Proton Therapy: A Better Way to Destroy Tumors

By Jim Stallard,

Tuesday, February 17, 2015

Oren Cahlon, MSK’s Director of Proton Therapy, examines a patient.
Summary

Proton therapy uses charged particles to target tumors with precision while reducing the risk of treatment-related side effects.

Traditionally, particle accelerators have been used to conduct elaborate physics experiments by propelling charged particles at very high speeds. In addition, some medical centers, including Memorial Sloan Kettering, employ these massive machines to produce molecules for PET imaging. But these giant devices have another important use: creating cancer-fighting energy in the form of a proton beam to kill or shrink tumors while minimizing harm to healthy tissue.

Proton therapy, a highly sophisticated form of radiation, is currently available at only 14 locations in the United States. In the fall of 2013, MSK physicians began using proton therapy at a facility in Somerset, New Jersey, to treat a variety of cancers under the leadership of Oren Cahlon, MSK’s Director of Proton Therapy, and radiation oncologist Nancy Y. Lee, Vice Chair for Experimental Therapeutics. Dr. Lee also serves as the medical director and president of the New York Proton Center (NYPC), an affiliation of three New York City hospitals, including MSK.

Here, Dr. Lee explains how proton therapy delivers its dose so precisely and why it represents a leap forward in patient care.

How does proton therapy work, and how does it complement more conventional radiation therapies?

Traditional radiation uses beams of x-rays, which are waves of high-energy light. MSK has always been at the forefront of developing ways to optimize this treatment. In fact, over the last 15 years MSK radiation oncologists, including myself, have been leaders in showing the benefits of intensity-modulated radiation therapy (IMRT), a technique that targets tumors with multiple beams at different angles and intensities that now is widely used.

With proton therapy, all energy has been released when it reaches the tumor site.
Nancy Lee MSK radiation oncologist

Proton therapy, by contrast, targets a tumor with charged particles, called protons. While proton therapy kills cancer cells through a process similar to that used in x-ray radiation — by damaging their DNA — the unique physical properties of protons allow them to deliver the dose at a specific depth in the body. With proton therapy, all energy has been released when it reaches the tumor site, so there is no dose beyond that point. This lowers the impact to normal tissues surrounding the tumor and reduces the risk of treatment-related side effects. There also are hints that proton therapy may work on recurrent tumors that are resistant to conventional radiotherapy, although this has not been confirmed.

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What types of tumors can be treated with proton therapy?

Are you a candidate for proton therapy?

Contact an MSK physician for a consultation.

  • For pediatric cancers, contact Suzanne Wolden:
    212-639-5148
  • For head and neck cancers contact Nancy Lee:
    212-639-3341
  • For all other cancers, contact Oren Cahlon:
    212-639-5219

Proton therapy is most useful for localized cancers that have not spread from the original site. We have used it most often for head and neck tumors and for pediatric cancers. Head and neck tumors are surrounded by many critical structures, such as the brain stem, spinal cord, optic structures, tongue, and esophagus, so it’s essential to confine the particles to the cancerous tissue. Proton therapy is also beneficial for pediatric cancers because developing tissues in children are incredibly sensitive to radiation.

Other cancers also lie near important organs or tissue. When treating breast cancer, you obviously don’t want to damage the heart, and in some patients, proton therapy can reduce unwanted exposure to that area.

In fact, proton therapy might be useful for any disease site and is increasingly being considered as an option for all cancer types. In addition to the cancers I already mentioned, our doctors are using it to treat select spinal tumors, soft tissue sarcoma, prostate cancer, and lung cancer.

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Have you already seen a reduction in side effects in patients receiving this therapy?

In our patients with salivary cancer in particular, there has already been a noticeable benefit. Almost all of these patients used to lose their sense of taste and have soreness on the inside of their cheek following conventional treatment, but it does not seem to happen with proton therapy. More broadly, we are conducting a study that compares side effects of proton therapy with IMRT in patients with head and neck cancer, and our preliminary findings indicate those treated with proton therapy have a better quality of life.

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Is proton therapy covered by insurance?

Many insurers recognize that proton therapy has proven effective. It is covered by Medicare and by many of the private insurance companies for things like pediatric cancers and brain tumors, and in patients requiring re-irradiation [radiating new tumors that emerge in the same location as tumors that already received radiation]. However, for many diagnoses, it is dependent on the particular insurer, the patient’s benefits, and the clinical scenario. Sometimes the patient’s physician needs to communicate with a physician at the insurance company in order to obtain approval. 

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What are the most common misconceptions about proton therapy?

Probably the biggest is that this technology is new or investigative. Patients actually have been treated with proton therapy in the United States for several decades, but it has been limited to a handful of centers. Another misconception is that the actual treatment experience is dramatically different from x-ray radiation. In reality, proton therapy typically involves the same number of treatments with the same session times as conventional radiation therapy, and the day-to-day experience is indistinguishable. I continue to be a very strong proponent of IMRT, but it’s important that patients realize proton therapy is now an option through MSK.

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Comments

Can this be used when the cancer has spread to the brain?

Mary, thank you for reaching out. We consulted with Dr. Cahlon, and he responded that proton therapy would be appropriate In rare cases, only after multiple prior courses of radiation to the brain. We would encourage you to come see someone at MSK for a full evaluation. If you are interested in making an appointment, you can call 866-886-9807 or go to:

http://www.mskcc.org/cancer-care/adult/brain-tumors-metastatic/appointm…

Call 866-886-9807

I am a patient here with pancreatic cancer. I know that florida univ. is doing trials on pancreatic cancer. Other locations may be using proton therapy on pc. Is that done here or being considered. I did not see it on the list

I read on a page of another institution that proton therapy can be used on liver metathesis (and probably cancers that have metathesized. Why is that not being done here? or will it be?
thanks

Jeanne, thank you for your comment. MSK is not currently using proton therapy to treat pancreatic cancer. We suggest you consult with your MSK radiation oncologist on this specific question and other treatment options.

Do you offer proton therapy for breast cancer? What are the survival rates?

Ann, thank you for your comment. Proton therapy is used for breast cancer, and survival rates are similar to treatment with other forms of radiation (although side effects may be less in some patients).

Does this therapy treat CLL?

Thank you for the response. I am not looking for treatment at this point. I just want to know why proton therapy would not be a viable option for the brain if the objective is to treat the tumor without harming the surrounding tissue. Where would this be more critical than in the brain?

Mary, sorry for the confusion---proton therapy is definitely appropriate for some brain tumors but not others, depending on the particulars of each specific case, which can involve a wide variety of factors.

If I have a pacemaker can I have proton therapy for parotid cancer

Belinda, thank you for reaching out. Yes, proton therapy can be used for parotid cancer in a patient with a pacemaker.

If you are interested in proton therapy for this cancer, you can call 212-639-3341.

Is proton therapy a real/strong possibility for lipo leiyomyo sarcoma that is determined by pathology to be localized? Your article states that it could be used for soft tissue sarcoma which llms is a type of. Thank you.

Thank you for reaching out. To find out whether proton therapy might be appropriate for your case of lipo-leiomyosarcoma, we suggest you contact the MSK office of Oren Cahlon to inquire about a consultation at:

212-639-5219   extension 5219

I have Ocular Metastatic Melanoma which had gone to my liver..had it removed..if it comes back..would your proton therapy be for me..

I have Ocular Metastatic Melanoma which had gone to my liver..had it removed..if it comes back..would your proton therapy be for me..

Linda, thank you for reaching out. According to Dr. Cahlon, proton therapy is not typically used to treat this cancer.

how is it different from DART TREATMENT…WHICH ONE MORE BENEFICIAL IN METASTATIS PCA.

Munish, thank you for your comment. According to Dr. Cahlon, proton therapy is not typically used to treat metastatic prostate cancer.

My mother had uterine cancer in 2012 and had her uterus removed and went through radiation too. Now in 2015 her report is- right lung upper lobe anterior segment ? Gasto hepatic,spenic hilum, peritoneal and mesentery. Anterior abdominal wall . Can proton treatment help.

Shubha, thank you for reaching out. We consulted with Dr. Cahlon, who says that proton therapy would not be the right treatment for this particular situation.

If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

How is proton therapy similar or different from gamma knife radiotherapy?
Have you used proton therapy to treat a chondrosarcoma at the brain stem?

Wendy, thank you for reaching out. Gamma Knife is a form of highly focused radiosurgery---it uses x-rays rather than proton beams. Gamma Knife is also limited by the size of the tumor, i.e. larger tumors are very difficult to treat with Gamma Knife. Proton therapy definitely can be used to treat chondrosarcoma. The best published outcomes for this tumor are with protons. We encourage you to contact Nancy Lee for a consultation at: 212-639-3341.

I am surprised by one of your answers.
Proton Therapy is used in prostate cancer but not in metastatic prostate cancer.
I understand the part that they are at different locations.
My friend (in Poland) have prostate cancer.
Prostate was removed manually by surgeon.
Latter hormonal therapy.
With time, cancer went to sacral bone, removed by gamma radiation.
Time passes, highly active otherwise healthy 76yo man.
His PSA is starting to raise, cancer is back.
When is the right time the new cancer location will be found.
Hopefully another gamma radiation will be possible.
But I was hoping that in case that gamma radiation is acceptable then proton therapy should also be acceptable but less damaging to surrounding tissue.
Please comment.

Jan, thank you for your comment. We consulted with Dr. Cahlon, who says that in general proton therapy is not used for metastatic disease unless there is prior radiation to the same area.

We recommend your friend speak with his personal physician for treatment options.

Have you ever heard of Proton Therapy being successfully in treating an AVM in the left frontal lobe of the Brain?

Cheryl, thank you for reaching out. Yes, protons can be used for treating AVM of the brain but MSK is not currently doing so. We recommend you contact Massachusetts General Hospital:

http://www.massgeneral.org/

I am a 67 y.o Dx. local recurrent prostate cancer after radical prostectomy in 2002 and external pelvic radiation for chemical recurrent prostate cancer in 2004. slowly PSA rising from 2009.a 7-8 mm nodule of local recurrent prostate cancer Dx.by MRI .between bladder and rectum and confirmed by Bx. march,2014,PSA was 2.I have been getting lupron injection every 3 montjhs.plus CASODEX 50mg po daily past year.PSA my radiology oncologist is considering local radiation treatment .PSA now is 0.2.Am I a candidate for proton treatment?

Michael, thank you for reaching out. Yes, proton therapy is a potential option for treatment. If you are interested in making an appointment, you can contact the office at Oren Cahlon at:

212-639-5219

Mi hija de 32 años tiene carcinoma neuroendocrino en el cuello del útero de 2,5 sin metástasis aparentemente. se podría aplicar terapia de protones???? Indican cirugia radical y quimioterapia tradicional porque donde vivo no hay otra cosa. Ella quería preservar su maternidad. que me puede decir???? Tenemos pensado llevarla al lugar que mas nos dé posibilidades. Gracias
Graciela

Querida Graciela, sentimos que tu hija ha sido diagnosticada con cáncer. No podemos ofrecer consejos médico a través de nuestro blog. Si ella quiere hacer una cita con uno de nuestros especialistas para discutir sus opciones de tratamiento, por favor llame a nuestro servicio de acceso médico: 800-525-2225. El personal del sevicio pueden contestar sus preguntas sobre la posibilidad de preserver su fertilidad ántes de recibir tratamiento. Puedes leer más sobre la fertilidad y cáncer en ésta página: http://www.mskcc.org/cancer-care/survivorship/fertility
Gracias por su comentario y desamos lo mejor para tu hija.

I had state 3 lung cancer in 2007 and was cured with lobectomy, chemotherapy (before and after surgery) and radiation. In 2012 I developed a a right supraclavicular metastatic node, and was again saved by surgery, followed by chemo and radiation. I am healthy, active and feel great . . . . but - should the cancer return at some point, might I be a candidate for proton therapy?

Mariela, thank you for reaching out. It is difficult to tell ahead of time whether proton therapy would be appropriate for a cancer that returns -- you might be a candidate, but it would depend on a number of factors specific to the case.

Is this procedure available for prostrate cancer

Norman, thank you for reaching out. Yes, proton therapy can be used to treat prostate cancer. If you are interested in a consultation, you can contact the office at Oren Cahlon at:

212-639-5219

I've had a left mastectomy which spread to the lymph nodes. I've had chemo and now I need to have radiation. Would proton therapy work for me?

Ann, thank you for reaching out. Yes, proton therapy can be used for this condition. If you are interested in a consultation, contact the office of Oren Cahlon at 212-639-5219.

Can proton therapy be used for anal cancer?

John, thank you for reaching out. Proton therapy very recently started to be used for anal cancer at some centers, although Memorial Sloan Kettering is not currently using protons for this cancer. We suggest you contact University of Pennsylvania and Massachusetts General Hospital, who may have begun using proton therapy for anal cancer.

Is this treatment possible/effective for primary extramammary paget's disease of the scrotal area?

Thank you for reaching out. We consulted with Dr. Cahlon, who informs us that MSK does not use proton therapy to treat this particular condition. We suggest you consult with your personal physician about treatment options. Thanks for your comment.

My mother has non hodgkins Lymphoma and we are looking at further treatments after it seems chemotherapy has failed with a view to a cure.
Having read up on Proton therapy, it seems that this targeted treatment is a viable option. Can you confirm if that is so and if MSK would provide such treatment? Currently, I have contacted MD Anderson in Texas but they only provide this treatment if the mass is located around the medial stynal or sturnam. She has the growth pushing against to her upper bowel. Thank you in advance for your help.

Chris, thank you for reaching out. MSK currently does not use proton therapy for the specific condition you are describing. If you are interested in a consultation for your mother regarding other treatment options, you can contact our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

My 3 year old niece diagnosed about 1 week ago with grade III anaplastic astrocytoma. Wrapped around her hypothamus with fingers into the thalamus. Inoperable. Is proton therapy an option for her?

Can proton therapy be used on recral cancer that has mestasized to the lungs

Brenda, thank you for reaching out. We consulted with Dr. Cahlon, and he responded that proton therapy is not typically used for metastatic cancers such as what you describe.

If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

Hello, how long after surgery for right flank Desmoid tumor, can proton trials and therapy begin? Should he have proton first or surgery first?
Thanks!

Hi, we are not able to answer personal medical questions on our blog. This is something you should discuss with your healthcare team. If you'd like to make an appointment for consultation at MSK, you can call 800-525-2225 during regular business hours or go to http://www.mskcc.org/experience/become-patient/appointment for more information. Thank you for your comment.

I have been diagnosed with prostate cancer in the right side of the prostate gland. My PSA was 8.8 and the Gleason score was 3+4. I am debating the pros and cons of IMRT vs. Proton Therapy vs. high dose brachytherapy. I'm interested in knowing if there is an article which compares the results and side effects of each.

Thank you for reaching out. There are a few studies that may be of interest, examining the use of IMRT combined with brachytherapy:

Comparison of high-dose (86.4 Gy) IMRT vs combined brachytherapy plus IMRT for intermediate-risk prostate cancer.

http://www.ncbi.nlm.nih.gov/pubmed/24447404

Combined brachytherapy with external beam radiotherapy for localized prostate cancer: reduced morbidity with an intraoperative brachytherapy planning technique and supplemental intensity-modulated radiation therapy.

http://www.ncbi.nlm.nih.gov/pubmed/18299108

For a consultation about whether proton therapy may be appropriate, contact the office of Oren Cahlon:

212-639-5219

If you want to make an appointment with a Memorial Sloan Kettering physician, you can call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment.

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