100th Patient Treated with Proton Therapy at MedStar Georgetown University Hospital

WASHINGTON, D.C. – Physicians and hospital staff are celebrating the first 100 patients treated at the MedStar Georgetown University Hospital Proton Therapy Center, the first and only center of its kind in the Washington D.C. metropolitan area. Proton therapy is the latest cancer-fighting technology designed to shrink some previously untreatable tumors.

MedStar Georgetown providers with Proton therapy some patientsThe proton therapy system used by radiation oncologists at MedStar Georgetown is the most advanced cancer treatment technology currently available. Using pencil beam scanning (PBS) and HYPERSCAN™ technology, physicians can precisely target tumors anywhere in the body with minimal exposure to healthy tissues. This is especially beneficial for younger patients, who have a higher likelihood of living many years after their cancer has been cured.

“With conventional radiation, when we aim at a target, there’s full dose radiation in front of the target and full dose radiation beyond the target. With the protons, they can stop in the center of the tumor,” says Brian Collins, MD, clinical director of the Proton Therapy Center.

“There are certain types of cancer where you have to deliver a very high dose of radiation right next to a critical structure like the spinal cord or brainstem,” says Radiation Oncologist Sonali Rudra, MD, “So, for some patients, proton therapy might be their only radiation treatment option.”

MedStar Georgtown's 100th Proton Therapy PatientThe center’s 100th patient, Kathleen Norris of Lexington Park, Maryland, began receiving proton therapy treatments in April for her inoperable lung cancer. Proton therapy helps Norris’ care team avoid targeting critical nearby organs, like the heart, that may be damaged by conventional x-ray radiation. Norris says she’s thankful for the opportunity to fight her cancer battle with cutting-edge tools never-before available in her area.

“This proton is so advanced.  It was able to hit my cancer without damaging my other tissues and it could avoid my heart.  I’m so glad.  The tumor has already shrunk by forty percent,” Norris said. “I’ve done really well. I’ve been very lucky.”

In March 2018, Martha Ramos, a mother of two from Germantown, Maryland, became the first patient treated by doctors at the MedStar Georgetown University Hospital Proton Therapy Center. Before treatment, Ramos underwent multiple operations to remove a non-cancerous recurring brain tumor. Some cells deep in the brain could not be removed in surgery. Proton therapy eradicated those remaining cells and preserved her quality of life.

“I want to have more time to be a mom to my children. I want to be very healthy so I can be there for them and help them in life,” Ramos said after treatment. “I am very, very grateful that my medical team at MedStar Georgetown told me about proton therapy. I now look forward to a long and happy life.”

Since proton therapy was approved by the Food and Drug Administration in 1988, over 75,000 patients have been treated at only about 30 centers across the United States. Now, patients have access to this state-of-the-art technology in Washington D.C.

National Cancer Institute Renews Prestigious Designation of Georgetown Lombardi Comprehensive Cancer Center

(Washington, D.C) - MedStar Georgetown University Hospital is proud to announce that the National Cancer Institute (NCI) has once again designated its research partner, Georgetown Lombardi Comprehensive Cancer Center, with its coveted distinction, "comprehensive cancer center."

First awarded to Georgetown Lombardi in 1974, MedStar Georgetown University Hospital serves as one of the cancer center’s primary hospital affiliates in Washington D.C.  Additionally, for the first time, MedStar Washington Hospital Center was also named as a Georgetown Lombardi primary hospital affiliate. 

"As the only NCI-designated comprehensive cancer center in the District of Columbia, we’re able to offer a comprehensive suite of services to our patients, providing them with research-inspired cancer care that they simply can't get anywhere else," says Dr. Louis M. Weiner, director of Georgetown Lombardi and the MedStar Georgetown Cancer Institute.

The MedStar Georgetown Cancer Institute combines medical expertise, the latest therapies, and research across the region. "What makes us special is the concept of cura personalis, or the care of the whole person. We don't treat diseases – we use evidence-based medicine to treat people in the context of their own lives, families, and communities. Having cancer is very frightening. Being a cancer patient can be a lonely journey.  At our hospital, you're going to be treated like a person, not like a disease," says Dr. Weiner. 

Of the 1,500 cancer programs in the United States, only 50 have this prestigious designation and Georgetown Lombardi is the only such center in the Washington, D.C. area.  

In order to renew its NCI designation, the cancer program in 2018 went through a rigorous, peer-reviewed grant renewal process conducted by cancer center experts from across the country. The renewal occurs every three to five years.

M. Joy Drass, MD, Executive Vice President and Chief Operating Officer of MedStar Health, says, "As the clinical partner for Georgetown Lombardi, our patients receive personalized care from physicians who are also, through innovative clinical trial research, offering breakthrough advancements in diagnostics, new technologies, and novel therapeutics. Our long-standing partnership provides patients with unparalleled access to a multidisciplinary team of experts, clinicians, and researchers who are leading the way in how cancer is detected and treated."

The NCI approved Georgetown Lombardi as a "consortium center" reflecting an integrated cancer research program with John Theurer Cancer Center, part of Hackensack Meridian Health in New Jersey. MedStar Georgetown, Georgetown Lombardi, and John Theurer began their clinical and research relationship in 2013 through which the world-class Bone Marrow and Blood Stem Cell Transplant Program at MedStar Georgetown was established. Because of this program MedStar Georgetown has been able to offer patients with blood cancers the latest in bone marrow transplantation, CAR T cell therapy and other new immunotherapies that require the infusion of cells into people to attack cancer.

Cancer-fighting technologies like proton therapy, which opened at MedStar Georgetown in 2018, and CyberKnife that has been used to treat cancers at the hospital since 2002 are also examples of the cutting-edge care available to treat patients in the region. 

The NCI designation as a comprehensive cancer center indicates that Georgetown Lombardi excels in laboratory science, clinical research and population-based programs, along with robust translational research that bridges these areas. It also demonstrates expansive public education and outreach capabilities, which focus on the community.

The populations in Washington, D.C., and in Bergen County, New Jersey, where the John Theurer Cancer Center is located have some of the highest cancer incidence and death rates in the country. Georgetown Lombardi researchers are working on new ways to address the underlying causes so that strategies to address these health disparities can be implemented and refined.

Edward B. Healton, MD, MPH, Executive Vice President for Health Sciences and Executive Dean of the medical school at Georgetown University Medical Center underscores the critical role of Georgetown Lombardi in the communities it serves.

"An important aspect of the research, outreach and education activities carried out at Georgetown Lombardi focuses on eliminating disparities in minority and medically underserved populations," Healton says. "This is especially important in the communities served by both Georgetown and Hackensack, as our special collaboration has the potential to be deeply impactful."

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Continence Confidence: Prostatectomy Patients Reporting ‘Startling’ Success After Robotic Retzius-Sparing Surgery

For healthcare industry executive Sean Hawkins, prostate cancer runs in the family. After his own diagnosis last year, the then 49-year-old already knew the potential challenges of treatment -- including losing control of his bladder. However, a breakthrough method of prostate surgery known as Retzius-sparing is now eliminating continence issues for many men treated at MedStar Georgetown University Hospital.

MedStar Georgetown Patient Sean Hawkins“You go through all sorts of mental gymnastics when you’re confronted with cancer,” he says. “My main concern was the ability to get back to normal.”

After consulting with MedStar Georgetown urological surgeon Keith Kowalczyk, MD, Hawkins learned that he was a candidate for radical prostatectomy – or removal of his entire prostate. Despite the possibility of temporary (and sometimes permanent) continence issues, Hawkins was willing to make difficult sacrifices for another chance at a cancer-free life.

“The first thing people do is go to the store and buy the 300-count diapers,” he says. “I had diapers under my desk and meetings were spaced out to allow for bathroom breaks. I built in contingencies to anticipate a lot more frequency. I was also sort of budgeting coffee and fluid intake.”

After a successful surgery, Hawkins returned to work only 2 weeks later. He sat through his first round of meetings without a continence problem.

“I didn’t really have any major issues. I kept waiting and wearing the diapers and pads as a precaution. I worried about getting up or sneezing,” he says. “I was tempted to text Dr. Kowalczyk and ask if there was something going on, because I wasn’t having the control problems I anticipated. It was startling for sure.”

During his prostatectomy, Hawkins was one of the first patients to undergo the new Retzius-sparing approach; a more technically advanced, robotically-assisted technique. Kowalczyk, who specializes in robotic surgery, learned the approach from urological surgeons in Italy. He says Retizus-sparing removes the prostate by way of an alternate route, preserving attachments to the bladder and urethra that may play a key role in continence preservation. He is part of a small group of urological surgeons in the United States now performing the procedure on a regular basis.

“The big advantage is that these patients become continent much earlier, sometimes immediately” says Dr. Kowalczyk. “Patients getting the standard approach do well -- but it tends to be a much slower process, sometimes up to a year, in regaining their continence.  This is likely due to the need to cut through crucial suspension ligaments that seem to be important in maintaining continence.”

Kowalczyk says traditionally, prostatectomy patients can wait from 6 months up to a year to regain continence, if it comes back at all. In patients who have undergone the Retzius-sparing surgery at MedStar Georgetown, 96% of patients regained adequate urinary continence after only 6 weeks, with only 23% wearing one “safety” pad just for reassurance even if not needed.

Hawkins with his Family“I can really confidently tell my patients now that this should not be a problem,” Kowalczyk says. “They’ve just been doing astonishingly well.”

For some patients, like Hawkins, incontinence is never a problem at all. Aside from a healing incision scar, he reports no other side effects or complaints from the surgery. Considering all possible outcomes, Hawkins says his journey from the prostate cancer diagnosis to recovery has been a smooth one.

“I’m very fortunate and thankful. From the minute I walked into the hospital to the minute I was wheeled out, I couldn’t have asked for faster, better treatment. To be able to say that out loud in an affirmative manner is very important to me.”

Watch the video below as Dr. Kowalczyk answers commonly asked question about prostate cancer and the use of robotic surgery to treat prostate cancer. 

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Georgetown-Led Study Leads to First FDA-Approved Drug in Decades to Improve Survival in Small Cell Lung Cancer

The U.S. Food and Drug Administration’s approval today of atezolizumab (Tecentriq®, Genentech) in combination with chemotherapy for the initial treatment of extensive-stage small cell lung cancer (SCLC) marks the end of numerous failed attempts to improve survival for people with the deadly disease.

“This is monumental for lung cancer patients,” says Stephen Liu, MD, an oncologist at MedStar Georgetown University Hospital who specializes in treating lung cancer and co-led the clinical trial leading to today’s approval through the Georgetown Lombardi Comprehensive Cancer Center. “Atezolizumab allowed us to achieve what for we thought for decades was beyond reach: an improvement in survival for these patients.”

Small cell lung cancer makes up about 10 to 15 percent of all lung cancers in the United States.  Almost all people who develop small cell lung cancer have a history of smoking, and, according to the American Cancer Society only about six percent of people with the disease survive five years or more.

“Since the 1980s, our standard treatment for small cell lung cancer has been platinum-based chemotherapy. This regimen reliably provides an initial response that is often dramatic, but almost always short-lived,” says Liu.

The regimen of carboplatin, etoposide and atezolizumab was first explored in an investigator-initiated trial at Georgetown Lombardi in 2016. It soon gave way to the global phase III IMpower 133 trial. Liu and Leora Horn, MD, of Vanderbilt University Medical Center, served as co-principal investigators of the study.

Results were first presented by Liu at the World Conference on Lung Cancer in September 2018 and simultaneously published in The New England Journal of Medicine.

The international, randomized, double-blind, placebo-controlled trial, compared standard chemotherapy alone or given concurrently with atezolizumab, an anti-PD-L1 antibody. The addition of atezolizumab extended overall survival for a median of 10.3 months to 12.3 months without notably increasing side effects. As of now, there has only been about one year of follow-up so the full potential of atezolizumab is not yet known, Liu says.

“In the context of over 40 failed phase III clinical trials, the improvement in survival seen with atezolizumab represents an important achievement,” Liu says.  

 “As SCLC is an unforgiving disease,” says Liu, “our first attempt at treatment is often our only chance to impact the natural history of this highly lethal cancer.”

The National Comprehensive Cancer Network (NCCN) has added atezolizumab to its treatment guidelines as the preferred treatment for extensive stage SCLC.

 “With the addition of atezolizumab to chemotherapy, we have finally moved the needle in SCLC,” says Liu. “It is now our charge to build upon these results and ensure that the next major advance is not another 20 years away.”

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Disclosure: Liu reports having received advisory board/consulting fees Apollomics, AstraZeneca, Bristol-Myers Squibb, Celgene, Genentech, Lilly, Merck, Pfizer, Regeneron, Taiho, Takeda.


Click the video below to watch Dr. Stephen Liu talk about cancer of the lung, head & neck and explain why getting involved in clinical trials for these conditions can be of great benefit for some patients, regardless of the stage of their disease.

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Large Study Reveals Long-Term Outcomes for Prostate Cancer Patients Treated with High Dose, Short Term Radiation like CyberKnife Radiotherapy

WASHINGTON –– A large, national study examining a radiation treatment for prostate cancer––popular because it delivers a high dose of therapy in a very short time frame––supports its routine use. 

The study, conducted at cancer centers around the United States including at Georgetown Lombardi Comprehensive Cancer Center, looks at long term follow up data for stereotactic body radiotherapy (SBRT) used to treat more than 2,100 men with prostate cancer that had a low or intermediate risk of recurring.

The results were published Feb. 8 in the journal JAMA Network Open.

At MedStar Georgetown University Hospital, the therapy is delivered by a system called CyberKnife, which delivers high doses of radiation precisely aimed to minimize the involvement of healthy surrounding tissue.

Radiation oncologist Sean P. Collins, MD, PhD, says curative treatment is a shared goal along with maintaining a person’s quality of life.  Side effects, including impotence, can occur with all treatments for prostate cancer and can happen years after treatment.

“While it is necessary to observe these men for decades, our interim seven-year data show that survival and side effects are comparable to other forms of radiotherapy,” says Collins, director of the CyberKnife Prostate Program at MedStar Georgetown University Hospital and an associate professor of radiation medicine at Georgetown University. 

The National Comprehensive Cancer Network, which establishes cancer treatment guidelines, classified SBRT as an alternative to conventional therapy, but had noted a lack of long term follow up data. There is much more experience with conventionally fractionated radiation therapy, delivered five times a week for up to nine weeks, and brachytherapy, in which radioactive seeds are implanted in the prostate.

“Our findings give us great confidence that CyberKnife should become a standard option for some men who want to avoid the hassle and inconvenience of standard therapy,” Collins says.

 

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Collins reports receiving grants from and being a paid consultant for Accuray Inc., the maker of CyberKnife.

 

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Prostate Cancer Patient Does His Research and Chooses Proton Therapy to Treat His Aggressive Disease

Dr.-Lischalk-with-Denwiddie(Washington, D.C.)  When Melvin Denwiddie, 73 was diagnosed with prostate cancer in late 2016 his physicians first told him the “watch and wait” strategy would be sufficient.  But in 2017 further testing showed that his cancer had become more aggressive and it was time to get treated.

“My prostate cancer was potentially fatal if I didn’t start treatment,” says Denwiddie. “My choices were surgery to remove the prostate, traditional radiation or proton radiation,” says the great-grandfather of three. “I did my research and I wanted proton therapy.  I found that proton therapy would be the most accurate; it would follow the shape of my tumor and would penetrate only the tumor and not any of the tissue outside of the tumor.  That was very important to me.”

That’s when he found proton therapy at MedStar Georgetown University Hospital and his radiation oncologist, Jonathan Lischalk, MD.

“It’s important to sit down with patients and discuss their treatment options,” says Dr. Lischalk. “For localized prostate cancer, a variety of treatment options exist including surgery and radiation therapy.  Even within radiation therapy, many options exist including proton therapy, x-ray-based therapy, and brachytherapy.  Helping a patient understand his treatment options, the related side effects, and the clinical outcomes is extremely important.”

The proton therapy system at MedStar Georgetown is the first and only in the Washington, D.C. metropolitan area and is the first in the world to offer proton therapy with HYPERSCAN™ technology. HYPERSCAN produces beams that are sharper than other proton systems and treats patients faster.

Denwiddie received 43 proton treatments over the course of July through September 2018.

“From my standpoint, proton therapy is a very good treatment process. It was not invasive, it wasn’t painful and I experienced very few side effects,” says Denwiddie.  “Aside from my bladder becoming overactive, it was a pretty easy treatment from beginning to end.  And any side effects I had are getting better.”

With proton therapy complete, Denwiddie continues with hormone treatments for his prostate cancer under the care of his urology team at MedStar Georgetown.

Denwiddie with Dr. Lischalk in an exam room
Melvin Denwiddie (left) and Dr. Lischalk (right)

“Proton therapy is proving to be an excellent option for prostate cancer treatment,” say Ryan Hankins, MD, a urologist at MedStar Georgetown University Hospital. “From a urology standpoint, I am able to use a small needle through the skin to place the needed fiducial markers and gel spacer to help improve patient outcomes and make proton therapy more precise. This is done with no incisions on the skin. Dr. Lischalk and I also coordinate patient visits to help make the patient's visit to MedStar Georgetown as seamless as possible.”

Denwiddie is a retired accountant for NASA but continues to prepare tax returns and represent clients before the Internal Revenue Service. “It’s a labor of love I’ve been practicing since 1972.  It’s such a pleasure to know that I can continue to help people when they need it in this way.”

With his wife of more than 50 years newly retired and his prostate cancer treated, Denwiddie looks to the future with optimism and excitement.

“I feel confident that this prostate cancer is a thing of the past. The rest of my life, I’m looking forward to enjoying the freedom and flexibility to move around and travel with my wife.  That includes visiting family and places I haven’t had the opportunity to see yet. I’m very excited about my future.”

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For Some Bladder Cancer Patients, Simple Test Could Reduce Over-Treatment, Ease High Cost

WASHINGTON — Bladder cancer is relatively common and imposes the highest per patient cost on the U.S. health care system than the management of any other cancer type. Now, a new test could be key to reducing the cost of care while at the same time, relieving some patients of unneeded over-treatment, say investigators led by Georgetown Lombardi Comprehensive Cancer Center researchers.

Deciding whether to treat bladder cancer aggressively has been difficult — predictive diagnostic data is limited.  Up to 70 percent of patients treated for early stage lesions that have not invaded the bladder wall will experience recurrence of these lesions, and 20 percent of these patients will develop an invasive cancer. 

Because clinicians do not know which tumors will become dangerous, they err on the side of caution and perform an extremely intensive post-surgery surveillance regimen, including cystoscopy (a lighted optical scope that examines the inside of the bladder) as frequently as every three months for two years after removal of the tumor, and every 6-12 months for the years after.

The Georgetown-led investigators offer a new solution to the dilemma. They have found that a fairly simple test that significantly improves the identification of bladder tumors that will likely become invasive.

The study, published in Clinical Cancer Research, “validates this test that helps predict whether an early stage bladder cancer will recur and progress,” says the study’s senior author, Todd Waldman, MD, PhD, a professor of oncology at Georgetown.

Working with researchers from the U.S. and Denmark, Waldman has found that, compared with using current diagnostic procedures, the new test is 2.4 times more accurate in identifying tumors likely to recur after treatment, and 1.9 times more accurate at predicting which tumors will likely to progress, invade the bladder wall and spread.

The test involves examining bladder tumors that had been removed during initial surgery for over expression of the STAG2 gene, which Waldman earlier identified as key to development of potentially deadly bladder tumors.

Checking for STAG2 is a “very simple and very robust” procedure for pathologists who routinely examine excised tumors, Waldman says. His studies have described how to run this test.

Using the test could, in some cases, spare patients constant surveillance and, in others, support forgoing aggressive treatment that can produce significant side effects, the researchers say.

So Waldman and his colleagues have worked on a diagnostic test for years. This study summed up several of those clinical studies, concluding that using the test “offers additional two-fold predictive discrimination,” Waldman says.

“We are closer to our goal of lowering the risk of both aggressive bladder cancer and over-surveillance and treatment side effects in bladder cancer patients,” he says. “In principle, it might be possible to reduce the frequency of post-resection surveillance and therapy in patients whose cancer is STAG2-negative, and, conversely, treat patients and keep up high frequency surveillance in patients who have positive test results.”

The study’s first author is Alana Lelo, an MD/PhD candidate at Georgetown University School of Medicine.  Additional Georgetown authors include Deborah L. Berry, PhD, Brent Harris, MD, PhD, George Philips, MD, Krysta Chaldekas, and Jung-Sik Kim, PhD. Frederik Prip, Lars Dyrskjøt, PhD, Jørgen Bjerggaard Jensen, MD, are from Aarhus University Hospital, Denmark; Jeffry Simko, MD, PhD, and David Solomon, MD, PhD, are from the University of California San Francisco School of Medicine; Ciaran Mannion, MD, and Pritish Bhattacharyya, MD, are from Hackensack University Medical Center, New Jersey, and Anagha Kumar, MD, is from MedStar Health Research Institute in Washington D.C.

The authors declare no potential conflicts of interest.

This work was supported by the National Cancer Institute grants (R01CA169345, T32CA009686, DP5OD021403), and Cancer Center Support Grant (P30CA051008) to the Histopathology and Tissue Shared Resource); the Danish Cancer Society; the National Center For Advancing Translational Sciences of the National Institutes of Health (TL1TR001431); and institutional funds from the John Theurer Cancer Center at Hackensack University Medical Center.

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Women Replacing Breast Implants with Their Own Tissue, a Growing Trend

(Washington, D.C.) – When Cynthia Davis of Virginia was diagnosed with breast cancer in 2015 she elected a double mastectomy with implants.  Before her surgery she had chemo therapy.  Radiation followed.

As she recovered and went back to her active and athletic lifestyle that included bicycling, yoga and weight lifting, Davis noticed that she was experiencing pain and irritation associated with her implants.   

“The more active you are the more you use your chest wall,” says Davis now age 60.  “If you’re not doing anything it doesn’t bother you, but I went back to bike riding, the gym and yoga and the more I did, the more it bothered me.”

Cindi-Davis-with-paddle

In 2017, Davis saw an opportunity to try a new sport. Having rowed years earlier, she knew she enjoyed water sports. Last summer, she found and joined “GoPink!DC”  - a dragon boat team made up of breast cancer survivors and supporters.

“The more I paddled with the team, the more uncomfortable my chest became.  I realized that if I wanted to continue being active and do well on this team, I was going to have to do something about the implants.”

Davis also noticed that cosmetically, because the implants were placed under her chest wall muscles that her breasts appeared to flex and there were certain yoga poses that were not possible because of her implants.

“A large part of my practice is fixing previous reconstructions with breast implants and replacing them with a woman’s own tissue,” says David H. Song, MD, Physician Executive Director of Plastic Surgery for MedStar Health and Chairman of Plastic Surgery at MedStar Georgetown University Hospital.

Davis went to see Dr. Song at MedStar Georgetown where he recommended a procedure that would replace her implants with her own tissue and make her more comfortable. The procedure Dr. Song recommended is called DIEP flap in which blood vessels called deep inferior epigastric perforators, as well as the skin and fat connected to them are removed from the lower abdomen and transplanted into the chest.

Dragon-Boat-teamDavis had the surgery in March of 2018.

“I’m thrilled,” says Davis.

“I woke up in recovery with the implants gone and when they asked me what my pain number was, I almost cried because I realized the pain in my chest was gone. Even with the stitches the pain was gone. I traded in my implants for a double DIEP.”

Davis had the surgery on a Wednesday and went home from the hospital four days later.

The DIEP flap procedure is performed using a surface incision from hip to hip.  Dr. Song says the use of a non-opioid pain medication called Exparel™ has been a “game changer.” 

“I believe that more than 90 percent of women needing breast reconstruction are candidates for a tissue-based procedure,” says Dr. Song.  “I can take tissue from the tummy, thigh, buttocks or back. In the case of a DIEP flap, patients get a tummy tuck and a breast reconstruction at the same time.”

In addition to DIEP flap, there are as many as 4 additional procedures that Dr. Song performs that use a woman’s own tissue for reconstruction.

(Video courtesy of Robin Barr)

Radiation therapy for breast cancer after reconstruction with implants is associated with complications. 

“Radiated implants put women at greater risk of pain, discomfort, hardened breasts and even ruptured implants,” says Dr. Song. “With radiation, the success rate for implants after five years is only about 65 percent.  The life span of implants is 10-14 years; when using your own tissue, once you’re done, you’re done.”

“I’m back to paddling with GoPink!DC twice a week,” says Davis.  “By the end of the summer I will be racing, and I’ll be pain free.”

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MedStar Georgetown First and Only Center in the Washington, D.C. Metropolitan Region to Offer Proton Therapy for Cancer Patients

Dr. Brain Collins with MedStar Georgetown’s first patient to receive proton therapy.(Washington, D.C) April 17, 2018- For the first time, cancer patients in the Washington, D.C. metropolitan region have access to the latest cancer-fighting technology, proton radiation therapy, now available at the MedStar Georgetown University Hospital Proton Therapy Center.

Martha Ramos, 53 of Maryland became MedStar Georgetown’s first patient to receive proton therapy.  Ramos is being treated for recurrence of a brain tumor.  

“It’s encouraging to know that this kind of radiation will result in less damage to the healthy area of my brain,” says Ramos. 

Proton therapy is more precise and targeted than conventional radiation. It works by using pencil beam scanning, similar to a 3D printer, to match the tumor’s exact shape and size with superior accuracy that eliminates the exit dose of traditional radiation, and spares healthy tissue.

MedStar Georgetown is the first and only proton center in the world to offer the Mevion S250i with HYPERSCAN™ technology, producing beams that are sharper than previous proton systems. Proton therapy with HYPERSCAN is also faster than other proton systems, benefiting patients whose treatment includes holding their breath.

“I am extremely excited to be able to offer this latest advancement, proton therapy, to my patients,” says Brian Collins, MD, a radiation oncologist and clinical director of the new proton therapy center.  “It’s clear that this treatment will help to improve the clinical outcomes for our cancer patients and decrease their side effects when radiation is needed.”

 “In certain cases, proton therapy can be a game changer,” says Keith Unger, MD, radiation oncologist at MedStar Georgetown.  “It allows us to treat cancers where traditional radiation might not even be possible."

How Protons Destroy Cancer

“Proton therapy is an advanced form of radiation that can destroy cancer cells,” says Peter Ahn, MD, a radiation oncologist at MedStar Georgetown.  “A machine called a cyclotron speeds up protons to two thirds the speed of light and they become highly charged.  These high energy protons are then delivered to the tumor as an invisible beam that eradicates the cancer.  Because we can more tightly control the protons than we are able with traditional radiation, proton therapy can be given without damaging critical tissues and structures near the tumor because the beam conforms  precisely to the tumor’s size and shape, sparing healthy tissue.”

Advantages of HYPERSCAN™

HYPERSCAN is an FDA-approved proprietary technology that has advantages over existing proton therapy systems. In addition to producing a micro beam that is sharper than many current proton systems and reducing damage to nearby healthy tissue, HYPERSCAN is also faster than other pencil beam scanning systems which can reduce the margin of error in treating tumors that are affected by breathing or organ motion.  This improves both treatment accuracy and patient comfort as patients need to spend less time lying still.

“HYPERSCAN is currently the most precise type of proton therapy in the world,” says Dr. Ahn. 

“Proton therapy with HYPERSCAN can be given from head to toe,” says Dr. Collins.

Cancer Treatment for Patients with Fewer Side Effects

Proton therapy is beneficial for pediatric cancer patients because it lowers their exposure to radiation avoiding unnecessary exposure to healthy tissue and resulting in less growth impairment as they grow up.  Children are less likely to develop a secondary cancer later in life when treated with proton therapy as it treats tumors while keeping health surrounding tissues unharmed.

proton therapy patient with doctorProton therapy is also effective in treating re-current tumors.

 “There are also certain types of cancer where you have to deliver a very high dose of radiation right next to a critical structure like the spinal cord or brainstem,” says Sonali Rudra, MD, radiation oncologist at MedStar Georgetown. “With proton therapy we can deliver a high dose to the area we are trying to target and minimize the radiation beyond the tumor.  So for some patients, proton therapy might be their only radiation treatment option.”

“Proton therapy can also be a good option for patients with left-sided breast cancer, which is close to the heart,” says Dr. Rudra. “When indicated for breast cancer, using proton therapy instead of traditional radiation means more control over the radiation itself and less potential damage to the heart and lungs.”

Proton Therapy Closer to Home and Under One Roof

“The addition of proton therapy is a logical next step for a center like MedStar Georgetown as part of the Lombardi Comprehensive Cancer Center, dedicated to and recognized for providing the latest cancer treatments and access to clinical research trials,” says Dr. Collins.

Lombardi Comprehensive Cancer Center is one of only 49 sites in the nation and the only center in Washington, D.C. to earn the prestigious Comprehensive Cancer Center designation by the National Cancer Institute.

“All the multiple specialties and disciplines involved in cancer care are here helping to support patients through their treatment, in one location, under one roof,” says Dr. Unger. “They no longer have to travel outside of our area to receive this advanced treatment.”

 “The addition of proton therapy means MedStar Georgetown offers the full range of radiation treatments for cancer that are available,” says Dr. Collins.  “For patients that means we take an individual approach when considering radiation therapy. Whether it’s CyberKnife, proton therapy or conventional radiation, we will choose the optimal treatment to achieve the best outcomes with the fewest side effects.”

 

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Family History Increases Breast Cancer Risk Even in Older Women: Weighing Screening Options

WASHINGTON Family history of breast cancer continues to significantly increase chances of developing invasive breast tumors in aging women — those ages 65­ and older, according to research published in JAMA Internal Medicine. The findings could impact mammography screening decisions later in life.

The large study of more than 400,000 women is the first to specifically look at family history as a breast cancer risk factor in two groups of women, age 65-74 and 75 and older, says the research team, led by Dejana Braithwaite, PhD, associate professor of oncology at Georgetown University School of Medicine and a member of Georgetown Lombardi Comprehensive Cancer Center.

“Family history of breast cancer does not decline as a breast cancer risk factor as a woman ages. The relationship didn’t vary based on whether a first-degree relative’s diagnosis was made in a woman age 50 or younger, or older than age 50,” Braithwaite says. “This means that women with that first-degree family history — breast cancer in a mother, sister, or daughter — should consider this risk factor when deciding whether to continue mammography screening as they age.”

Currently, the U.S. Preventive Services Task Force (USPSTF) recommends mammography screening every two years between ages 50 and 74 for women at average risk. After age 75, the evidence is insufficient to assess risk and benefit of mammography, according to USPSTF’s most recent update in 2016.

The American Cancer Society recommends yearly mammograms in women age 45, and then biennial screening at age 55 and on “as long as a woman is in good health.”

“As breast cancer screening guidelines change from age-based to risk-based, it is important to know how standard risk factors impact breast cancer risk for women of different ages,” said Karla Kerlikowske, MD, senior author of the new study and a member of the UC San Francisco Helen Diller Family Comprehensive Cancer Center.

“The goal of our work is to provide evidence that helps inform breast cancer screening guidelines for older women,” Braithwaite says. “Older women who are in good health and have a first-degree family history may consider a screening mammogram even as they age beyond the screening recommendations for average risk women.”

Researchers from Washington, California, Wisconsin, Vermont, New Hampshire and North Carolina participated in the research by examining 1996-2012 records from the Breast Cancer Surveillance Consortiums (BCSC) registries in their regions.

The team found that while age is the strongest risk factor for breast cancer — any adult woman in the general population has a baseline 12 percent risk of developing the disease — first-degree family history can almost double that risk.

Overall, a first-degree family history leads to an absolute increase in 5-year risk of breast cancer ranging from 1.2 to 10.3 percentage points depending on breast density and age. For example, in women 65-74 years old with scattered areas of dense tissue in their breasts, the team found an increased 5-year risk of breast cancer that ranged from 15.1 percent in women without a family history of the disease to 23.8 percent in women whose first degree female relatives had developed breast cancer.

Similarly, among women 75 years or older with the same scattered breast density, 5-year cumulative risk of breast cancer increased from 15.9 percent for women without a family history to 23.1 percent for women with a family history.

Researchers also discovered that breast density, one of the strongest risk factors for breast cancer, did not attenuate the association of family history of breast cancer and breast cancer risk in the women studied as a whole. But when broken into age groups, fatty breasts added a little risk to women age 65-74 years with a family history; in the older cohort, the association was flipped — dense breasts added slight risk.

Study co-authors include: Diana L. Miglioretti, PhD, from the University of California, Davis; Weiwei Zhu, MS, and Diana S. M. Buist, PhD, Kaiser Permanente Washington Health Research Institute in Seattle; Joshua Demb, MPH, Elad Ziv, MD, Jeffrey A. Tice, MD, and Louise C. Walter, MD, of the University of California, San Francisco; Amy Trentham-Dietz, PhD,   of the University of Wisconsin at Madison; Brian Sprague, PhD of the University of Vermont College of Medicine;  Tracy Onega, PhD, of Dartmouth; and Louise M. Henderson, PhD, of the University of North Carolina, Chapel Hill.

The authors report having no personal financial interests related to the study.

This work was supported by a National Institutes of Health, National Cancer Institute–funded Program Projects (P01 CA154292, 1R01CA207361-01A1). Data collection was additionally supported by the Breast Cancer Surveillance Consortium (HHSN261201100031C).

Media Contact

Marianne Worley
Director of Media Relations
Office: 703-558-1287
Pager: 202-405-2824
[email protected]