Pink Ribbon Symposium - Virtual Event
Dr. Raymond Mailhot presenting on Proton Therapy for Breast Cancer
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Clinical care and clinical research are essential to the UF Health Proton Therapy Institute’s mission. Our purpose is to give patients the best quality cancer treatment. Careful planning and attention to detail goes into every single patient treatment, beginning with the development of treatment protocols and clinical trials. We invest heavily in research because we want to see a day when all patients with cancer are cured and none are burdened with side effects of treatment.
Since opening in 2006, our clinical researchers have published more than 130 articles in peer-reviewed journals. The best available evidence in the field of proton therapy is presented in the current issue of the International Journal of Radiation Oncology Biology Physics. Among more than 70 articles accepted for publication in the issue, only 20 deal with actual treatment outcomes, including six UF Health Proton Therapy Institute articles reporting patient outcomes following proton therapy for five types of cancers – stage IIA - IIIB breast cancers; sinonasal cancers such as olfactory neuroblastoma, squamous carcinoma and adenoid cystic carcinoma; chordoma and chondrosarcomas of the sacrum, cervical spine and thoracolumbar spine; stage III non-small cell lung cancer; and stage T1 - T3 prostate cancers.
Our investment is paying off. Meaningful data is being generated that helps us understand the effect of proton therapy on many kinds of cancer and how patients’ bodies respond to the treatment. We are encouraged that proton therapy is able to meet or exceed standard treatment cure rates, often with a reduced risk of side effects. These discoveries lead to more exploration and will continuously improve patient treatment for years to come.
Stuart L. Klein
By Theresa Edwards Makrush
A positive attitude has taken 14-year-old Sophia Gall far. Even through a tough year of cancer diagnosis and treatment, Sophia continues smiling and is determined to find the good in a bad situation.
Her desire to make others aware of proton therapy and encourage other cancer patients, especially teens, prompted her to start a YouTube channel. She has posted several videos since the first week of January 2016 that describe her medical journey.
Because of the location of the tumor in her pelvis, Sophia was not a candidate for surgery. Her treatment option was a combination of chemotherapy and radiation therapy.
Sophia’s dad began researching radiation therapy options and discovered the benefits of proton therapy. Unfortunately, it is not available in Australia where the family lives, so he sent Sophia’s records to six proton therapy centers around world to get their opinion on whether they would accept her for treatment and estimates for the cost of treatment. Sophia’s radiation oncologists recommended that he include UF Health Proton Therapy Institute and Dr. Daniel J. Indelicato in the review. The physicians were comfortable with Dr. Danny and the program at the Institute – the treatment and the facility.
At the same time, he wrote to the Health Minister and other elected officials to petition support of expediting review of Sophia’s case by the health agency that could approve funding for proton therapy abroad. Time was critical since the window to begin radiation following chemo was limited.
According to her parents Linda Fleming (Gall) and Mark Gall, their daughter spent seven months in hospital for 22 rounds of chemotherapy that took a significant toll. Prior to her illness, Sophia was physically active, playing soccer and swimming competitively. She was involved in the theatre arts dancing and acting. The chemotherapy left her very weak and she either walked with support or was transported by wheelchair. She was on a feeding tube for six months and bedridden for four months. Her weight dropped to 87 pounds, which for her height of 5’10” was quite low.
Things started to turn for the better in early October after Sophia began a new steroid medication to control the persistent nausea and her pain medication was better managed. She started gaining weight, regaining her strength and feeling more like her usual self. Even more reason for optimism, scans confirmed that the tumor was responding to the chemo.
She flew from her home in Australia on January 18 to the United States for proton therapy in Jacksonville, Fla., at UF Health Proton Therapy Institute.
Her mom Linda added “There’s just no stress. You don’t have to worry about anything.”
While in Jacksonville, Sophia enjoyed shopping at the St. Augustine Premium Outlets, the St. Johns Town Center, the Avenues Mall and the shops in San Marco, which was within walking distance of the apartment they rented. Sophia remarked that she enjoyed being outdoors and even walked to her appointments at Nemours Children’s Specialty Care.
Ten weeks after arriving in Jacksonville, Sophia headed back home on March 27, looking forward to seeing her brother, friends and school. She is especially anticipating the eight-week school trip to Chiang Mai, Thailand, that they have been planning since she was five years old. Her mom Linda said, “The school principal told us even if he had to carry Sophia on his back, Sophia would go.” Indeed, Sophia’s positive attitude is taking her far.
By Theresa Edwards Makrush
A large-scale study of men treated with proton therapy for prostate cancer confirms proton therapy is a highly effective treatment for low-, intermediate-, and high-risk prostate cancer. The cohort of 1,327 men was treated at the University of Florida Health Proton Therapy Institute between 2006 and 2010 with median follow-up of five-and-a-half years.
Researchers report that 99 percent, 94 percent and 74 percent of men with low-, intermediate-, and high-risk prostate cancer, respectively, have no signs of cancer recurrence after five years of follow-up. Less than one percent (0.6 percent) in the cohort experienced serious gastrointestinal side effects and approximately three percent (2.9 percent) experienced serious urologic side effects.
“This study is the largest published series to date documenting the efficacy of dose-escalated proton therapy for localized prostate cancer with prospectively collected patient-reported quality of life and toxicity data,” reported lead researcher Curtis Bryant, M.D., M.P.H., UF Health Proton Therapy Institute radiation oncologist, in the article Five-Year Biochemical Results, Toxicity, and Patient-Reported Quality of Life Following Delivery of Dose-Escalated Image-Guided Proton Therapy for Prostate Cancer.1 The study is published in the International Journal of Radiation Oncology Biology Physics (IJROBP), the main journal of the American Society of Radiation Oncology (ASTRO).
The primary goal of the study was to find out if the results from three benchmark clinical trials2 with prospectively reported data by UF Health Proton Therapy Institute could be replicated in a larger population of unselected consecutive patients treated in a similar fashion. The researchers also wanted to identify factors that could predict either disease recurrence or urologic toxicity.
Proton therapy is a form of external beam radiation therapy that uses the positive-charged particles of atoms, protons, to deliver targeted treatment in cancerous tumors.
Tumor control data
The new study confirms similar results as the benchmark study for rate of tumor control in low-risk (both 99 percent) and high-risk prostate cancer (74 percent in the new study vs. 76 percent in the benchmark study). Intermediate-risk prostate cancer tumor control was slightly lower in the new study – 94 percent vs. 99 percent in the benchmark study. The reason for the difference in patient outcomes in intermediate-risk is unclear, researchers say, though may be related to a larger, broader sample of patients in the larger study. Overall, the presence of more than one intermediate-risk or high-risk factor may predict whether the disease will recur following treatment.
Toxicities were graded using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4). Incidence of serious urologic toxicity in the larger series study is 2.9 percent vs. 1 percent in the benchmark study. Incidence of serious gastrointestinal toxicity in the larger series study is consistent with the benchmark study, 0.6 percent and 0.5 percent, respectively.
The risk of developing a serious urologic toxicity appears to be higher in men who have one or more of the following predictive factors: a large prostate volume, pretreatment use of alpha blockers, pretreatment prostate reductive (TURP) procedures, diabetes, or a higher volume of bladder tissue receiving a dose of 30 Gy (RBE).
Quality of life data
Patient-reported quality of life scores following proton therapy for prostate cancer were good for urinary and bowel function, but significant decreases were seen in sexual function. Comparing pretreatment scores with scores at five years after treatment, the median baseline International Prostate Symptom Score remained unchanged. Similarly, the median and mean EPIC summary scores for bowel, urinary irritative/obstructive, and urinary incontinence domains remained relatively stable. The only significant change reported was in sexual function scores. Between baseline and 5 years, mean scores in patients not receiving hormone therapy declined from 67 to 53 and median sexual summary scores fell from 75 to 55.
Currently there are no published prospective clinical trials comparing proton therapy with other forms of external beam radiotherapy that use X-rays to treat prostate cancer, intensity modulated radiotherapy (IMRT) and 3-dimensional conformal photon radiation (3DCRT). A few retrospective studies comparing proton therapy and IMRT have been published in recent years, however, the reliability of the study conclusions is limited since the studies had short follow-up, lacked treatment-related information (e.g., radiation dose, field size), lacked toxicity grading and reporting, or lacked quality-of-life patient-reported outcomes. “Prospective comparative studies are needed for definitive comparison of proton therapy with IMRT,” concluded Bryant.
About prospective clinical trials
Prospective studies have an advantage over retrospective studies because they are prospectively designed to answer a specific study question. In addition, participants must meet specific criteria for inclusion and exclusion in order to reduce the chance that results will be confused by confounding variables. Finally, specific times and methods of collecting the information on cancer control and problems related to treatment are defined. These factors improve the quality of the data and potential reliability of the conclusions associated with these studies.
About proton therapy
Proton therapy is a type of radiation treatment that uses particles of an atom, protons, to deliver radiation. Protons have the potential to improve the therapeutic ratio in patients: delivering more curative dose in the tumor while delivering little or no dose to surrounding healthy tissue, thereby increasing the chance for cure and reducing the risk of side effects. Until recently, only a handful of academic medical centers in the U.S. were equipped with proton therapy. Today, 23 facilities offer proton therapy in the U.S, but access remains limited. Approximately one million people are treated with some form of radiation annually in the United States.3 Proton therapy accounts for an estimated one percent of those treated.
1. Bryant C, Smith TL, Henderson RH, Hoppe BS, Mendenhall WM, Nichols RC, Morris CG, Williams CR, Su Z, Li Z, Lee D, Mendenhall NP. Five-Year Biochemical Results, Toxicity, and Patient-Reported Quality of Life Following Delivery of Dose-Escalated Image-Guided Proton Therapy for Prostate Cancer. International Journal of Radiation, Oncology, Biology, Physics. 2016; 2016;95(1):435-43.
2. Mendenhall NP, Hoppe BS, Nichols RC, Mendenhall WM, Morris CG, Li Z, Su Z, Williams CR, Costa J, Henderson RH. Five-year outcomes from 3 prospective trials of image-guided proton therapy for prostate cancer. International Journal of Radiation, Oncology, Biology, Physics. 2014;88:596-602.
3. Statistics About Radiation Therapy. Rtanswers.org. Last modified June 13, 2013. Accessed April 18, 2016.
By Theresa Edwards Makrush
The University of Florida Health Proton Therapy Institute has announced vendor selections for its $39 million expansion and upgrades. The project is being managed by the University of Florida Planning, Design & Construction Division.
UF Health Proton Therapy Institute has signed an agreement with IBA (Ion Beam Applications S.A.) to install the proton therapy equipment manufacturer’s compact Proteus®One system. The single-room treatment system is the centerpiece of the multiphase project announced earlier this year. IBA will also install advanced treatment technologies to the existing proton therapy system.
The construction manager selected for the 10,000-square-foot expansion is Gilbane Building Company. The company’s Jacksonville office will oversee the project. Gilbane has extensive experience in building hospitals and health care facilities, including multiple proton therapy facilities in the United States.
The architectural firm chosen to design the expansion is Walker Architects, Inc. Based in Gainesville, Florida, recent projects include the renovation and expansion of the University of Florida’s J. Wayne Reitz Union.
The 12th Annual Play Golf. Fight Cancer.® Classic is scheduled for October 9 and 10. Mark your calendar and plan to join us at the World Golf Village, St. Augustine, Florida, for a fun event to raise money for the research program at UF Health Proton Therapy Institute. Sponsorships are available. For information contact firstname.lastname@example.org.
By Theresa Edwards Makrush
Every day in the UF Health Proton Therapy Institute main lobby, patients and their caregivers wield brushes, pencils, crayons, and knitting needles to paint, draw, color, knit, and sew their way to their daily proton therapy appointment. They are gently and expertly guided through art exploration by Pamela Gardener and Barbara Fryefield who are each professional artists.
Earlier this year, the artists-in-residence organized the patients in a group effort to create an art exhibit for display in the room where weekly patient luncheons are held. The theme of the exhibit is water. As noted on an exhibit description, water is everywhere in Jacksonville, and bodies of water can change color and appearance depending on the time of day, angle of light, or effects from other elements. “Our artists were asked to look at the water as they travel in and around Jacksonville. Here is what they saw.”
The water exhibit patient-created artwork is being sold to raise funds for art supplies. For more information, contact Development Director Molly Dworkin, email@example.com; 904-588-1519.
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The Precision Newsletter is an electronic-only publication that is distributed by email. Each issue is sent monthly to patients, alumni patients and friends of the University of Florida Health Proton Therapy Institute. As the official newsletter of the Institute, the content is compiled and prepared by our communications representative and approved by the editor Stuart Klein, executive director of UF Health Proton Therapy Institute. Special bulletin newsletters may occasionally be prepared when timely topics and new developments in proton therapy occur. If you would like to send a Letter to the Editor, please click here.
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