cancer cases linked to smoking, efforts to reduce the prevalence of the disease are largely focused on kicking the tobacco habit.

“Smoking continues to be the #1 most preventable cause of death and disease in the U.S.,” says Kerri Thompson, Public Health Educator for the Knox County Health Department (KCHD) in Knoxville, Tenn. “It kills so many people and it’s something that can be prevented.”

Thompson spearheads KCHD’s tobacco prevention programs, which focus on three main areas: Youth Prevention, Secondhand Smoke Reduction and Smoking Cessation (quitting). Through educational programs designed to teach children about the dangers of smoking, KCHD hopes to dramatically reduce tobacco product usage in our next generation.

“We’re trying to change the trajectory so, hopefully, we can have an impact on lung cancer,” Thompson notes. “Having (our youth) not use tobacco or not be addicted to nicotine in the first place is really key to addressing the huge impact that smoking has on society.”

Knox County’s programs aimed at youth education actually have a trickle-down effect, impacting its Secondhand Smoke Reduction and Smoking Cessation efforts, as well. Children tend to share resources they receive in school with their parents in hopes they will then try to quit. One of these resources is the Tennessee Tobacco Quitline. This is a free service that offers personalized support from counselors who are trained to help you kick the habit. More resources to help you quit smoking can be found at Smokefree.gov.

When it comes to quitting, Thompson says relapse is common, so persistence is very important. “When someone quits smoking, on average it takes seven to 10 times for someone to quit for good. Many people think since they’ve been smoking for years, the damage is already done, so what’s the point in quitting.” However, if there’s one thing she hopes people take away from Knox County’s education and prevention efforts, it’s this – “It’s never too late to quit.”

LUNG CANCER SCREENING CAN SAVE LIVES

According to the National Cancer Institute (NCI), risk factors for lung cancer include tobacco use, secondhand smoke, family history, HIV infection and environmental risks like exposure to asbestos, radon or other substances. If you believe you may be at risk for lung cancer, you should start by speaking to your doctor. A general practitioner can perform an assessment, then offer advice for your next step. This could be a referral to a pulmonologist or oncologist, or a prescription for nicotine replacement therapy. Since early detection is so important, at-risk individuals may also benefit from a lung cancer screening.

The NCI says the most effective type of screening is a low-dose spiral Computed Tomography (CT) scan. In its National Lung Screening Trial, the NCI studied people between 55 and 74 years old who had smoked at least one pack of cigarettes a day for 30 years or more. They compared low-dose spiral CT scans with another type of screening, chest x-rays. Researchers observed a 20% lower risk of dying from lung cancer in people who received low-dose spiral CT scan screenings.²

Fortunately, there are resources available to help people get screened. The American Lung Association (ALA) offers an online quiz to help you determine whether you are at risk. The ALA can also help you find information about insurance coverage and screening facilities near you.

In an effort to make lung cancer screenings more accessible, CHI Memorial Hospital in Chattanooga, Tenn. brings low-dose CT scans into the community with its Breathe Easy mobile lung CT coach. The bus serves counties from three different states in the Southeast.

PROTON THERAPY AS A TREATMENT

Given the serious prognosis of lung cancer, it’s important to evaluate all your treatment options before making any decisions. Treatment for lung cancer is based mainly on the type (non-small cell vs. small cell) and the stage of the cancer. Other factors like a person’s health and lung function should also be considered. Treatment options may include surgery, chemotherapy and radiation therapy.

Doctors and scientists have been studying the results of proton therapy in the treatment of non-small cell lung cancer (NSCLC). One study in particular showed that patients with Stage 3 NSCLC who were treated with proton therapy experienced lower rates of lung and esophagus inflammation compared to patients treated with traditional (x-ray/IMRT) radiation.³

Proton therapy for lung cancer treatment is non-invasive and usually painless. Physicians provide doses of radiation to specific areas, controlling the depth of the protons emitted and reducing the impact on the surrounding tissue. Provision CARES Proton Therapy uses a technique known as pencil beam scanning, which provides precise dose of radiation to targeted areas, resulting in a decreased risk of side effects. Proton therapy decreases the risk of damage to healthy tissue and organs surrounding the cancer. This is because the unique physical properties of protons allow the radiation dose to better conform to your cancer, avoiding unnecessary radiation to nearby areas. This is especially important for lung cancer treatment because the tumor may be close to your heart, healthy lung and other critical organs.

Since each cancer diagnosis is unique, we encourage anyone seeking treatment options to speak with one of our Cancer Care Experts to see if proton therapy is right for you.

Sources

American Cancer Society. What Causes Lung Cancer? Read More
National Cancer Institute. National Lung Screening Trial. Read More
National Cancer Database Analysis of Proton Versus Photon Radiaion Therapy in NSCLC. Read More
American Cancer Society. Key Statistics for Lung Cancer. Read More
Proton Beam Radiotherapy and Concurrent Chemotherapy for Unresectable Stage III Non–Small Cell Lung Cancer Final Results of a Phase 2 Study. Read More
High-dose hypofractionated proton beam radiation therapy is safe and effective for central and peripheral early-stage non-small cell lung cancer: results of a 12-year experience at Loma Linda University Medical Center. Fractionation 10 for PBT vs 6-8 weeks for IMRT. Read More

Nov

Provision CARES Proton Therapy Orlando announces arrival of cyclotron in Hamlin development

By Provision CARES Proton Therapy

WINTER GARDEN, Fla. — Provision CARES Proton Therapy Orlando is under construction in the Hamlin development in Southwest Orange County. The center will offer one of the most promising new cancer therapies available, proton therapy; and will utilize the latest advancement in proton therapy systems, the ProNova SC360 manufactured by ProNova Solutions, LLC located in Maryville, Tennessee.

On Wednesday, November 20, one of the key components of the proton therapy system, the cyclotron, will travel from Cape Canaveral to Hamlin on a flatbed truck along a FDOT pre-approved route. The cyclotron travel time is expected to take approximately four hours before arrival at Hamlin. The cyclotron generates the proton beam that is used to treat patients through the ProNova SC360 system. Delivery of the cyclotron is a milestone event in the construction of the proton therapy treatment center.

Once the cyclotron has arrived at the proton center, the Provision team, which includes personnel from ProNova Solutions, Sumitomo Heavy Industries, Ltd., Barnhart Crane & Rigging Co., will then begin the rigging and installation of the cyclotron into the new proton therapy center building. Following installation of the cyclotron, installation, testing and commissioning of the ProNova SC360 will continue as the proton therapy center building is completed.

The cyclotron accelerates a proton beam that is incorporated into the ProNova SC360 delivery system and then used to deliver this advanced cancer treatment. This treatment provides a means to treat the cancer and spare the patient with fewer side effects.

The Provision CARES Proton Center is located in the 17-acre Provision CARES Cancer Center in Hamlin and is a member of the Provision CARES Cancer Network. Provision CARES Cancer Centers with Proton Therapy are also located in Knoxville, TN, Nashville, TN and recently announced Kansas City, KS, where all Provision centers provide comprehensive and integrated diagnostic and therapy services for all patients and all physicians who need those services.

Provision’s leadership team, cancer center partners, and media will be viewing the cyclotron delivery from the construction site at 15775 New Independence Parkway, Winter Garden, Florida.

ABOUT PROTON THERAPY

Proton therapy is an advanced form of radiation therapy that uses a single beam of high-energy protons to treat various forms of cancer. Proton therapy treats tumors by directing protons into the tumor site destroying cancerous cells. Unlike with other forms of radiation, radiation oncologists can control both the dose and range of protons, which allows the maximum deposition of energy into the tumor. This reduces damage to nearby healthy tissue and limits negative side effects. Proton treatment can be combined with chemotherapy and biological treatments, depending on the cancer type, to provide better outcomes with less tissue damage. According to the National Association of Proton Therapy, there are currently 35 proton therapy centers in operation.

ABOUT PROVISION’S PRONOVA SYSTEM

An affiliate of Provision Healthcare, ProNova Solutions, LLC is committed to making proton therapy accessible to a greater number of patients and physicians worldwide. ProNova was founded by former leaders of CTI Molecular Imaging, which brought positron emission tomography (PET) technology out of the laboratory and made it a clinical reality for millions of cancer patients. Today the same team is redefining cancer treatment once again with the introduction of the first and only superconducting 360-degree compact proton therapy system. It is the only proton therapy system developed in a clinical setting, benefitting from continuous input from physicians, medical physicists, and therapists during design and development. The system includes state-of-the-art features such as pencil beam scanning and advanced imaging with cone-beam CT, all in a compact design.

ABOUT PROVISION HEALTHCARE

Provision Healthcare, LLC was formed in 2005 with the purpose of developing innovative healthcare solutions focused on improving patient care and clinical outcomes and developing support for research, educational and charitable causes. Provision has developed a unique, comprehensive expertise in proton therapy including Provision’s patient focused “Culture of Care” that distinguishes Provision from other proton and cancer center developers and operators that have a much narrower focus. The combination of unique expertise and an innovative, entrepreneurial approach continues to propel Provision towards a position of industry leadership with respect to both cancer care and proton therapy.

Nov

National Radiologic Technology Week honors radiation therapy and medical imaging professionals..

How Radiation Therapy and Medical Imaging help shape cancer patient experience

By Provision CARES Proton Therapy

Every year in early November, the American Society of Radiologic Technologists (ASRT) celebrates National Radiologic Technology Week. It’s an opportunity to recognize the crucial role that medical imaging and radiation therapy professionals play in patient care and safety. The celebration takes place during the week of November 8, which is the day Wilhelm Conrad Roentgen discovered the x-ray in 1895.

The Radiologic Technologists (R.T.s) at Provision CARES Proton Therapy are an integral part of our team. They are educated in anatomy, patient positioning, examination techniques and radiation safety, allowing them to perform highly skilled and precise procedures. Most importantly, though, they are on the frontlines of caregiving during treatment. All of our R.T.s are passionate about Provision’s Culture of CARE, putting the patient’s comfort, safety and overall experience first.

To show our appreciation for the Radiologic Technology (Rad Tech) staff at Provision, we’re taking a closer look at the industry to which they’ve devoted their lives, and how their jobs help shape the cancer patient experience.

WHAT IS RADIOLOGIC TECHNOLOGY?

Following Roentgen’s discovery, the x-ray gained popularity as a way to diagnose and treat illness in the early 1900s. The x-ray machine remained the primary tool of medical imaging until the 1960s and 1970s, when newer procedures like computed tomography, mammography and sonography became commonplace in the healthcare industry¹. The x-ray is also a traditional tool used for radiation therapy to treat cancer. In the 1950s, however, proton radiation therapy for cancer treatment was introduced. Since then, studies have shown proton therapy avoids unnecessary radiation to nearby healthy tissue and organs, reducing the risk of side effects². There are now more than 30 proton therapy centers in the United States.

Modern Radiologic Technology covers two main areas – medical imaging and radiation therapy. According to the ASRT, there are several practices in which an R.T. can specialize, including general radiography, computed tomography (CT), mammography, magnetic resonance imaging (MRI), radiation therapy and others.

In the medical imaging field, an R.T. is responsible for making sure the patient is properly positioned for a quality diagnostic image. Rad Techs in medical imaging are typically specialists, like Radiographers, Mammographers, Sonographers, MRI techs or CT Techs.

A Radiologic Technologist may also choose the radiation therapy path. Radiation Therapy is the administration of targeted doses of radiation to a patient’s body to treat cancer or other diseases. In this case, an R.T. would be a member of the Radiation Oncology team and could work as a Medical Dosimetrist or Radiation Therapist.

RADIOLOGIC TECHNOLOGY AT PROVISION

Radiologic Technology is part of the patient experience from diagnosis all the way through treatment and the cancer care experts at Provision can help coordinate each step of the process. Of course, radiation therapy is at the heart of what we do – treating cancer with proton therapy – and we are proud of the work our Radiation Therapists do and the passion they show for everyone who walks through our doors. Along the course of your treatment, you may also meet MRI Techs, CT Techs, Medical Dosimetrists and other radiologic specialists.

All of these Radiologic Technology roles are highly specialized and require quality education and experience. Most importantly, though, each of our R.T.s believes in Provision’s Culture of CARE. It is our mission to respect the dignity and value of every person by providing an environment of compassion, sensitivity and thoughtful consideration.

The Rad Tech staff at Provision is also dedicated to increasing awareness about the benefits of proton radiation therapy. In fact, the ASRT Foundation recently recognized Justin Pigg, Manager of Radiation Therapy at Provision CARES Proton Therapy Nashville, with its International Speakers Exchange Award for his efforts to promote the sharing of research, best practices and professional development in the radiologic sciences. As a recipient of this award, Pigg presented “Technical Aspects of Proton Therapy” at a Radiologic Technology conference in Nova Scotia.

THE BENEFITS OF PROTON RADIATION THERAPY

Proton therapy for cancer treatment has become a trusted method for precisely targeting tumors and reducing the risk of side effects. The advantage of proton therapy is distinct from traditional radiation therapy because the timing and dosage of proton energy can be specifically controlled. Since a proton beam can conform to a tumor’s shape and size, maximum beam energy is deposited directly into the tumor, decreasing the risk of damage to surrounding tissue and organs. Protons have unique characteristics that prevent radiation from traveling beyond the tumor. Contrastingly, traditional radiation therapy deposits energy from x-ray beams along the entire path of the beam. Radiation is absorbed from the time the beam enters the body until it exits on the other side of the tumor area.

Provision CARES Proton Therapy uses the most precise form of proton therapy, called pencil beam scanning. Pencil beam scanning provides even greater customization and precision in cancer treatment. Physicians use a proton beam only millimeters wide to target the tumor area with the highest radiation dose, while controlling both the depth and the position of the beam and planning the exact point at which the proton beam stops inside the body. This means there will be no exit dose, sparing even more healthy tissue and organs from unnecessary radiation.

Proton therapy is beneficial for treating patients with a localized tumor where cancer has not spread to other parts of the body, or in situations where tumors cannot be removed with surgery. It may also be an option if a patient requires radiation therapy in addition to surgery or chemotherapy. We encourage you to speak with one of cancer care experts to find out if proton therapy is right for you.

Ultimately, Provision CARES Proton Therapy is passionate about caring for anyone who is fighting cancer. In honor of National Radiologic Technology Week, thank you to all of our Rad Techs who help us live up to that mission.

Sources:

American Society of Radiologic Technologists. History of the American Society of Radiologic Technologists. https://www.asrt.org/main/about-asrt/asrt-history
Baumann BC, Mitra N, Harton JG, Xiao Y, Wojcieszynski AP, Gabriel PE, Zhong H, Geng H, Doucette A, Wei J, O’Dwyer PJ, Bekelman JE, Metz JM. Comparative effectiveness of proton therapy versus photon therapy as part of concurrent chemo-radiotherapy for locally advanced cancer. American Society of Clinical Oncology poster session. June 1, 2019.

Oct

Breast Cancer Facts: 5 Common Myths Debunked

By Provision CARES Proton Therapy

One of the toughest parts about researching breast cancer online is trying to sort fact from fiction. The internet is full of half-truths, conflicting reports and flat-out myths about the disease. Provision CARES Proton Therapy is committed to our Culture of CARE, putting the patient experience first. So, for Breast Cancer Awareness Month, we’re debunking five of our most commonly heard myths. All of these breast cancer facts have been verified for quality and accuracy by our cancer care experts to help you make an informed decision about your healthcare.

MYTH: I found a lump in my breast, so I have cancer.

TRUTH: Lumps don’t always indicate cancer. Likewise, the absence of lumps doesn’t always mean you don’t have breast cancer.

While the most common symptom of breast cancer is a lump, most breast lumps are caused by conditions other than cancer. According to the Centers for Disease Control and Prevention (CDC), the two most common causes are fibrocystic breast condition and cysts. Fibrocystic condition causes noncancerous changes in the breast that can make them lumpy, while cysts are small fluid-filled sacs that develop in the breast.

The American Cancer Society (ACS) says lumps are more likely to be cancerous if they are painless, hard and have irregular edges. However, some breast cancers can be painful, soft or round. That’s why you should always check with your doctor if you notice any changes in your breasts.

There are many other symptoms of breast cancer, even if a lump is not detected. These can include swelling of the breast, skin dimpling, breast or nipple pain, nipples turning inward, red or flaking breast skin, nipples discharging fluids other than breast milk, and swollen lymph nodes under your arm or around your collar bone. The ACS recommends contacting your doctor if you experience any of these symptoms.

MYTH: Breast cancer only happens to older women.

TRUTH: Breast cancer can develop in younger women, too, as well as men.

While your risk does increase with age, the NCI reports women in their 30s have a 1 in 208 chance of developing breast cancer. By the time a woman reaches her 40s, that risk has increased to 1 in 65. Overall, it’s estimated that 1 out of every 8 women in the United States will develop breast cancer at some point in her life.⁷

Breast cancer in men accounts for less than 1% of cases in the United States. However, the ACS says male breast cancer is on the rise.¹ Unfortunately, a higher percentage of men are diagnosed with advanced-stage breast cancer, likely a result of less awareness and fewer early-detection screenings.

If you’ve been diagnosed with breast cancer and would like to learn more about proton therapy as a possible treatment, please visit our Proton Benefits page or contact a Care Coordinator.

MYTH: My family has no history of breast cancer, so I am not at risk.

TRUTH: While a family history of breast cancer does put you at greater risk, most women who develop breast cancer do not have a family history of the disease.¹

According to the CDC, a family history of breast cancer may put you at higher risk for the disease, but is not indicative of whether you’ll actually develop cancer.² In fact, the ACS says most women with one or more affected first-degree relatives (parents, siblings, children) will still never be diagnosed.

The CDC provides a table with examples of average, moderate and strong family health histories, along with suggestions for preventative measures each group can take. Regardless of your family history, the CDC recommends you get mammograms and other breast exams as recommended by your doctor, maintain a healthy weight and exercise regularly. As family history of breast cancer increases, genetic counseling becomes an option to test for hereditary breast cancer. Be sure to talk to your doctor about what screenings are best for you and when you should get them.

MYTH: A double mastectomy will eliminate my risk of breast cancer.

TRUTH: If the cancer is detected early enough, other treatment options can eliminate the cancer without removing the entire breast.

A mastectomy involves removing the entire breast and is typically performed when breast-conserving surgery (lumpectomy) is not an option. However, women with early-stage cancers can typically choose between the two types of surgeries. The ACS notes that while it’s normal for your gut reaction to be to “take out all the cancer as quickly as possible” with a mastectomy, the fact is that, most of the time, a lumpectomy combined with radiation therapy results in the same outcome.

Many patients at Provision CARES Proton Therapy choose to combine a lumpectomy with proton radiation therapy. Proton therapy for breast cancer treatment is non-invasive and painless, causing less cosmetic damage than conventional x-ray radiation. It is extremely precise and therefore more effective at targeting cancerous cells without causing damage to surrounding breast tissue. Because proton radiation has little to no impact on a patient’s energy level, quality of life during treatment is improved.

For women who do opt for a mastectomy, it’s important to remember that post-surgery treatment is still necessary. Even after removing the breast, there’s a small chance the cancer could recur on residual breast tissue or the chest wall. You should continue to perform self-breast exams and see your doctor on a regular basis.

MYTH: Antiperspirants and wire bras can cause breast cancer.

TRUTH: There has been no conclusive evidence linking antiperspirants or bras to breast cancer.

Rumors have swirled across the internet claiming underarm antiperspirants cause breast cancer. The National Cancer Institute (NCI) says the basis of these claims is the aluminum-based active ingredient in antiperspirants. Some scientists have suggested that absorbing these aluminum compounds into your skin could increase your risk factor for breast cancer.⁴ Still, no clear link has ever been established between antiperspirants and breast cancer. In fact, the NCI even cites a study from 2002 that concluded there is no increase in risk for breast cancer among women who reported using an underarm antiperspirant.³

Another rumor making its rounds across cyberspace is that wearing a wire bra can increase your risk of breast cancer. This myth was debunked by a 2014 study published by the American Association for Cancer Research. According to the authors, it had been suggested in the media that bras impede lymph circulation and drainage, interfering with the process of waste and toxin removal.⁶ However, the study concluded that wearing a bra had no effect on your risk of breast cancer.

Sources:

Breast Cancer Facts & Figures 2017-2018. American Cancer Society. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf
Breast and Ovarian Cancer and Family History Risk Categories. Centers for Disease Control and Prevention. https://www.cdc.gov/genomics/disease/breast_ovarian_cancer/risk_categories.htm
National Cancer Institute. Antiperspirants/Deodorants and Breast Cancer. https://www.cancer.org/cancer/cancer-causes/antiperspirants-and-breast-cancer-risk.html
Darbre PD. Aluminium, antiperspirants and breast cancer.Journal of Inorganic Biochemistry 2005; 99(9):1912–1919. [PubMed Abstract]
Mirick DK, Davis S, Thomas DB. Antiperspirant use and the risk of breast cancer.Journal of the National Cancer Institute 2002; 94(20):1578–1580. [PubMed Abstract]
RayCC. Q and A – Bras and Cancer [Internet]. NY times; 2010 [cited 2013 Dec. 16]. Available from: http://www.nytimes.com/2010/02/16/science/16qna.html?ref=science.
Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975-2016, National Cancer Institute. Bethesda, MD,https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site, April 2019.

Oct

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

By Provision CARES Proton Therapy

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 organs^3,4. 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:

Phase II Study of Proton Beam Radiation Therapy for Patients with Breast Cancer Requiring Nodal Irradiation. Journal of Medical Oncology
Pragmatic Randomized Trial of Proton vs. Photon Therapy for Patients with Non-Metastatic Breast Cancer: A Radiotherapy Comparative Effectiveness (RADCOMP) Consortium Trial. ClinicalTrials.gov
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
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.
Early Toxicity in Patients Treated with Postoperative Proton Therapy for Locally Advanced Breast Cancer. U.S. National Library of Medicine, National Institutes of Health