Proton therapy cancer treatment significantly lowers the risk of second cancer compared to IMRT and 3DCRT

Proton Therapy significantly lowers your risk of second cancer

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X-ray (also called photon) therapy has long been known to cause the development of potentially deadly new cancers in patients who undergo radiation therapy to treat their cancer. However, research shows that patients who choose proton therapy for cancer treatment have a significantly lower risk of developing a second cancer later in life. In a  comprehensive study published last month in Cancer, the prestigious, peer-reviewed journal of the American Cancer Society, researchers at Stanford University found that patients who were treated with x-ray therapy developed more than three times as many new cancers as patients treated with proton therapy.1

ABOUT THE STUDY

The study was conducted by Stanford University physicians Michael Xiang, MD, PhD; Daniel T. Chang, MD; and Erqi L. Pollom, MD, MS. Their research team conducted a retrospective cohort study using the National Cancer Database (NDCB), the most comprehensive cancer registry in the United States.

The study included over 450,000 patients of all ages with a variety of cancers, such as:

  • Prostate
  • Head and neck
  • Breast
  • Gastrointestinal
  • Gynecologic
  • Lymphoma
  • Lung (non-small cell)
  • Bone/soft tissue
  • Brain/central nervous system

Patients included in the study were treated with intensity-modulated radiation therapy (IMRT), 3-dimensional conformal radiation therapy (3DCRT), or proton therapy between 2004 and 2015. They were followed for a minimum of 2 years and an average of 5 years after receiving radiation therapy.

RESULTS HEAVILY FAVOR PROTON THERAPY

Compared to proton therapy, the incidence of second cancers was 3.5 times higher after IMRT and 3.6 times higher after 3DCRT, the two most common forms of x-ray radiation therapy. These differences were found to be highly significant. Proton therapy decreased the overall risk of developing a second cancer by over two-thirds (69%) compared to IMRT. In fact, proton therapy reduced the occurrence of second cancer for eight of the nine types of cancer most commonly treated with radiation therapy.

Compared to IMRT, proton therapy substantially reduced the risk of developing a second cancer for most disease sites, including:

  • 82% reduction among prostate cancer patients
  • 58% reduction among head and neck cancer patients
  • 38% reduction among breast cancer patients with at least five years of follow-up
  • 69% reduction among all cancer patients

“These findings show the extraordinary benefits of proton therapy when it comes to reducing the risk of second cancers, confirming the results of prior modeling studies,” says Mike Sommi, President of Provision CARES Proton Therapy Knoxville. “The data powerfully bears out the theories regarding the benefits of proton therapy in terms of reducing the risk of second cancers.”

The dramatic reduction in risk of second cancers is likely due to to the fact that protons concentrate their radiation delivery within the cancer much better than x-rays. Patients treated with x-rays absorb 2-3 times more radiation in their bodies than patients treated with protons.4-6 The excess radiation from x-rays can severely damage and mutate healthy cells, resulting in serious toxicities, including causing a new cancer.

Proton therapy cancer treatment reduces your risk of developing a second cancer, compared to x-ray/IMRT.

STUDY CONFIRMS PRIOR RESEARCH

The Stanford study confirms the findings of a previously published study from Harvard using the other main American cancer registry, the Surveillance, Epidemiology, and End Results (SEER) Program. The Harvard study found the second cancer rate to be 48% lower after proton therapy, compared to x-ray treatment. The average follow-up period in the Harvard study was 6 years after radiation therapy. 18

The Harvard study noted that while proton therapy reduced second cancers in all age groups, protons may be particularly beneficial for young patients, who have decades to accumulate radiation-induced cancers. In children, for example, x-ray therapy is estimated to increase second cancers by 600-1,000%.19-21

“As time passes and the follow-up period for these patients lengthens, the benefits of proton therapy will become even more pronounced,” Sommi agrees. “This is especially important for patients who expect to survive 10 years or more.”

OTHER BENEFITS OF PROTON THERAPY FOR CANCER TREATMENT

The results of this study highlight yet another clinically-proven benefit of proton therapy for cancer treatment. Because proton therapy precisely targets the tumor and avoids unnecessary radiation to nearby healthy tissue and organs, patients have a lower risk of short-term and long-term side effects.

Depending on cancer type, other benefits of proton therapy include:

Prostate Cancer

  • 25% lower risk of erectile dysfunction7
  • 35% less radiation to bladder8
  • 59% less radiation to rectum8

Head, Neck and Oral Cancer

  • 27% reduction in overall risk of needing a feeding tube for oropharyngeal cancer9
  • 45% reduction in overall risk of needing a feeding tube for nasopharyngeal cancer10
  • Dramatic reduction of negative impact on taste, nausea and painful changes to the mouth in salivary gland treatment11

Breast Cancer

  • 88% less radiation to the heart for left-sided breast cancer9,10
  • 44% reduction in clinically significant radiation doses to the lung10
  • 90% of partial breast irradiation cases result in good to excellent cosmetic outcomes at 5 years11

Brain and Spine Cancer

  • 31% increase in disease control for aggressive tumors at base of skull (chordomas) at 5 years12
  • 50% less likely to have secondary brain tumor from treatment13
  • 55% reduction in average dose to the hippocampi (memory function) in treatment of meningioma14

Esophageal

  • 26% reduction in lung toxicity compared with IMRT15
  • 21% reduction in the risk of severe, treatment-related lymphopenia, particularly in lower esophagus16
  • 3-4 day reduction in average hospital stay after surgery17

To learn about other cancers that can be treated with proton therapy, and to read about the benefits of proton therapy for those cancers, visit our Cancers We Treat page.


Sources & Studies

  1. Xiang M, Chang DT, Pollom EL. Second cancer risk after primary cancer treatment with three-dimensional conformal, intensity-modulated, or proton beam radiation therapy. Cancer. 2020;0:1-9.
  2. Journy NM, Morton LM< Kleinerman RA, Bekelman JE, Berrington de Gonzalez A. Second primary cancers after intensity-modulated vs 3-dimensional conformal radiation therapy for prostate cancer. JAMA Oncol. 2016;2:1368-1370.
  3. Diallo I, Haddy N, Adjadj E, et al. Frequency distribution of second solid cancer locations in relation to the irradiated volume among 115 patients treated for childhood cancer. Int J Radiat Oncol Biol Phys. 2009;74:876-883.
  4. Eaton BR, MacDonald SM, Yock TI, Tarbell NJ. Secondary malignancy risk following proton radiation therapy. Front Oncol. 2015;5:261.
  5. Chargari C, Goodman KA, Diallo I, et al. Risk of second cancers in the era of modern radiation therapy: does the risk/benefit analysis overcome theoretical models? Cancer Metastasis Rev. 2016;35:277-288.
  6. Hoppe BS, Flampouri S, Su Z, et al. Consolidative involved-node proton therapy for stage IA-IIIB mediastinal Hodgkin lymphoma: preliminary dosimetric outcomes from a phase II study. Int J Radiat Oncol Biol Phys. 2012;83:260-267.
  7. Comparative toxicity and cost of Intensity-Modulated Radiotherapy, Proton Radiation, and Stereotactic Body Radiotherapy Among Younger Men With Prostate Cancer. Read More
  8. Dose–Volume Comparison of Proton Therapy and Intensity-Modulated Radiotherapy for Prostate Cancer. Read More
  9. Gastrostomy Tubes Decrease by Over 50% With Intensity Modulated Proton Therapy (IMPT) During the Treatment of Oropharyngeal Cancer Patients. Read More
  10. Proton therapy reduces treatment-related toxicities for patients with nasopharyngeal cancer: a case-match control study of IMPT and IMRT. Read More
  11. Proton beam radiation therapy results in significantly reduced toxicity compared with intensity-modulated radiation therapy for head and neck tumors that require ipsilateral radiation. Read More
  12. Effectiveness and Safety of Spot Scanning Proton Radiation Therapy for Chordomas and Chondrosarcomas of the Skull Base: First Long-Term Report. Read More
  13. A comparison of critical structure dose and toxicity risks in patients with low grade gliomas treated with IMRT versus proton radiation therapy. Read More
  14. Projected second tumor risk and dose to neurocognitive structures after proton versus photon radiotherapy for benign meningioma. Read More
  15. A Multi-Institutional Analysis of Trimodality Therapy for Esophageal Cancer in Elderly Patients. Read More
  16. Lymphocyte-sparing Effect of proton therapy in patients with esophageal cancer treated with definitive chemoradiation. Read More
  17. Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer. Read More
  18. Chung CS, Yock TI, Nelson K, Xu Y, Keating NL, Tarbell NJ. Incidence of second malignancies among patients treated with proton versus photon radiation. Int J Radiat Oncol Biol Phys. 2013 Sep 1;87(1):46-52. doin: 10.1016/j.ijrobp.2013.04.030. Pub 2013 Jun 15.
  19. Curtis RE, Freedman DM, Roe E, et al. eds. New malignancies among cancer survivors: SEER Cancer Registries, 1973-2000. NIH Publ. No. 05-5302. National Cancer Institute; 2006.
  20. Yock TI, Caruso PA. Risk of second cancers after photon and proton radiotherapy: a review of the data. Health Phys. 2012;103:577.
  21. Taylor C, Correa C, Duane FK, et al. Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart and from previous randomized trials. J Clin Oncol. 2017;35:1641-1649.

 

Esophageal Cancer Awareness Month

Proton Therapy for Esophageal Cancer

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Content and information provided by Rebecca Bergeron, RN, BSN, OCN Director of Clinical Services for Provision CARES Proton Therapy Knoxville

Spring is here, and as flowers and trees bring forth new life and color, we are reminded that positive change is possible. Likewise, innovative therapies that have emerged over the years are offering hope to not only have a stronger fight against cancer, but to reduce treatment-related problems during and after the fight. April is Esophageal Cancer Awareness Month and proton therapy is our spring season in cancer treatment. (more…)

National particle therapy conference boosts proton therapy’s profile

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Proton therapy got positive billing at the recent Particle Therapy Cooperative Group, as researchers from across the country presented findings that showed proton therapy reduced potentially life-altering side effects and improved survival rates for cancer patients.

The National Association for Proton Therapy (NAPT) released a summary of the results, which included the findings of studies focused on esophageal, prostate and breast cancer. (more…)

Do your part to save your life…

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Nobody wants cancer, but in the U.S. one in every two men and one in every three women will get it at some point in their lives.

February is National Cancer Prevention month, and although there are no guarantees—we all know those who have developed the disease through circumstances beyond their control—science has shown us that many cancer cases are preventable through practical, healthy lifestyle choices.

The Harvard School of Public Health estimates up to 75 percent of cancer deaths in the U.S. could be prevented, while the American Cancer Society declares about 60 percent of American cancer cases to be preventable. (more…)

A special tribute…

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This is an edited version of an article that originally appeared in Vibrant Life Magazine.

Patty sits in the waiting room chair, hair still boyish thanks to a recent round of chemo, divorced shortly before her diagnosis, mother of two young boys.

She is telling me about her experience with breast cancer. The surprising news. Juggling work and single motherhood. Her eyes spill, not with tears of sorrow or bitterness but thankfulness.

“I’m very independent, but I’ve had to learn to depend on friends and family. Cancer has helped me allow other people into my life,” she says. “Cancer has shown me the power of prayer. Cancer has taught me how to appreciate every single day.”

I would not have guessed, when I started my new job at a cancer treatment center earlier this year, that it would be such a happy place.

Each day patients, in various stages of illness, come to receive the therapy they hope will save their lives. None of them would choose to be here. And yet, again and again they express their gratitude for the simple gifts life brings.

Bob with esophageal cancer speaks of his daughter-in-law, who faithfully took him to daily appointments. Dennis, a prostate cancer patient visiting the center from out of town, is grateful for the employees who make sure his stay is as comfortable as possible and accommodate needed trips back home. Toni is grateful for the doctors and therapists who made her daughter laugh during treatment for a brain tumor. Melvin is simply glad to have his wife, treated for breast cancer earlier this year, alive and well.

Sharon, who works the front desk, is a stage 3 breast cancer survivor—and has the battle scars of a mastectomy, hysterectomy and radiation damage to her heart and lungs to prove it.

Still, she says, “If I had to choose between having cancer and not having cancer, I wouldn’t change anything. I don’t let the little things bother me. I’m a more caring person. I don’t worry about the future. I appreciate what I have right now.”

“You simply will not be the same person two months from now after consciously giving thanks each day for the abundance that exists in your life. And you will have set in motion an ancient spiritual law: the more you have and are grateful for, the more will be given you,” writes Sarah Ban Breathnack in her book, Simple Abundance: A Daybook of Comfort and Joy.

Indeed. Scientific research shows gratitude, and in particular the repetitive practice of it, improves a sense of well-being, relieves depression and other mental health disorders, improves sleep, lowers blood pressure—all contributors to better physical and mental health.

Thankfulness is linked to spiritual well-being too.

One study showed that gratitude served as a connecting factor between those who were spiritually inclined and also experienced positive impacts on their health. Another study from the Journal of Religion and Health bears the title: “Spirituality and positive psychology go hand in hand…”

At Provision, thankfulness is typically couched in faith. It’s not that patients haven’t done their share of questioning, been through dark days, wondered “why me?” It’s that, somehow, in that journey of their greatest fears they’ve found peace in not having all the answers, in being grateful for the moment, in trusting God with the rest.

As author Ann Voskamp writes, “When I give thanks for the seemingly microscopic, I make a place for God to grow within me.”

 

Proton Therapy Extremely Effective for Esophageal Cancer

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When Bill Garland learned of his esophageal cancer, he knew nothing about proton therapy except that his doctors highly recommended the treatment. And he fully expected to suffer the same kind of side effects as traditional radiation—fatigue, site burns, loss of appetite. But Garland says he felt good most of the five weeks he underwent proton therapy, even though he was taking chemotherapy at the same time.

“I got the biggest surprise of my life—it didn’t bother me at all,” Garland, 80, says. “At church, there’s five men who’ve got cancer of different kinds. I was almost hesitant to tell them how I really felt, because they felt so bad.”

Garland discovered his cancer after being admitted to the hospital for internal bleeding. A tumor at the base of his esophagus turned out to be the culprit, and Knoxville medical oncologist, Tracy Dobbs, MD, recommended Provision Center for Proton Therapy, where he was treated with protons by Allen Meek, MD, board-certified radiation oncologist. “The esophagus is a difficult organ to treat with radiation therapy since it is so close to the heart, lungs, and spine,” said Dr. Meek. “Proton therapy allows us to only target the cancer cells, sparing surrounding tissues.”

“Because of (other) health issues, he was not going to be a candidate for surgery,” says Inez Garland, Bill Garland’s daughter-in-law, who accompanied him to doctors appointments as well as some of his treatments. “He did exceptionally great with everything,” she says. “He didn’t get nauseated, didn’t have any burns. He never had to get on liquids or anything. The people were so nice, everybody made us feel comfortable,” Inez Garland says.

The treatments ended in October, and Bill Garland is free again to enjoy his life and family of four children, 12 grandchildren and eight great-grandchildren.

“It really worked for me,” he says. “I tell everybody about proton.”

If you or a loved one has been diagnosed with esophageal cancer, Provision is here to help. Please call 1-855-566-1600 to speak with one of our Care Coordinators or visit ProvisionProton.com.

Esophageal Cancer Facts *

According to the American Cancer Society, more than 16,000 Americans are diagnosed with esophageal cancer each year. It affects men much more often than women. Middle-aged men who are overweight with a history of acid reflux (heartburn) seem to be at the highest risk. Because the disease often has no symptoms in the early stages, it is usually detected at a more advanced stage that is more challenging to treat.

The esophagus is a foot-long tube that carries food and liquids from the mouth to the stomach. Its lining has several layers. Esophageal cancer begins in the cells of the inside lining. It then grows into the channel of the esophagus and the esophageal wall.

A sphincter, a special muscle that relaxes to let food in or out, is on each end of the esophagus. The one at the top lets food or liquid into the esophagus. The one on the bottom lets food enter the stomach.

Acid Reflux Raises Risk

This sphincter also prevents stomach contents from refluxing (coming) back into the esophagus. If stomach juices with acid and bile come into the esophagus, it causes indigestion or heartburn. Reflux and gastroesophageal reflux disease (GERD) are the medical names for heartburn.

If you have reflux for a long time, the cells at the end of the esophagus change to become more like the cells in the intestinal lining. This is called Barrett’s esophagus, and it is a pre-malignant condition. This means it can become esophageal cancer and needs to be watched closely.

Esophageal Cancer Types

The types of esophageal cancer are named after the cells where they begin.

Adenocarcinoma is the most common type of esophageal cancer in western societies, especially in white males. It starts in gland cells in the tissue, most often in the lower part of the esophagus near the stomach. The major risk factors include reflux and Barrett’s esophagus.

Squamous cell carcinoma or cancer, also called epidermoid carcinoma, begins in the tissue that lines the esophagus, particularly in the middle and upper parts. In the United States, this type of esophageal cancer is on the decline. Risk factors include smoking and drinking alcohol.

This is the most common type of esophageal cancer worldwide. In other countries, including Iran, northern China, India and southern Africa, this type of esophageal cancer is much more common than in the United States.

* (Esophageal Facts Source: mdanderson.org)