Proton Therapy for Kids
More than 13 million children are diagnosed with cancer in the U.S. each year. Many of them will need radiation to destroy their tumors, but side effects can be scary. Now, a more precise form of the treatment that's been used in adults is also helping kids.
Four-year-old James and his twin sister Eleni have big plans for the future.
James told Ivanhoe, "I want to go to outer space!"
But James' first mission on earth is to get better. He was diagnosed with a brain tumor when he was three.
Kathy Contes, James' Mother told Ivanhoe, "The way that we understand it is the tumor was spreading with its fingers around the optic nerves."
James had two craniotomies to remove the tumor but he still needed radiation, a therapy that can cause harsh side effects, even memory or vision loss.
Andrew L. Chang, M.D., Radiation Oncologist at Scripps Proton Therapy Center in San Diego, California told Ivanhoe, "Children are especially susceptible to the side effects of radiation therapy because their bodies are still growing and developing."
But doctors offered James proton radiation. It uses a beam of protons rather than x-rays to kill cancer.
"Proton radiation is like a target rifle. It allows us to pinpoint just where we're going to give the radiation" Dr. Chang explained.
Doctors mapped out James' tumor and made 3D models. Then they used the proton radiation to precisely target the tumor, without affecting surrounding healthy tissue. That means fewer side effects.
James exclaimed, "We're going to ring the bell!"
After seven weeks of radiation James gets to ring a bell to celebrate his last treatment!
Kathy told Ivanhoe, "I'm feeling very hopeful."
For now, James' mission is accomplished.
Dr. Chang says there's greater than a 90-percent chance that James' tumor will not come back. Patients typically undergo the proton radiation five days a week for six to seven weeks at a time. With young patients, doctors use anesthesia to keep them calm and still during treatment.
Contributors to this news report include: Cyndy McGrath, Supervising Producer; Marsha Hitchcock, Field Producer; Cortni Spearman, Assistant Producer; Rusty Reed, Videographer and Jamison Koczan, Editor.
BACKGROUND: Every year about 13,500 children are diagnosed with some form of cancer in the United States. Currently there are 35,000 kids being treated for cancer and about 25-percent of all children diagnosed will die from it. Cancer kills more children than AIDS, asthma, diabetes, cystic fibrosis and congenital anomalies combined. Although the loss of anyone to cancer is traumatic, the death of a child is one of the most traumatic events a family may face. Families who have lost children are often financially and emotionally depleted. Cancer kills, but many children do survive and win the fight for cancer. Although the child may live, due to the harsh chemicals and radiation treatments they must endure to get to that point, the side effects can have a huge impact on their development. Cancer treatments can affect a child's growth, fertility, and endocrine system. Child survivors may be permanently immunologically suppressed. Radiation treatments to a child's brain could significantly damage the cognitive function of their brain. If radiation is given at a very young age, it could limit the ability to read, do basic math, tell time or even talk.
PROTON BEAM THERAPY: Proton beam therapy is a very precise pinpoint form of radiation therapy. Instead of burning away all of the tissue around the tumor along with it, proton therapy is able to pinpoint exactly where to give the radiation. This form of therapy is especially important for children because they are more susceptible to the side effects from the radiation therapy. Because their bodies are still growing and developing it is very important that doctors limit the amount of normal tissue that gets exposed to radiation. Before proton therapy, the only way to target brain tumors was through standard x-ray radiation therapy. It works well, but it has more side effects than proton beam therapy. Andrew L. Chang, MD, Radiation Oncologist of Scripps Proton Radiation Therapy Center says "Our focus isn't so much on just curing the cancer, but curing the cancer with the least side effects possible to give the best quality of life."
(Source: Andrew L. Chang, MD)
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Andrew L. Chang, M.D., Radiation Oncologist with a specialty in pediatric cancers at the Scripps Proton Radiation Therapy Center, talks about using proton radiation therapy in children.
Interview conducted by Ivanhoe Broadcast News in November 2014.
Is using the proton beam relatively new for someone as little as James?
Dr. Chang: Yes. Proton therapy has been around for many decades, but there were not very many of these centers. With the increasing numbers of proton centers, we're able to treat more and more cancers and children who may not have had access before are now able to get it more readily.
What is proton therapy?
Dr. Chang: Proton therapy is a very precise, pinpoint form of radiation therapy. I explain the difference to patients in this way; if one thinks of x-ray therapy like a shotgun that hits everything in the area, proton radiation would be like a target rifle that allows us to pinpoint just where we're going to give the radiation.
That's especially important for these little ones because they're still growing?
Dr. Chang: Exactly. Children are especially susceptible to the side effects from the radiation therapy because their bodies are still growing and developing. It's very important that we limit the amount of normal tissue that gets exposed to radiation.
With proton beam therapy, is it very targeted so less healthy tissue is damaged?
Dr. Chang: Yes. Proton therapy is very targeted so that allows us to minimize the amount of radiation that the normal healthy tissue would receive as compared to standard radiation.
Before proton therapy, how would children with tumors in their brain get radiation?
Dr. Chang: Before proton therapy, we would use x-ray based radiation therapy. It works very well but it has side effects. As we get better and better at curing cancer, our focus isn't now just curing the cancer, but curing the cancer with the least side effects possible to give the best quality of life.
How do you get a small child to stay still?
Dr. Chang: Radiation treatments are very straightforward in that they don't hurt, patients don't feel anything, hear anything or see anything. Trying to get a young child to stay still though can be very difficult and for that reason we use a little anesthesia. It puts them in a kind of deep sleep to help ensure that we're pointing radiation in the right area.
How fast does this procedure work?
Dr. Chang: The type of tumor that James has is something that we like to take out with surgery as much as possible. In his case, he had a tumor about the size of a grape that was left behind. What the radiation will do is shrink this grape and in essence shrivel it up like a grape becoming a raisin. Then, afterwards, it will stay a small scar for the rest of his life. What we want to do is make sure it never grows again.
Will it get rid of all the cancer?
Dr. Chang: Yes. James has a type of tumor that we can see where it is and are able to get around it very well. We have a very good chance of keeping this ever from coming back again.
Why didn't you take it out in the surgery?
Dr. Chang: For these types of tumors, we would like to take it all out in surgery if possible. James' tumor was right up against the nerves that control his vision as well as against the major blood vessels in that area. To go in to do more surgery could be quite dangerous. For that reason, we use radiation therapy.
Can you tell me about James' tumor?
Dr. Chang: James has a tumor called a craniopharyngioma which has components that are like little grapes and happens right in the middle of the brain. It often has a portion that is solid like a mass with a lot of little fluid filled bubbles next to it. These bubbles like to keep growing and will start pushing on the nerves and that's why they cause problems.
How likely would it be for the tumor to come back?
Dr. Chang: With the type of tumor that James has, after surgery and radiation treatment, like proton beam radiation, we have a very good chance of keeping this ever from coming back. Usually, an excess of 90-percent keeps it from ever becoming a problem again.
Can you walk me through what we're going to see in the proton therapy?
Dr. Chang: When a patient comes in for proton radiation therapy, the whole process takes about half an hour to 45 minutes. The majority of that time is spent making sure we're pointing the proton radiation right at the correct area. Because proton therapy is more precise than standard x-ray radiation, we have to take some extra measures to make sure we're pointing it in the correct area. We use several devices to help remind patients where to stay. After they are perfectly aligned, we will turn the protons on , which only last about 30 to 45 seconds for that treatment. At that point, we move around and treat from a different side.
How do you line up to know where the tumor is?
Dr. Chang: The general way we do radiation therapy is when a patient first comes to see me, I will make a mold of the body and then create a three-dimensional rendering which goes in my computer for me to plan exactly how the radiation goes in. With this three-dimensional reconstruction, I use MRIs, CT scans and the notes from the other doctors that take care of the patient to make sure that I'm pointing the radiation in the correct area. This planning process takes about two weeks. Once that's done, the patient actually starts radiation treatment on a daily basis.
How many days does the patient have radiation?
Dr. Chang: During the radiation planning process, the patient doesn't need to be here. But, once we start the radiation, it is done Monday through Friday five days a week for typically six to seven weeks of the treatment. The treatments themselves take only about 30 to 45 minutes. During each day's treatment, we line up using x-rays and various markers on the body to make sure I'm pointing right at the right area.
Are there any other risks?
Dr. Chang: Because the proton therapy is very accurate, we want to be very sure we line up a patient on a daily basis to make sure we're pointing in the right area. We are very accurate in terms of using the various bones of alignment and the various three dimensional renderings we've created of the body to make sure we're pointed in the right area. We aim to be within about one millimeter which is about a tenth of an inch of where we're trying to get.
How many different angles did you do for James?
Dr. Chang: In James' case, with his tumor right in the middle of the brain, I used three different beam angles to treat this. Typically I deliver the radiation from the right side to avoid the very sensitive left portion of the brain. This allows us then to be able to give him the best chances to grow and develop without any of the side effects of cognitive development.
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