Success for Mesothelioma Patients at New York Proton Center
August 3, 2020
Many patients know that proton therapy is a type of mesothelioma radiation therapy. Still, few may realize that proton therapy is one of the safest and most precise forms of cancer treatment available.
Since opening our innovative New York Proton Center over a year ago, our team has worked to maximize the potential of this new therapy for as many mesothelioma patients as possible.
New York Proton Center remains the only proton center in the state of New York, and features the most advanced type of radiation treatment in the world. In partnership with Memorial Sloan Kettering Cancer Center, Montefiore Health System and Mount Sinai Hospital, we are working closely to provide proton therapy to malignant mesothelioma patients across a spectrum of disease presentations.
Patients are traveling from across the United States, as far away as Texas and California, to receive this groundbreaking treatment.
Proton therapy is already proving its advantages relative to other forms of radiation, and mesothelioma patients are reaping the benefits.
Combination Mesothelioma Therapy Provides More Options
For most mesothelioma patients, chemotherapy is an important and necessary part of their treatment. Many of these patients may also need radiation therapy during the course of their disease.
It’s important to note, though, that additional treatment modalities often translate to increased risks of side effects. However, by dramatically decreasing or even eliminating the exposure of normal cells and organs to unnecessary irradiation, proton therapy has the ability to significantly reduce the toxicity burden compared to other radiation methods.
Proton therapy can also be more safely combined with chemotherapy and other systemic therapies such as immunotherapies.
Other radiation oncology techniques are not as highly targeted and ultraprecise as proton therapy. The increased safety and higher accuracy of this technique enable this advanced modality to be useful across many different presentations of mesothelioma.
Post-operative patients, patients who are not surgical candidates, patients with bulky and symptomatic disease, and patients who have progressed following prior chemotherapy, immunotherapy or surgery can all benefit from proton therapy.
When I was working at the University of Pennsylvania Abramson Cancer Center, I treated a young patient with sarcomatoid mesothelioma, a type that is notoriously difficult to treat. The conventional approach for this patient would have been systemic chemotherapy alone, but her expected response to treatment was quite limited.
Instead, we were able to treat this patient with definitive proton therapy alongside chemotherapy for mesothelioma. The patient tolerated the combination treatment quite well and extended her survival by about three years. In addition, she never progressed in the areas where she had bulky disease that was irradiated.
Proton therapy allows us to combine modalities not previously possible or treat large or difficult-to-treat tumors in patients who otherwise have limited treatment options.
New York Proton Center Celebrates a Year of Safe and Effective Treatment
After having published over 80 peer-reviewed scientific papers specifically assessing proton therapy, and demonstrating that proton therapy can reduce toxicities, better preserve quality of life and improve survival across a variety of malignancy types, I can truly say that we are able to offer patients the very best in radiation oncology care.
Between our 16 physicians with long-standing experience in the delivery of proton therapy before New York Proton Center ever opened, and our highly experienced proton therapy medical physicists, treatment planning dosimetrists and radiation therapists, our staff has a unique set of skills.
With our experienced team and the latest and most advanced type of proton therapy — pencil beam scanning proton therapy that can deliver intensity-modulated proton therapy — we are one of the few centers in the world that can treat the entire pleura with proton therapy.
In traditional photon radiation therapy, beams of energy travel through the patient. While this radiation targets disease in the pleura, it exposes the heart, esophagus, liver and lung on the opposite side to significant doses of irradiation that can lead to serious side effects.
Protons are heavier charged particles, allowing them to deposit all of their irradiation and stop at a specific depth — in this case, targeting the pleura and stopping before the opposite lung or any appreciable amount of heart or liver get exposed to collateral irradiation.
Thanks to the skill and experience of our team, we were able to begin treating mesothelioma patients right after opening our center a year ago. Many of our first patients came from our partners in New York City at Memorial Sloan Kettering, Mount Sinai and Montefiore.
The benefits of receiving mesothelioma treatment at high-volume centers are clear. A study I led in 2018 demonstrated that, compared to those treated at low-volume centers, patients experienced shorter hospital stays, fewer complications and lower readmission rates after surgery at high-volume centers.
Additionally, survival rates were also higher at high-volume centers.
We are seeing some patients referred to New York Proton Center who would not otherwise be candidates for traditional radiation. Typically, once a patient receives conventional radiation therapy to the chest, they are not a candidate for repeat radiotherapy.
However, with proton therapy, it is often possible that reirradiation can be delivered safely since the therapy can better protect normal tissues, allowing patients a new treatment option otherwise not possible.
A Bright Future for Proton Therapy
Proton therapy allows radiation therapy to be an effective treatment option for more mesothelioma patients than ever before. With the practice that we’ve built over the past year at the New York Proton Center, we hope to expand the availability of proton therapy.
The average age of mesothelioma patients is about 70 years, and Medicare regularly covers this treatment. For the less-common mesothelioma patient who does not have Medicare, many private insurance carriers generally approve the treatment due to its demonstrated benefits relative to other radiation modalities.
Some private insurance companies will initially deny proton therapy, but the majority of patients across all disease types get approved after an appeal process. I’ve actually never had a mesothelioma patient who did not get approval for proton therapy through their insurance.
Across the field, more physicians are using radiotherapy in combination with other treatments for mesothelioma. We’re seeing its effectiveness at controlling the disease, or palliating symptoms, and we’re able to protect healthy tissue through intensity-modulation proton or photon radiation therapy.
I see the future application and availability of proton therapy increasing substantially. Right now, only about 2% of radiation therapy is proton therapy, and only 36 proton centers are in operation nationally.
Notably, the majority of NCI-designated Comprehensive Cancer Centers have or are affiliated with proton centers, which speaks to the safety and effectiveness of the treatment.
I also expect to see immunotherapies for mesothelioma used more often with radiation therapy, including proton therapy. There is noteworthy preclinical evidence that these therapies can be synergistic, which may allow for improved outcomes for our patients.