Proton Therapy For Left-Sided Breast Cancer: Why Choose This Treatment?

Posted by on Friday, May 5th, 2017

Breast cancer is the most commonly diagnosed cancer for females, with one in eight being diagnosed in her lifetime. The National Breast Cancer Foundation, Inc. predicts that over 246,660 females and 2,600 men will be diagnosed with the disease this year. As the second leading cause of death for women, breast cancer will take the lives of 40,000 females and 440 males each year on average.

Treatments for breast cancer 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.

In some of these cases, however, certain treatments pose higher risks. For women with left-sided breast cancer, it is important to consider what type of radiation is best. Since the tumor is close to the heart, certain treatments can cause significant damage to this vital organ, while other treatments may spare damage to this vital organ.

In these cases, proton therapy is often a better option.

What Is Traditional Radiation?

Oncologists have been using radiation therapy since the beginning of the 20th century, making it one of the most dependable cancer treatments to date. This method, along with chemotherapy and surgical procedures, are frequently prescribed for a wide variety of cancers.

According to the American Cancer Society, radiation therapy “uses high-energy particles or waves, such as x-rays, gamma rays, electron beams, or protons, to destroy or damage cancer cells.” Again, this treatment is either used alone or in combination with other drugs to shrink and destroy the cancerous area.

Patients generally receive radiation therapy in one of three forms: external radiation (with a machine), internal radiation (through an implant), and systemic radiation (through an IV or by mouth).

Traditional Radiation May Not Be The Best Option For All Breast Cancer Patients

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Traditional radiation (photons) IMRT (Intensely-Modulated Radiation Therapy) is an advanced mode of high-precision radiotherapy that uses computer controlled linear accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor.

Women who are undergoing radiation treatment for breast cancer, especially of the left breast, may face higher risk for health complications down the line. This is because the high-energy beams are targeted at a body region shared with the heart and other vital organs. Traditional radiation is often criticised for this reason, as it may destroy the cancer cells while destroying healthy cells in the process. If these healthy cells are located in the heart, the patient could experience serious health issues in the future according to a study published in the New England Journal of Medicine.

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New research published in JAMA Internal Medicine quantifies this risk. According to the study, women who have received radiation treatment for breast cancer face a 0.5-3.5% higher risk of heart attack or other cardiovascular conditions. The researchers also said in the study that this risk is higher for women who have been treated for left-sided breast cancer because of the radiation target’s proximity to the heart.

image9These harmful effects may not show up right away either. The European study published in The New England Journal of Medicine found that these harmful cardiovascular effects generally appear as soon as five years after treatment. This means that the patients who have undergone radiation may feel healthy for several years before experiencing these heart issues.

Proton Therapy Is A Viable Solution To Avoid Cardiovascular Harm

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Proton therapy could help patients avoid these adverse effects, targeting the cancer cells in the breast tissue while avoiding the healthy cells of the heart, lungs, and other organs. If the treatment is successful, the patient can experience a healthy, cancer-free life without anticipating cardiovascular issues later on.

image5This treatment is a form of radiation, as it still uses high-energy beams to target problematic areas of the body. The difference? Proton therapy is more targeted. The protons send their full energy directly into the tumor site, reducing radiation exposure to the heart, lungs, bone, and other healthy tissue.

According to The National Association of Proton Therapy, this treatment is non-invasive and painless for the patient. Because of its highly-targeted nature, proton therapy has minimal side effects. Much like more traditional radiation therapy, this treatment can be used in conjunction with other treatments and drugs, making it customizable to each patient’s specific needs.

image6Oncologists will prescribe proton therapy for anywhere from one day to eight weeks, depending on the location, size, and severity of the cancer. According the association’s website, this treatment is often chosen for children to protect their growing bodies from the adverse effects of x-ray radiation.

Proton therapy is not an oncology treatment newcomer. It began as a cancer treatment over 50 years ago and has been used in a hospital setting since 1990. Scientists have been enhancing the treatment over the past 20 years, using technology, imaging, and computer software to deliver protons more accurately and to target breast cancer specifically.

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Proton Therapy’s Proven Benefits For Breast Cancer Patients

Recent studies have shown the direct benefit of proton therapy for breast cancer. Since this therapy directly targets the breast tissue, avoiding surrounding organs, researchers have found that survival rates are increasing and adverse health effects are decreasing.

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In a 2014 clinical trial by Loma Linda University in California, researchers monitored 100 breast cancer patients who underwent proton therapy treatment. The study tracked the patient’s health for the five years following the end of treatment, and found “that the in-breast recurrence-free survival rate was as high as 97% with minimal effects to the breast, lungs, and heart.”

David Bush, M.D. and vice-chairman of the Department of Radiation at the university and one of the main researchers on the study, said in a press release that these results show great potential for the future of breast cancer treatments.

“With proton therapy the size of the radiation area is reduced significantly, lessening radiation exposure to the heart, lungs and other parts of the body,” Bush said. “Proton beam allows us to do this better than any other type of radiation treatment.”

The researchers also found that proton therapy reduced the average breast cancer treatment time from seven to two weeks. The patients also showed that the treatment preserves the outer appearance of the breast, with 90% of patients and physicians rating the appearance of the skin as “good” or “excellent” during the five years following treatment. The researchers cited past studies that have shown that this cosmetic preservation diminishes overtime and were ultimately optimistic about their results.

“This study confirms that proton therapy effectively eradicates tumors while also preserving the cosmetic appearance of the breast,” Bush said. “Clearly this is very good news for breast cancer patients.”

Proton Therapy Boosts Vitality For Breast Cancer Survivors

There are over 2.8 million breast cancer survivors alive in the United States today, according to the National Breast Cancer Foundation, Inc. With access to better treatments, survivors can live a life free of health complications from their cancer treatment. Otherwise, these individuals are forced to move forward not knowing whether organs and tissues were damaged by radiation, leaving them anticipating other problems.

Proton therapy may be the solution to this fear.

By targeting only the cancerous cells and tumors, the protons only damage and shrink the cells they are meant to affect. This means that harm to surrounding organs and tissues is greatly reduced, diminishing the risk of diseases and complications once the patient has entered remission.

For left-sided breast cancer patients, this could be the key to a healthier life after treatment. With traditional radiation therapies risking damage to the heart, lungs, bones, and other tissue, patients could unknowingly walk away from their last treatment session with harm to their bodies. Proton therapy takes away this guessing game.

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Knowing the proven benefits of proton therapy for breast cancer and other types of cancers, industry leaders are opening facilities all over the United States. Currently, there are 25 centers dedicated to proton therapy, and there are a total of 19 in various stages of development. With 72 treatment centers currently operating globally, this growth makes the United States an industry leader for this type of therapy.

As more proton therapy centers open, more breast cancer patients will have access to this form of treatment. These facilities will also offer more opportunities to collect data and perform research on the effectiveness of this treatment, laying the foundation for more scientific advancement. If oncologists have access to more facilities and better technology, we will likely see more healthy cancer survivors. If you are interested in proton therapy as part of your cancer treatment, be sure to ask your physician about your options.

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Dr. Meek Discusses Radiation Options for Breast Cancer

Posted by on Wednesday, October 22nd, 2014

Radiotherapy, surgery and chemotherapy are the mainline treatments for patients with breast cancer. As a treatment modality, radiotherapy has many roles to offer these patients.  These include treatment of the breast after a partial mastectomy in order to conserve the breast and treatment of the chest area after a total mastectomy in order to decrease the chance of the cancer recurring in that area.  In both these situations radiation may also be given to the lymph node regions around the breast in order to prevent a relapse in these sites.  Many studies have demonstrated that radiotherapy given in these settings decreases the chance of the cancer recurring and increases the probability of cure for the patient. Another role for radiotherapy is in treating recurrences of breast cancer, either in the chest area or elsewhere in the body known as metastasis.  Radiotherapy is very effective at remitting these secondary lesions and relieving associated symptoms leading to an improved quality of life.

Along with surgery and chemotherapy, radiotherapy is becoming more targeted, providing more punch to the cancer cells and less to the normal cells.  This is partly due to improved diagnostic imaging which provides us better localization of targets for the radiotherapy and partly due to improved technology in radiotherapy which allows us to conform the dose of radiation to these targets more precisely.  The goal in developing a plan of radiotherapy for a patient is to develop the plan with the maximum therapeutic ratio, namely the ratio of the dose to the cancer target to the dose delivered to normal tissues.

Compared to conventional x-ray therapy, proton beam radiotherapy generally provides a greater therapeutic ratio.  This is due to the fact that whereas x-rays will travel the entire thickness of the part of the body they are aimed at, protons will only travel a limited distance in the body depending on their energy.  The energy imparted to a proton and its direction of travel can be very precisely set and thus the range of the proton beam in the body can be carefully limited.  In breast cancer this allows us to thoroughly treat the breast or chest area and the lymph nodes while substantially limiting the dose of radiation to the heart and lung compared to x-ray therapy.  This will lead to decreased heart and lung disease later in the patient’s life.  With more and more patients being cured of their breast cancer, reducing these preventable medical conditions becomes even more important.  As proton beam radiotherapy becomes more generally available, more and more patients will be able to take advantage of this safer treatment option. Proton beam has a more limited role in treating patients with metastatic breast cancer, though frequently is considered when a patient needs retreatment of a previously radiated area.  Because the volume of tissue receiving this second course of radiotherapy can be better limited with proton beam, it can be the less risky treatment option for these patients.

To find out if proton therapy is right for you, contact Provision Center for Proton Therapy at (865) 862-1600 or visit www.ProvisionProton.com

 

Dr. Allen Meek is Medical Director of Provision Medical Group and a board-certified radiation oncologist practicing at Provision Radiation Thearpy and Provision Center for Proton Therapy.  Dr. Meek was recognized as a 2012 U.S. News and World Report “Top Doctor” and one of the Best Doctors in America® for 2014.

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Patient Story: Kimberly Krause

Posted by on Saturday, October 11th, 2014

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Kimberly Krause is the first breast cancer patient to complete treatment at Provision Center for Proton Therapy.  She shared her proton therapy journey with the Shopper News.

Kimberly Krause is an energetic woman with a fast-paced job managing a restaurant. But, when she was diagnosed with breast cancer last year, the Provision Center for Proton Therapy helped keep her on her feet through treatment.

With a grandmother and two aunts diagnosed with breast cancer, Krause started yearly mammograms early. At age 39, her mammogram showed a possibility of breast cancer, and she went in for a biopsy Dec. 18. She was out of town on Dec. 20, when her doctor called with the news. She had breast cancer in the early stages, and six weeks of radiation, plus a lumpectomy or mastectomy was recommended.

Krause is a patient at Knoxville Comprehensive Breast Center, on the same campus as the Provision Center for Proton Therapy at Dowell Springs. Her surgeon for the lumpectomy was Dr. George Webber. Each morning, a multi-disciplinary task force, including pathologists, oncologists, surgeons, radiation therapists and more, meet to review patients and recommend the best course of action for each patient.

“We all meet in order to provide input into a patient’s case so they can get the best possible recommendations,” said Webber.

Included on that task force is Dr. Allen Meek, board-certified radiation oncologist and Medical Director of Provision Medical Group. Because of the placement of Krause’s tumor, traditional radiation could have affected her lungs, giving her a higher chance of developing lung cancer later in life.

“This is not an immediate effect,” said Meek. “What can happen is potential long-term radiation damage to the left side of the chest. This includes a higher incidence of heart disease and a higher incidence of lung cancer. Proton therapy is certainly advantageous for younger women. Many chemotherapy drugs can potentially affect the heart, also.”

The proton beam can be controlled to send as little radiation as possible to nearby organs. Meek said another concern with traditional therapies is the chance of radiation scattering to the opposite breast.

“The benefit in my view is that we get the same benefit for the breast, and we reduce by a considerable margin the damage to the heart and lung,” said Webber. “The less we irradiate the internal organs, the better it is for the patient, period.”

“People need to know that side effects from protons are similar to traditional radiation: sunburn-like irritation at the site, fatigue, sore throat,” said Meek. “But most of our patients can keep working right through that. They have noticed some fatigue but bounce back quicker.”

Krause started treatment at Provision in early 2014, soon after the center opened.

“It was amazing. I had minimal side effects and was able to keep the same work schedule,” she said.

Krause is the first breast cancer patient to complete treatment at the Provision Center for Proton Therapy. She has been cleared and has a follow-up appointment scheduled for December.

“Everybody here was so nice,” she said. “They are very caring and wonderful people. I would suggest this 1,000 times over traditional radiation. “I got very lucky. It could have been way worse.”

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