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Special report: Radiation therapy on trial

by Nancy Ryerson, Staff Writer | September 30, 2013
From the September 2013 issue of HealthCare Business News magazine

“I think a lot of the initial data from that study is from patients who were treated with an earlier form of proton therapy,” says Steven Frank, MD, associate professor of radiation oncology at the MD Anderson Cancer Center. “We here at MD Anderson have the most novel and newest form of proton therapy, which is intensity modulated proton therapy. It allows us to shape the radiation around the tumor, and avoid the radiation around structures.”

He says he understands why prostate has gotten so much attention, and agrees that proton therapy needs to demonstrate in a randomized trial that it’s truly better for patients in order to put the debate to rest.

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As the debate on the value of proton treatment for prostate cancer rages on, many centers continue to perform a large volume of head and neck cancer treatments. At Indiana Proton Therapy Center, for one, head and neck treatments make up 55 percent of its patient volume.

In preliminary studies, MD Anderson Cancer Center found a 50 percent reduction in feeding tube use when treating head and neck cancer compared with photon treatment. Randomized trials are in the works.

“There is currently an epidemic in this country of HPV-related head and neck cancer,” says Frank. “These tumors are affecting younger patients who are going to have to live with the side effects of treatments for 40 to 50 years, so proton therapy is ideal for them.”

The same logic follows for pediatric cancer treatment, as children have even longer to live with the effects of radiation.

Help for liver and lung
Other radiation therapy equipment manufacturers and oncologists are working to get treatments like SBRT (stereotactic body radiation therapy), which uses advanced localization and targeting technologies to treat cancer, into more clinical trials.

Early-stage lung cancer, for example, is starting to be treated with SBRT more frequently, says Calvin Huntzinger, senior director of surgical sciences at Varian. Recently, the National Comprehensive Cancer Network and the American College of Chest Physicians have both included SBRT for lung in their national guidelines.

Ironically, the treatment’s promising early results may be one factor holding it back from more clinical trials.

“It’s hard to get patients to agree to be randomized between radiotherapy and minimally invasive surgery, for example, when the early evidence for SBRT is so compelling, and they’re such different treatment modalities,” says Huntzinger.

He predicts that the increased support for screening of people at high-risk of developing lung cancer may also help drive an increase in SBRT treatment for the disease.

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