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.

 

Maintaining a Healthy Nutritional Status When Diagnosed with Head & Neck Cancers

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Content and information provided by Casey Coffey MS, RD, LDN Registered Dietician for Provision CARES Proton Therapy Knoxville

As we raise awareness of head & neck cancers during the month of April, it is important to be aware of the unique challenges that are at risk when diagnosed with head and neck cancer. Studies for patients who choose proton therapy treatment for head and neck cancers have shown less side effects during first 3 months after treatment and quicker return to normal function. The potential side effects for head and neck cancer patients make swallowing food and fluids difficult and sometimes painful. Malnutrition affects an estimated 40 – 80% of cancer patients – particularly those with gastrointestinal or head and neck cancers.

The four main nutritional goals for cancer patients include:

  • Strive to maintain a healthy weight
  • Consume foods and beverages for managing cancer and treatment-related side effects
  • Select and eat healthy foods that supply the body with fuel and nutrients for repair and healing
  • Reduce risk of cancer recurrence and the development of a second malignancy

Many patients do not realize the importance of nutrition while under treatment. Primary goals of nutrition therapy are to prevent or reverse nutrient deficiencies, preserve lean body mass, support the immune system, and minimize and manage the impact of nutrition related symptoms and side effects to maximize quality of life. Adequate nutrition is more than just maintaining body weight. The foods we eat contain nutrients necessary to support healing and restoration but also to support our healthy cells as well. Adequate nutrition has been shown to improve outcomes in cancer patients, improve strength and energy, avoid dose reduction or treatment breaks.

Make Every Bite Count.

Initially, it is recommended patients eat what they can tolerate while focusing on protein with each meal and including whole foods (minimizing the processed nature of foods). Why? Well, quality counts. High quality foods, which are those that are less processed, are more nutritious due to their higher nutritional value. As treatment progresses and possible side effects begin, the ability to swallow can become difficult. If difficulty to swallow becomes a problem for head and neck cancers, here are three ideas on how to maintain nutritional value through your diet:

  • Graze throughout the day on nutrient dense foods: Nutrient dense foods that have been fortified with protein and additional calories without adding volume and lots of sugar or highly processed foods. Some examples are olive oil, butter, coconut oil, coconut butter, peanut butter, heavy cream, half & half, or any nut butter.
  • Alter texture of foods to improve tolerance: focus on soft or smooth foods such as, bananas, watermelon, canned fruits, peach, pear, and apricot nectars, pureed or mashed vegetables, oatmeal, cooked cereal, cottage cheese, yogurt, milkshakes, custards, puddings, gelatin, macaroni and cheese, scrambled eggs, and ground meats.
  • Avoid irritating foods, such as, citrus fruits or juices, spicy or salty foods, pickled or vinegary foods, tomato-based foods (salsa, spaghetti sauce, and pizza), rough or dry foods, hot spices (pepper, chili powder, nutmeg, cloves, and curry).

For more information about how to overcome nutritional challenges when diagnosed with head & neck cancers or to learn about proton therapy, contact our CARE Team at 865-229-4689.

 

Latest research shows benefit of proton therapy for children with head and neck cancer

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Thousands of cancer patients have and could benefit from proton therapy, and children definitely top the list.

This week, exciting news has emerged from the renowned Children’s Hospital of Philadelphia confirming that proton therapy effectively treats pediatric cancers of the head and neck and reduces the side effects often experience with conventional radiation treatment.

It’s one more step toward growing and full recognition of proton therapy in the medical community as a state-of-the-art treatment option for cancer. (more…)

Provision patients report on life after treatment

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For the past three and a half years, patients have been coming to Provision Cares Proton Therapy Center seeking the best treatment and care for the cancer diagnosis. Many of them have shared their stories with us. Today, we celebrate these survivors by checking in with some of the Provision alumni whose stories we have featured in the past. Click the links to find out more about them on our website, protonstories.com (more…)

Protons offer promise for reirradiation

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For those with cancer who have already an initial course of radiation therapy, a recurrence of their disease can be an understandable cause for concern.

With conventional (X-ray) based radiation, we generally can only safely give one round of treatment to the primary site of disease. But with proton therapy, because of its ability to zero in on the cancer and spare healthy surrounding tissue, a second course of treatment could offer hope to patients with recurrent tumors. (more…)

Patient with oral cancer finds hope in proton therapy

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This is Oral, Head and Neck Cancer Awareness Week. Click here to learn more about these types of cancer.

Before her cancer diagnosis, Holly Caster worked in hospitality at Beaumont Hospital in her Michigan hometown, coming up with creative ways to make patients’ stays more comfortable.

There was the flash mob she planned for a high school senior who’d been hospitalized and couldn’t go to prom. The laptop, CDs and company-keeping for a young pregnant woman confined to bed rest whose family lived 50 miles away. She gave cancer patients afghans in their favorite color. She planned in-hospital celebrations for weddings and anniversaries and new babies, all to help people cope as best they could when life dished up the unexpected.

Then the unexpected happened to her. (more…)

Provision dosimetrist ranks with best in planning contest

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When his boss sent out an email encouraging those in the Provision medical physics department to participate in an international treatment planning competition, Kevin Kirby decided to give it a shot.

Sponsored by ProKnow, a radiation analytics and quality assurance company, the assignment of creating a radiation treatment plan for a head and neck cancer case attracted more than 200 entries.

In the final results, Kirby’s entry ranked 21st among 238 treatment plans, and first among proton therapy entries.

“A perfect score was 150,” said Kirby, a medical dosimetrist at Provision Proton Therapy Center. “I got 144.” The top score was 146.9.

He is the second Provision employee to place high in the ProKnow competition, known as the QADS Plan Study. Samantha Hedrick, a medical physicist, achieved third place out of 124 entries in 2013.

ProKnow develops and sells software to “help improve the standard of care in radiation oncology” through analytical tools and databases that help customers measure and track their planning efforts with a goal of identifying best practices for treating a variety of diseases.

The plan Kirby submitted was scored on a scale of 20+ criteria categories, with the ultimate goal of providing the most dose to the tumor versus the least dose to the surrounding, healthy parts of the body.

Kirby credited his treatment modality, proton therapy, with giving him an edge over competitors using conventional radiation treatment methods.

Proton therapy is particularly suited to treatment of head and neck cancer, because “you are dealing with some very critically sensitive areas to radiation, such as the spine and brain,” Kirby said. “Proton therapy is just one of the top ways to treat one of the most difficult areas to get to in the body.”

“Kevin is an outstanding dosimetrist.  Along with the rest of our staff, Kevin’s knowledge and work ethic has kept Provision’s planning capabilities at the forefront of radiation therapy,” said Ben Robison, Provision director of medical physics.

Kirby’s high score got him a phone interview with ProKnow in which he was asked about his personal background and more details about his planning methods. ProKnow is making the interview available via its website. Ranking so high among other treatment plans is quantitative validation that proton therapy and, specifically, the medical care at Provision, is best-in-class, he said.

“There’s a lot of hyperbole,” Kirby said. “This is a blind, metric product that shows our treatment is one of the best in the world. It just validates what we’re doing here.”

Throat cancer patient high on proton therapy

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When Terry Vinson first felt a small grown the size of a pinkie fingertip on his neck, he dismissed it as a harmless cyst.

Even two weeks later, when it had doubled into the size of a thumb and then doubled again the following week, he had not yet sought medical help.

“I’m in medical sales,” Vinson says. “I should have known better.” (more…)

National Cancer Survivors Day celebrates life, health and survival

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On this, National Cancer Survivors Day, we take a moment just to appreciate. Life. Health. Survival.

Those who receive a cancer diagnosis no longer take those things for granted. They have become a precious gift. Something to be celebrated. But, better to hear the words of those who’ve been there. Below are thoughts from two young cancer survivors and Provision alumni. You can read the stories of their cancer journeys, and many others, at ProtonStories.com. (more…)