Recognizing Excellence in Radiation Oncology Practice and Education

Excellence in Radiation Oncology

Providing excellent patient care is fundamental at UF Health Proton Therapy Institute. This dedication extends to medical education, community education and advances in radiation oncology practice. We are proud of the commitment our employees make every day and applaud those who have recently received recognition for their exemplary efforts.

Julie A. Bradley, MD, was recognized as the 2016-17 Educator of the Year by the Association of Residents in Radiation Oncology for excellence in teaching, enthusiasm, and support for radiation oncology residency training. The award is presented in partnership with the American Society for Radiation Oncology (ASTRO).

Roi Dagan, MD, received the 2017 UF Department of Radiation Oncology Medical Student and Community Education Award. The award recognizes outstanding educational opportunities and mentoring to medical students and/or community education and outreach.

Daniel J. Indelicato, MD, was named 2017 Pioneer of Innovation by the Northeast Florida Pediatric Society. The award recognizes his leadership and development of the pediatric program at the UF Health Proton Therapy Institute.

Maria Mamalui-Hunter, PhD, received the 2017 UF Department of Radiation Oncology Medical Physics Education Award, recognizing a physicist who provides outstanding educational opportunities to graduate and/or postdoctoral students.

Bradlee Robbert, Patient Services Director, has recently become a fellow of the American College of Healthcare Executives

Executive Director Message

StuartKlein.pngAs an academic health institution, we develop and use treatments informed by clinical research. Our clinical research program tracks the outcomes data of thousands of patients treated with proton therapy. In fact, 98 percent of patients treated here participate in an outcomes registry study and 25 percent of patients are enrolled in clinical trials. The national average of participation in a clinical trial is three percent. We use this high-quality data to document the effectiveness of proton therapy and to develop additional cutting-edge clinical trials for future patients. 

This month, several of our physicians will present new research at the Particle Therapy Co-Operative Group’s (PTCOG) annual meeting in Japan, the largest international gathering of scientists, physicists and radiation oncologists who study and use protons. Presentations at PTCOG are often the first step to publishing research in medical journals. Ultimately, the goal of our clinical research is to realize the full potential of proton therapy to improve cancer patients’ lives.

Survivor Spotlight: Brandon Bell

Brandon Bell was 12 years old in 2010 when he was diagnosed with a brain tumor. At the time, his mother Sarah was studying to be a radiation therapist and knew about the benefits of proton therapy. She chose to have Brandon treated with proton therapy at UF Health Proton Therapy Institute in Jacksonville, even though it meant being away from their home in Scotland. “I wanted him to have the best outcome and the best chance to survive and for the tumor to be destroyed,” Sarah said. Now, nearly seven years later, Brandon has no sign of cancer and studies electrical engineering in a Glasgow college. He considers Jacksonville his second home and his family says he’s even picked up a bit of an American accent.

See more of Brandon’s story here.

Brain Tumor Treatment and Proton Therapy Clinical Trials

Rotondo_Ronny_Dr._0.jpgTreating brain tumors and central nervous system (CNS) tumors has been an integral part of the UF Health Proton Therapy Institute since day one. Two-thirds of the children we treat have brain tumors, most commonly craniopharyngiomas and ependymomas. Hundreds of adults and children have benefited from targeted proton therapy that effectively treats the tumor and reduces the risk of side effects. Ronny Rotondo, MD, CM, FRCPC, leads the brain tumor and CNS program, with expertise in pediatric and adult malignancies and base-of-skull tumors. Following is a Q&A with Dr. Rotondo about brain tumors and proton therapy.

Q: May is brain tumor awareness month. What should people know about this type of cancer?

A: There are many kinds of brain tumors. Tumors that arise in the brain can be malignant or benign. Sometimes tumors in the brain are caused by a cancer that has spread from another part of the body. The type of cancer determines the type of treatment which can include surgery, radiation and chemotherapy, often in combination.

Q: What are the symptoms of a brain tumor? How do you know when you should see a doctor?

A:   The signs and symptoms of a brain tumor vary greatly and depend on the brain tumor’s size, location and rate of growth. General signs and symptoms caused by brain tumors may include:

  • New onset or change in pattern of headaches, or headaches that gradually become more frequent and more severe
  • Unexplained nausea or vomiting, vision problems, hearing loss
  • Numbness, weakness, difficulty with balance, speech
  • Confusion/personality changes
  • Seizures, especially in someone who doesn’t have a history of seizures

Make an appointment with your doctor if you have persistent signs and symptoms that concern you.

Q: What role does proton therapy have in treating brain tumors?

A: The benefit of proton therapy is it can deliver high dose radiation to the tumor site while minimizing or even avoiding depositing radiation in other parts of the brain. The higher the dose of radiation, the better chance we have of controlling the tumor. By minimizing radiation to healthy brain tissue, we can reduce the loss of memory function and cognitive function. By minimizing or avoiding damage to critical structures near the brain, we can preserve vision, hearing and hormone function.

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Q:  And for children who have brain tumors, preserving healthy brain tissue can mean a lifetime of benefit.

A: That’s right. Proton therapy’s benefit is seen in both adults and children. We safely treat children who are as young as 18 months old. We can give children an excellent chance of survival and a good quality of life. Studies show that even small amounts of radiation exposure can have a negative impact on a developing child’s IQ. Because proton therapy deposits less radiation in healthy brain tissue than conventional X-ray radiation, we can have a better chance of preserving the child’s IQ.  

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Q: What would a patient experience while having proton therapy for a brain tumor?

A: Brain tumor patients are usually treated over a 5 ½ - 6 ½ week period. Prior to treatment starting, we take CT scans to accurately identify the treatment area. Custom devices are made for each patient, including immobilization masks and body molds. These enable us to position the patient in the exact same spot each day of treatment. Once the patient is in position, the proton beam is delivered for about one minute, during which the patient remains completely still. Overall treatment time is about 35-45 minutes (one hour door-to-door).

Q: Are there side effects?

A: Most patients tolerate treatment very well with minimal side effects. Some side effects may occur including fatigue, nausea/vomiting, headache, hair loss, skin irritation.  

Q: What is the success rate of proton therapy in treating brain tumors? 

A:  Success rates vary significantly depending on the type of brain tumor, spanning from benign or low-grade tumors with excellent long-term survival and more aggressive, high-grade tumors such as a glioblastoma multiforme (GBM) for which outcomes remain poor. 

Q: Is there more that can be done with protons for brain tumors?

A: We have ongoing research to explore opportunities to intensify treatment in some cases which may lead to improved outcomes. We are currently participating in a multi-institutional clinical trial funded by the National Cancer Institute for GBM tumors, the most common primary brain tumors. This study compares a higher radiation dose using proton radiation to the standard radiation dose using IMRT. Both groups will receive the standard chemotherapy, Temodar. The study will allow the researchers to better understand whether this higher dose technique is better, the same or worse than the standard approach. This study is geared towards newly diagnosed GBM. Recurrent tumors and patients who have received prior chemotherapy or radiation therapy for GBM are not eligible. Given patients on this trial must begin treatment within five weeks of surgery, prompt referral after surgery is essential, ideally within two weeks. For further information about this study, please call toll-free 877-686-6009.

Clinical Trials: Moving Proton Therapy Forward

Patient & Mendenhall2_1.jpgSince day one, UF Health Proton Therapy Institute has had an active clinical research program. As a result, the Institute has published more than 130 research articles in medical journals, documenting proton therapy techniques, some that have become the standard of care, and patient outcomes. With more proton therapy centers opening across the country, not only do more patients have access to the treatment, but also the Institute has more opportunities to collaborate on research.

Collaborative group clinical trials offer advantages for patients and researchers, said Amanda Durrance Prince, RN, BSN, CCRP, Assistant Director of Research Programs & Services. For patients it means access to cutting-edge treatment. For researchers it means advancing what is known about proton therapy at a more rapid pace. “Investigators have a larger pool of eligible patients and so clinical trials can enroll faster. Once enrollment is complete, researchers can analyze results, report their findings and move on to a new clinical trial that will answer the next question,” said Prince. 

But what is a clinical trial? Simply put, it is a scientific way to get answers to a specific question about an existing treatment. Some of the questions being asked in proton therapy clinical trials are: Can we reduce the number of treatments needed for effective treatment? Can we intensify treatment for better tumor control? Can we do less damage to normal healthy tissue? Can we improve upon other forms of radiation therapy?

The first joint clinical trial the Institute conducted was in 2009 with St. Jude Children’s Research Hospital, before it had its own proton therapy capability. Since then, the Institute has participated in multiple clinical trials with the renowned pediatric hospital and with other institutions such as MD Anderson and Mayo Clinic.  

Another type of collaborative research is cooperative group trials. There are several large national groups, such as the Radiation Therapy Oncology Group/NRG Oncology and the Children’s Oncology Group, that are funded by the National Cancer Institute. Its members are hundreds of clinical and laboratory investigators who combine their expertise in research. The Institute participates in several of these clinical trials, including the currently open-to-enrollment trial for patients with glioblastoma, an aggressive and the most common primary brain tumor, and another trial open for lung cancer patients.

More recently, proton therapy centers have started their own cooperative groups. The Institute currently participates in the Proton Collaborative Group and leads several studies. For example, Dr. Bradford Hoppe is the Principal Investigator for a proton therapy dose escalation lung cancer study.

So how does all of this benefit patients? It means that they will have the best possible treatment with the latest techniques for the best possible outcome. “At an academic center the standard of care won’t stay standard for long,” said Prince. “The investigators are always trying to come forward, move the treatment forward. Many researchers will look at the problem from different angles at the same time, it’s always moving forward.”

For a list of all open clinical trials, click here.

By Theresa Edwards Makrush

Honoring Our Nurses

We are fortunate to have so many exceptional nurses at UF Health Proton Therapy Institute. Their dedication to patients and the advancement of proton therapy research is beyond compare. With gratitude, we honor these amazing professionals during National Nurses Week (May 6-12).

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A Special Thank You

Thank you to all of our friends who helped to make the renovation of our Pediatric Recovery Room possible. The renovation is complete and we are thrilled with our new space. From all of us here at Proton, thank you so very much for your support.


Executive Director Message

StuartKlein.pngLast week, the U.S. Preventive Services Task Force issued new guidelines for prostate cancer screening. They recommend that men between the ages of 55 and 69 should discuss having a PSA blood test to screen for prostate cancer, a reversal of their 2012 position. We applaud this change. Too many men in recent years have been diagnosed at later stages of cancer, or when it has spread beyond the prostate, resulting in too many deaths. Early detection of prostate cancer saves lives. Treatment with proton therapy for early stage prostate cancer is very effective. Our five-year outcomes show 99 percent of men with low-risk prostate cancer are cancer-free and have an excellent quality of life. We encourage men, especially those who have a family history or who are African-American, to be screened. It could save your life.

Stuart L. Klein

Executive Director

Survivor Spotlight: Carlotta Cooley

Carlotta Cooley was diagnosed in 2008 with esthesioneuroblastoma, a rare cancerous tumor that occurs in the sinuses. Her surgeon told her that proton therapy was the only way to have radiation that would give her the best chance for cure and save her vision. She said the warmth and caring of the UF Health Proton Therapy Institute staff and other patients helped put her at ease and able to cope during treatment. Hear more of Carlotta’s story in this video.

Proton Therapy for Head and Neck Cancer

DSC0260_0_0.jpgDr. Roi Dagan, director of the head and neck program at the UF Health Proton Therapy Institute, is among the leading experts on proton therapy for this disease site. He will be in Japan next month to present research on head and neck cancer during the scientific sessions at the Particle Therapy Co-Operative Group’s 56th Annual Conference, the premier international proton therapy gathering of scientists and professionals. Following is a Q&A with Dr. Dagan about head and neck cancers and proton therapy.

Q: April is head and neck cancer awareness month. What should people know about this type of cancer?

A: Head and neck cancers are not one cancer. There are over 20 sites where cancers of the head and neck originate and many different types of cancers. Cancers can arise from the mouth, throat, nose, sinuses, voice box, skin of the face, and salivary glands. The most common cancer of the head and neck is called squamous cell carcinoma and arises from the lining of our mouth and throat. Head and neck cancers account for about three percent of all diagnosed cancers, and an estimated 50,000 people will be diagnosed in the US in 2017. 

The outcomes of patients with head and neck cancer, unlike some other cancers, will heavily depend on the quality and/or effectiveness of local therapies such as surgery and radiation. These tumors tend to not spread to other parts of the body unlike lung cancer or colon cancer. Also, the delicate normal tissues of the head and neck are integral to so many parts of our daily life, such as the way we look, how we speak and sound, or what we can eat. Although radiotherapy is very effective for many of these cancers, it can have a severe negative impact on quality of life, often resulting in significant pain from sores in the mouth and throat, loss of taste, severe dry mouth, and difficulty swallowing.

Because these cancers are rare and the anatomy of the head and neck is complex, treatment of these cancers should be performed at centers with multidisciplinary subspecialty expertise. Multiple studies have demonstrated improved survival and quality of life outcomes in patients with head and neck cancers treated at such centers.

Q: Are there ways to prevent head and neck cancer?

A: The best way to reduce your risk of a head and neck cancer is to stop smoking or using tobacco products like chewing tobacco or snuff. Heavy alcohol use is also a potential risk factor for developing head and neck cancer.

We are seeing an increase in cancers that occur in the oropharynx – the tonsils, tongue base, soft palate and pharyngeal wall – that are caused by the human papillomavirus (HPV). This is the same virus that leads to cervical cancer in women. One way to reduce the risk is to have the HPV vaccination. It is recommended for boys and girls beginning at age 11 to be vaccinated to reduce the risk.

Q: What about preventive screening?

A: There are really no standard screening tests. Because of the rarity of these cancers, population-based screening is not likely to be cost-effective. However, now most dental professionals will perform an oral cavity cancer screening exam during routine dental examination. 

Head and neck cancers are usually diagnosed when symptoms are present such as a lump in the neck, trouble swallowing, or a sore that doesn’t heal, bleeding from the mouth or throat, or a change in your voice (hoarseness). These can be symptoms of other less serious conditions, but you should talk to your doctor so the proper assessment can be made at as early a stage as possible.

Q: What role does proton therapy have in treating head and neck cancer?

A: The advantages of proton therapy over conventional techniques will vary by disease site in the head and neck. In some situations there will be clear advantages, and in others not. Generally, we can leverage these advantages in one of two ways depending on the specifics of each individual’s case. In some, we may use the advantages of proton therapy to increase the intensity of treatment without risking additional complications and/or side effects, and thereby, we can improve the probability of controlling the cancer. One example of this is in cancers that occur in the nasal cavity and surrounding sinus cavities where the use of aggressive surgery and conventional radiotherapy is limited by the adjacent delicate normal tissues, such as the eyes, visual pathways, and brainstem. Here, we have successfully applied more aggressive treatment, and our studies show that after proton therapy, more than 80 percent of patients are living without local disease recurrence following proton therapy (and 90 percent after complete resection and proton therapy). Historically, the best we ever did in this disease site with conventional therapy was 50 to 60 percent.

In cancers that occur in the salivary glands that are lateralized to one side of the neck and in oropharyngeal cancers, we are able to use proton therapy to reduce the side effects of therapy. Here, we can significantly reduce the severity and duration of taste loss, inability to swallow and development of mouth sores. Patients treated with protons don’t lose as much weight because they are able to tolerate the treatment better due to less radiation to normal healthy tissue.

Q: These seem like excellent results. Is there more that can be done with protons for head and neck cancer?

A: We are continuing to actively explore ways to better harness this technology. Recent improvements in proton delivery systems, image-guided therapy, and immobilization technology to better target the head and neck region could open up the doors for more patients with head and neck cancer to take advantages of proton therapy.


About This Newsletter

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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