Delaying cancer screening tests during COVID puts patients at risk

Delayed Cancer Screenings in COVID-19 Era Put Patients at Risk

By

When the COVID-19 pandemic began, life as we knew it came to an abrupt halt. That included routine healthcare visits, as many providers postponed appointments and cancer screening tests that were deemed “non-essential.”

In the United States alone, an estimated 22 million cancer screening tests were disrupted by COVID-19 from April to June 2020. As a result, about 80,000 patients could be at risk for delayed or missed diagnoses.

The IQVIA Institute for Human Data Science recently published these estimates as part of its report on shifts in healthcare demand, delivery and care during the COVID-19 era. In this article, we’ll look at how diagnostic procedures for some of the most common cancers are impacted. We’ll also share some tips to help you move forward with your cancer-related care in a timely and safe manner.

DRAMATIC DROP IN DIAGNOSTIC TESTS

The IQVIA report looked at insurance claims for five of the most common cancer screening tests – breast, cervical, colorectal, lung, and prostate – and found a significant reduction across the board as a result of COVID-19.

“Claim codes for diagnostics commonly used to screen and monitor for cancer were generally stable from March 2019 through February 2020,” noted the report’s authors. “However, as the country prepared for COVID by canceling/postponing non-essential visits, procedure codes throughout March declined dramatically, coming to a near stand-still for some tests by the first week in April.”

The number of cancer screenings during COVID dropped by up to 90%

As you can see in the chart above, colorectal cancer screenings took the biggest hit. In the week ending April 10, 2020, claims filed for colonoscopies dropped by 90%. Mammograms for breast cancer screening saw a similar decline (87%), as did pap smears for cervical cancer screening (83%).

The number of CT scans related to lung cancer and PSA tests for prostate cancer was also lower, but the reductions weren’t quite as dramatic.

While PSA tests did drop by 60%, some physicians may have opted to continue with scheduled screenings in order to adhere to the patient’s testing plan. This is because the severity of a potential prostate tumor is often measured by how much time it takes for the PSA level to double.

The report’s authors also reasoned that the lower rate of disruption for CT scans (a 39% reduction) could be due to the generally more serious nature of lung cancer. Physicians may have also been trying to rule out COVID-related issues in the lungs for some patients.

RISK OF MISSED CANCER SCREENINGS DURING COVID ERA

Using the screening data from early April, the IQVIA report went on to project how many patients could miss a diagnostic procedure between April and June 2020, and the risk that would create for potentially delayed or missed diagnoses.

More than 80,000 patients may have delayed or missed diagnoses because of delayed cancer screenings during COVID

In the chart above, you can see the estimated reduction in the number of tests ranges from 30 to 72 percent, depending on the cancer type. As a result, COVID-19 potentially disrupted more than 22 million cancer screening tests overall. That included an astonishing 13.2 million fewer pap smears and 7.2 million fewer mammograms over the three-month period.

It’s important to note that not all abnormal test results lead to a cancer diagnosis. With the rate of positive cancer diagnosis per test in mind, the report’s authors determined the reduction in screenings could put more than 80,000 patients at risk for a delayed or missed diagnosis. Breast cancer is estimated to be the most impacted (36,000 patients), followed by prostate cancer (22,600) and colorectal cancer (18,800).

A delayed diagnosis could ultimately lead to a more advanced cancer when it is diagnosed. Not only will that have negative impacts on a patient’s prognosis, but it could also have long-term effects on our healthcare system.

“Current excess healthcare capacity to catch-up on missed tests and associated cancer treatments would require providers to shift priorities to make time and space in schedules and facilities,” said the IQVIA report authors. “An immediate return to previous volumes of testing and care will require substantial reallocation of resources and likely last months after social distancing rules are relaxed.”

WHAT YOU CAN DO TO MOVE FORWARD WITH YOUR CARE

Provision CARES Proton Therapy is a strong advocate for timely cancer screening and treatment. As such, we have developed a list of guidelines to help you move forward with your care and avoid putting yourself at higher risk.

First and foremost, we encourage you to call your primary care physician and discuss any regularly scheduled procedures like a mammogram, pap smear, colonoscopy or PSA test. Based on your medical history, your provider can help you determine whether it’s appropriate to continue with your cancer screening during the COVID-19 pandemic or delay it.

If you do receive a cancer diagnosis, we can help you move forward with your cancer care in a timely and safe manner. Depending on your diagnosis, it may be appropriate to delay treatment until the COVID risk is lowered. However, some patients may be better off beginning their cancer treatment immediately. As a first step after your diagnosis, we recommend calling the Provision treatment location nearest you to speak with one of our Cancer Care Experts. They can discuss your specific diagnosis and, if necessary, schedule you for a consultation with one of our physicians.

During your consultation, you’ll be able to meet with one of our board-certified Radiation Oncologists. They will be able to answer any questions you may have about your diagnosis and review all of your treatment options, as well as the possible side effects of each.

Provision offers both telehealth and in-person consultations. Telehealth consultations allow you to speak directly with a physician from the comfort and safety of your own home.

Some patients may benefit more from an in-person consultation. We encourage you to follow the CDC’s guidelines for leaving your house for doctor visits during the COVID-19 pandemic. When you arrive at our facility, rest assured we have established our own standards of excellence to keep our patients, visitors and employees safe. All Provision cancer centers are stand-alone medical facilities, which helps limit your exposure to others compared to a busier hospital setting.

——

As part of the Provision CARES Cancer Network, Provision CARES Proton Therapy has locations in Knoxville and Nashville, Tenn. If you or someone you know has cancer, we encourage you to call a Provision treatment center near you. One of our Cancer Care Experts can speak to you about your specific diagnosis and help determine if proton therapy is right for you.

 

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

By

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.

 

NAPT celebrates 30 years of supporting access to proton therapy

National Association for Proton Therapy celebrates 30 years supporting access to proton therapy

By

The National Association for Proton Therapy (NAPT) announced it will host its annual National Proton Conference through a virtual experience. The online event, which will take place on July 24, 2020, is a celebration of the organization’s 30-year anniversary of supporting access to proton therapy, one of the world’s most advanced cancer treatments.

NEW PLANS, SAME MISSION

The NAPT was planning to host the 2020 National Proton Conference in Nashville earlier this year, with keynote speaker Scott Hamilton, an Olympic Gold Medalist and U.S. and World Figure Skating Champion. However, the group was forced to shift their efforts to offer an interactive live virtual conference due to the COVID-19 pandemic.

“We knew in early March that it would not be safe for our attendees to travel and gather in person at our National Proton Conference,” says Jennifer Maggiore, NAPT Executive Director. “Just as it is vital for cancer care to continue in this pandemic, we felt it was important to support patients by ensuring education about advanced treatments continues for the proton therapy community.”

As part of its mission, NAPT supports increased awareness and access to proton therapy by providing education and bringing leaders in the field together. This is especially important now, with the travel concerns brought on by COVID-19, as many cancer patients who need proton therapy do not have access to it in their region.

In response to the global crisis, Maggiore says the NAPT quickly re-worked the logistics of its conference so the proton therapy community would not miss an opportunity to learn about the latest advancements in the field of Proton Beam Therapy (PBT). There has been significant research published recently supporting the benefits of PBT. The NAPT says the need to educate the community on that research in a timely manner validates their decision to move forward with a virtual conference.

WHAT TO EXPECT AT THE 2020 NAPT CONFERENCE

The original conference planned a special reception in Nashville to celebrate 30 years as the “Voice of the Proton Community.” Now, the online conference will feature a virtual Happy Hour with a nod to Nashville’s “Music City” fame.

“For the virtual conference, we are supporting the community of musicians who are unable to perform during the pandemic by hiring Nicole Zuraitas to provide live music at our virtual Happy Hour,” explains Maggiore. “We will toast to our 30-year anniversary at the end of the conference. This will be a great opportunity to engage with our proton therapy community in a safe environment.”

The conference will still include a speech from Hamilton, says Nancy Howard, 2020 Conference Chair and Vice President of Marketing at Provision CARES Proton Therapy. “We are honored that Scott Hamilton will kick off the conference with a welcome to conference attendees,” Howard remarks. “He is a cancer survivor and a true advocate for cancer patients and proton therapy.”

In addition to these festivities, the program agenda includes presentations from leaders and experts in proton therapy from Penn Medicine, Johns Hopkins Proton Center, Mayo Clinic and other leading cancer programs. These speakers will share their insight on relevant research and issues affecting cancer patients.

“During this pandemic, we have witnessed the decline in access to cancer care and major barriers for patients seeking preventative and curative treatment for cancer,” adds Maggiore. “It is more important than ever to strengthen our collaboration through shared knowledge to advocate and promote cancer care, research and access to the most advanced and innovative technologies available for cancer patients.”

MORE ABOUT NAPT

The NAPT began as the Proton Therapy Consortium in 1990. It is an independent nonprofit organization founded with the goal of educating and increasing awareness about the clinical benefits of proton therapy. Currently, its members include 37 of the nation’s leading cancer centers, some of which are comprehensive cancer centers as designated by the National Cancer Institute, as well as members of the National Comprehensive Cancer Network.

“NAPT evolved beyond my wildest dreams,” says Len Artz, one of the organization’s founding members. “It continues to make a profound difference in patients’ health and wellbeing. It stands on the shoulders of many proton community leaders over the years. It continues to grow as an organization and expand its outreach that makes me very proud.”

The NAPT states is mission is to work collaboratively to raise public awareness of the clinical benefits of proton therapy, ensure patients’ choice and access to affordable proton therapy, and encourage cooperative research and innovation to advance the appropriate and cost-effective utilization of proton therapy.

Provision CARES Proton Therapy is a member of the NAPT and shares a similar vision of making proton therapy a clinical reality. With locations in Knoxville and Nashville, Provision represents the only cancer centers offering proton therapy in the East and Middle Tennessee regions. As of June 2020, the centers have treated more than 4,000 patients with a wide range of cancer types.

Male cancer patient using telehealth

Telehealth can help cancer patients during coronavirus pandemic

By

Trying to navigate your cancer care journey is challenging enough without the added stress of a global pandemic.  Normally, you would schedule an in-person consultation with a physician to discuss your treatment options. Understandably though, many cancer patients now have reservations about going out in public during the coronavirus pandemic. Thankfully, telehealth provides a safe way for someone with cancer to continue moving forward with their care in a timely manner.

Provision CARES Proton Therapy implemented an expanded telehealth program in March 2020. This has allowed us to continue helping cancer patients in a safe environment, while also limiting the number of people at our centers. Since March, our physicians have conducted many telehealth consultations and virtual follow-up appointments. Our telehealth program allows someone who has been recently diagnosed with cancer to remain at home and speak directly to a physician through a video connection about their diagnosis, treatment options and next steps.  Our Cancer Care Experts can help patients through this process.

CANCER CARE PROVIDERS TURN TO TECHNOLOGY

The coronavirus pandemic has changed many aspects of the healthcare industry. When the outbreak began to gain momentum in the United States, hospitals made operational changes to accommodate a potential influx of COVID-19 patients. Many general practitioners and specialists began to postpone well-visits and elective procedures. Specialty healthcare providers, including cancer treatment centers, also made adjustments to keep their patients, employees and visitors safe. Many of those providers, including Provision CARES Proton Therapy, turned to technology, broadening their ability to provide cancer care through the use of telehealth.

A recent survey indicated nearly half of all physicians are now communicating with patients through telemedicine, a stark rise from just two years ago. The survey, conducted by Merritt Hawkins, a physician search firm, in collaboration with The Physicians Foundation, sought to learn how COVID-19 is impacting physicians and how they are responding. It found that 48 percent of physicians are using telemedicine with patients. A similar study by The Physicians Foundation in 2018 had that number at just 18 percent.

The increase in telehealth usage was aided further after the Centers for Medicare & Medicaid Services announced they would broaden access to Medicare telehealth services as part of the federal government’s emergency pandemic response.

CANCER & TELEHEALTH FROM A PHYSICIAN’S PERSPECTIVE

James Gray, MD, FACRO, Medical Director at Provision CARES Proton Therapy NashvilleSince the use of telehealth for medical appointments is becoming more common, we’re providing some firsthand insight into how it works and why it’s such a valuable tool for cancer patients. We asked the medical director of Provision CARES Proton Therapy Nashville, Dr. James Gray, a few questions about his experience with telehealth during the pandemic. Dr. Gray is a board-certified radiation oncologist who has spent 30 years studying cancer and helping patients navigate their cancer care journey.

What are your general thoughts on the use of telehealth for cancer care?

“I believe telehealth substantially contributes to our ability to communicate with patients.  While this applies across all areas of healthcare, it particularly applies to services which are restricted or to which there is limited access.  Proton therapy is a prime example of this.  I can interact with and advise patients who might not otherwise find it reasonable or even possible to travel to our center, or any other proton center.  Such patients may find that proton therapy has possible benefits for their circumstance and might make the trip worthwhile.”

What kind of feedback have you heard from cancer patients who’ve used telehealth?

“Generally good.  Telehealth allows us to help prevent a delay in the cancer patient’s process. As long as an in-person assessment is not necessary, then a telehealth consult allows me to counsel a patient quite well based on medical records and images forwarded to us in advance.  If equally feasible, an in-person visit is still superior for this communication, but a telehealth visit allows me to get the message across and answer the patient’s questions.”

What would you tell a patient who’s nervous about trying a telehealth appointment?

“I reassure the patient and family members that the telehealth visit can start the process of managing their cancer, but more interactions will follow in order to answer subsequent questions and direct further workup of their disease.  If the reason the patient feels nervous or uncomfortable is simply a technology concern, we can have our administrative staff reach out to them and their family to provide assistance.”

As a doctor, how has telehealth helped you during the coronavirus pandemic?

“It allows me to interact with more patients, and in a more timely manner, than I otherwise could due to visitation restrictions, or perhaps just logistics of travel for the patient.  I receive gratification from counseling patients through a rough time, always hoping to alleviate concerns and fears about issues they don’t understand and taking away some of the uncertainty of their next steps.”

Are there other ways cancer care providers are taking advantage of technology during the pandemic?

“Besides avoiding unnecessary contact between care providers and patients, physicians have suspended our in-person meetings called tumor boards or tumor conferences.  But there is a silver lining to this change because we have been forced to become better at virtual meetings, allowing us to exchange ideas and recommendations through audio/visual software.  Again, in-person meetings will likely always be preferable when reasonable, but the ability to attend the meeting virtually from your office or home has been given a big boost during this time.  Ultimately, comfort with this type of meeting attendance makes the meeting more accessible.  And the more we interact, the better we explore all options for our patients.”


To learn more about Dr. Gray and the other board-certified radiation oncologists at Provision CARES Proton Therapy, please visit Our Physicians page. If you are interested in learning more about proton therapy or scheduling a telehealth consultation, please call the Treatment Location closest to you and speak with one of our Cancer Care Experts.

Benefits of proton therapy for liver cancer

Liver cancer patients may benefit from advantages of proton therapy

By

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

  1. Cancer Stat Facts: Liver and Intraheptic Bile Duct Cancer. National Cancer Institute. Read More
  2. Cancer Stat Facts: Female Breast Cancer. National Cancer Institute. Read More
  3. Cancer State Facts: Prostate Cancer. National Cancer Institute. Read More
  4. 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.
  5. Wang X, Krishnan S, Zhang X, et al. Proton radiotherapy for liver tumors: Dosimetric advantages over photon plans. Med Dosim 2008; 33:259-267.
  6. Protons versus Photons for Unresectable Hepatocellular Carcinoma: Liver Decompensation and Overall Surival. International Journal of Radiation Oncology. Read More
  7. 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

 

Breast Cancer Awareness Month

Breast Cancer Facts: 5 Common Myths Debunked

By

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:

  1. 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
  2. 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
  3. National Cancer Institute. Antiperspirants/Deodorants and Breast Cancer. https://www.cancer.org/cancer/cancer-causes/antiperspirants-and-breast-cancer-risk.html
  4. Darbre PD. Aluminium, antiperspirants and breast cancer.Journal of Inorganic Biochemistry 2005; 99(9):1912–1919. [PubMed Abstract]
  5. 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]
  6. 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.
  7. 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.

 

proton therapy for breast cancer treatment

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

By

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

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

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

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

How Massachusetts General Hospital conducted the study

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

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

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

Summary of the study’s results

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

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

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

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

What’s next for proton therapy research?

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

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

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

The Benefits of Proton Therapy for Breast Cancer Treatment

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

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

Sources:

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

 

Am I at Risk for Prostate Cancer

Am I at Risk for Prostate Cancer?

By

September is Prostate Cancer Awareness Month.  It is important to know if you are at risk of prostate cancer and whether you should get an annual Prostate-Specific Antigen (PSA) level test.

In Tennessee, as well as the United States, prostate cancer has the second highest new cancer rate overall and is the number one cancer for new cancer types among men.(1)    According to the Center for Disease Control (CDC), there are an estimated 3,110,403 men living with prostate cancer in the US.  Based on their 2014-2016 data, approximately 11.6% of men will be diagnosed with prostate cancer at some point in their lifetime.  According to SEER, there will be an estimated 174,650 new cases of prostate cancer in 2019 with an estimated 31,620 deaths from prostate cancer.  The five year survival rate for prostate

Prostate cancer is most frequently diagnosed among men aged 65-74 with a median age of 66.  However, 9.2% of new prostate cancer cases are among men under the age of 55.(2)

In addition to age, other factors can increase the risk of being diagnosed, including family history, genetic factors, race, lifestyle and dietary habits.

If an immediate family member such as your father or brother have been diagnosed with prostate cancer, then your risk of developing prostate cancer is 2 to 3 times higher than normal.  Your risk increases with each relative that has been diagnosed with prostate cancer.  Your risk will also increase if two or more close relatives on the same side of the family have been diagnosed with prostate cancer before the age of 55.(3)

African American men have a higher risk and are more likely to be diagnosed at a younger age and have been found to have a more aggressive tumor.

There have not been any studies to prove that diet and nutrition has any direct correlation with developing prostate cancer.  However, if a male who is overweight is diagnosed with prostate cancer, they are at a greater risk for developing a more aggressive cancer.

While there can be lifestyle and dietary habits that can increase your risk of prostate cancer, there are a few myths that have been rumored to increase your risk of prostate cancer.   Sexual activity level is a non-factor as well as having a vasectomy.  Alcohol is another non-risk factor for prostate cancer.

If you do have any of these risk factors, it is important to have your PSA level checked annually.  If you do have an elevated PSA level, your doctor can provide information on additional testing to confirm your diagnosis.

Source:

(1) Center for Disease Control.  Prostate Cancer Statistics.  https://www.cdc.gov/cancer/prostate/statistics/index.htm

(2) National Cancer Institute.  Surveillance, Epidemiology, and End Results Program.  Cancer Stat Facts:  Prostate Cancer. https://seer.cancer.gov/statfacts/html/prost.html

(3) Cancer.Net.  Prostate Cancer Statistics.  https://www.cancer.net/cancer-types/prostate-cancer/statistics

Proton therapy for treating left-sided breast cancer plays a crucial part in sparing damage to your heart.

By

As with other cancers, the best possible outcomes for breast cancer treatment come through early breast cancer care. However, if breast cancer is diagnosed, treatments can include chemotherapy, hormone therapy, targeted therapy, surgery, and radiation. As there is not one perfect formula to eliminate the disease, many patients will need to undergo a combination of these treatment methods.

When it comes to radiation therapy, it is important to know your options and which type of radiation treatment is best for you.

Proton therapy is an advanced form of radiation therapy that is noninvasive and precisely targets your tumor using a single beam of high-energy protons to kill cancer cells. Proton therapy’s unique characteristics as a positively charged particle can precisely deposit radiation directly in the cancerous tumor with no exit dose. Both x-rays and protons damage cancer cells, but unlike standard radiation therapy, proton therapy deposits the majority of the radiation dose directly into the tumor. This spares nearby healthy tissues and organs from receiving unnecessary radiation, thus reducing damaging side effects and complications, compared to conventional radiation.

This is especially important in left-sided breast cancer, as the cancer is close to critical organs such as the heart and the lungs.

According to research published in JAMA Internal Medicine, women who have received breast cancer radiation treatment via x-rays face a 0.5% to 3.5% higher risk for heart attack or other cardiovascular issues. The risk is highest among women who’ve had conventional radiation to the left breast because of the target’s close proximity to the heart.

A European study in The New England Journal of Medicine revealed that the harmful cardiovascular effects typically begin to emerge as soon as five years after cancer radiation treatment.

With proton therapy treatment for breast cancer, on average, there is no radiation to the heart and 50% less radiation to the lung as compared with conventional radiation.

Furthermore, a 2014 clinical trial by Loma Linda University found that 90% of proton therapy cases result in “good: to “excellent” cosmetic result for partial breast radiation patients during the five years following treatment.

Proton therapy is extremely precise and therefore more effective at targeting cancerous cells without causing damage to surrounding breast tissue. Proton therapy is not a substitute for a lumpectomy and works with other modalities such as chemo-therapy and surgery. 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.

For left-sided breast cancer patients, this could be the key to a healthier life after treatment.

Mason Strong:  One teenage boys fight against pediatric brain cancer brings together an entire community.

No parent wants to hear that their child has cancer.  Unfortunately, those were the words Ginger and Richard Cobble, parents of son Mason Cobble, 16, heard on Tuesday February 26, 2019.  Mason is a sophomore at Walker Valley High School in Cleveland, TN and an overall healthy child.  On Friday morning, February 22nd of 2019, Mason had a seizure and was later diagnosed with Glioblastoma multiforme GBM, a rare brain cancer in children.  He immediately had surgery to remove the tumor followed by proton therapy radiation at Provision CARES Proton Therapy Knoxville.

Proton therapy is an advanced form of radiation therapy that can be used in conjunction with pencil beam scanning technology.  The combination allows radiation oncologists to precisely target the tumor, minimizing the dose of radiation received to nearby healthy tissues and organs.  Because children and adolescents are growing, their tissue is more sensitive to radiation and its potential for negative side effects. The American Society of Radiation Oncology (ASTRO) ranks using proton therapy to treat solid tumors in pediatric patients with the highest importance (ASTRO Model Policy, 2014).  For Brain tumors, proton therapy can minimize negative side effects that include developmental delays, hearing loss, damage to salivary glands and hormone deficiencies.

A recent study presented at the European Society for Radiotherapy and Oncology Congress  (ESTRO) compared three types of radiotherapy for pediatric brain tumors and found that in pediatric brain tumors, pencil beam scanning proton therapy consistently delivered the lowest amount of radiation to the hippocampus and temporal lobes, areas of the brain that are vital for memory function.  Laura Toussaint, a PhD student in the Department of Medical Physics, presented the study and said, “alongside surgery and chemotherapy, radiotherapy plays an important role in treating brain tumors in children, but we need to protect children’s developing brains from unnecessary radiation.  The more we learn about how to effectively target brain tumors while minimizing the dose to other parts of the brain, the better we can preserve children’s cognitive abilities and quality of life after treatment.”

After seeking the opinion of several medical professionals, Mason Cobble started proton therapy treatment at Provision CARES Proton Therapy Knoxville.  In a post on the Team Mason Strong Facebook page, Mason’s mom Ginger Cobble said, “It is such a blessing that Provision Proton Radiation Therapy is in Knoxville.  So thankful we get to treatment so close to home.”  The Chattanooga and Cleveland Tennessee community has pulled together to support Mason in his fight against cancer.  His story has been featured in the Cleveland Banner, on News Channel 9, on area radio stations and other media outlets.

On Wednesday May 8, 2019 Mason rang the bell as he graduated from his treatment at Provision CARES Proton Therapy Knoxville.  He still has a fight ahead of him with more chemotherapy treatments and participation in a clinical trial at Duke, but the staff at Provision is thankful for him and are #TEAMMASONSTRONG.