“Developments in Radiation for Cancer Care”
Featuring: Carl Rossi
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Carl Rossi
“Developments in Radiation for Cancer Care” (Carl Rossi) [#57] Brian McCloskey, Allen Morris, and Brad Power May 15, 2023 “The cancer cells could care less what you're hitting them with. They don't know protons versus X-rays. It's what you do or do not do to the surrounding tissue that makes the biggest difference.
” – Carl Rossi “If you can identify a target, which means your imaging is showing you something, you want to hit it harder.” – Carl Rossi “Radiation is a toxin and there probably is no dose below which toxicity does not occur… Let's limit toxicity … by whatever technology we have to maximize target dose and minimize normal tissue dose.
” - Carl Rossi Meeting Summary Advanced cancer patients face enormous challenges in eradicating their metastatic lesions, especially when their cancer has spread to several different locations in the body, hard to reach locations due to proximity to vital organs, and tough body parts like bones or the brain. They can consider surgical removal and various kinds of radiation.
The disadvantages of surgery include: inability to kill microscopic disease around the edges of the tumor, which may leave tumor cells in the patient after surgery, and difficulty in tolerating the surgery and anesthesia (i.e., they must have minimal medical problems, good lung function, and not be on certain medications).
Traditional radiation delivers X-rays, or beams of photons, to the tumor and beyond it. This can damage nearby healthy tissues and can cause significant side effects. By contrast, proton therapy delivers a beam of subatomic particles that stops at the tumor, so it's less likely to damage nearby healthy tissues.
Most commonly, proton beam therapy is used to treat tumors near critical organs or structures, such as head and neck cancers, and increasingly in spine, breast, sarcoma, brain, and prostate cancers. This is particularly beneficial to those who are vulnerable to radiation or have received prior radiation either to or immediately adjacent to the area that needs to be treated.
Proton beam radiation therapy may be safer and just as effective as traditional radiation therapy for adults with advanced cancer. Proton therapy is generally more expensive than traditional radiation, and not all insurance companies cover the cost of the treatment, given the limited evidence of its benefits.
Nevertheless, over 40 medical centers, including such NCI flagship institutions as Memorial Sloan-Kettering, Mayo Clinic, and Johns Hopkins have spent millions of dollars building proton therapy centers, and many advertise the potential, but unproven, advantages of the treatment.
Carl Rossi, MD, and Medical Director at California Protons, is uniquely qualified to discuss the issues and solutions in proton radiation. Dr. Rossi has personally treated more than 13,000 prostate cancer patients with proton radiation over the last 31 years—more than any other physician in the world.
Rossi, MD, and Medical Director at California Protons, is uniquely qualified to discuss the issues and solutions in proton radiation. Dr. Rossi has personally treated more than 13,000 prostate cancer patients with proton radiation over the last 31 years—more than any other physician in the world. Internationally recognized for his achievements in cancer treatment, Dr.
“Developments in Radiation for Cancer Care” (Carl Rossi) [#57] Rossi is a radiation oncologist with a research focus on the quality of life and cure rate in prostate cancer and lymphoma. Specializing in proton beam therapy, he has been treating prostate cancer patients with proton therapy since 1991.
Prior to serving as the Medical Director of California Protons, he was the Medical Director of the Scripps Proton Therapy Center and was an Associate Professor in the Department of Radiation Medicine at the Loma Linda University Medical Center. He is currently also a professor of radiation medicine on the UCSD Radiation Medicine faculty. Dr.
Rossi gave an overview of proton therapy for prostate cancer and a summary of recent papers. He discussed success stories in prostate cancer, why to choose proton therapy vs. alternative radiation approaches, and when proton therapy works/doesn't work. Key Take-aways ●The target for radiotherapy is DNA. With any type of radiation you are causing DNA breaks.
The idea is that you create enough breaks to overwhelm the cell's ability to repair that damage, so the cell dies when the cell attempts to replicate. Normal tissue is somewhat better at repairing this versus malignant tissue. But that difference is often not that great. You try to target specifically because the more dose that can put in the bad stuff, the greater you can crack that window open.
Unfortunately, the repair difference between bad tissue and good tissue is small. Radiation is a toxin, and there probably is no dose below which toxicity does not occur.
●To be able to hit what you're aiming at you need a good idea of the target, which depends on getting multiple images from multiple technologies, such as CT (computer tomography, which uses X-rays to create a 3D picture), MRI (magnetic resonance imaging, which uses magnetic waves), and PET (positron emission tomography, which uses radioactive substances to visualize; PSMA PET scans are used to view prostate- specific membrane antigen cells in prostate cancer) scans.
Some cancers, such as prostate cancer, uterine cancer, and certain liver cancers, are pretty much invisible or very hard to detect on a CT scan.
●If you compare the standard X-ray (Intensity modulated X-ray therapy) therapies and proton radiation therapies in prostate cancer, you create a lot less toxicity using protons because you aren't hitting the intestines with radiation when you are using protons. Proton patients had secondary cancers at less than 1/3 the rate that was seen with other types of X-ray therapy.
and proton radiation therapies in prostate cancer, you create a lot less toxicity using protons because you aren't hitting the intestines with radiation when you are using protons. Proton patients had secondary cancers at less than 1/3 the rate that was seen with other types of X-ray therapy.
●The higher the dose you can give, the lower the probability of either local failure or failure elsewhere in the body. ●Pencil Beam proton radiotherapy is effectively a 3D printer. You're painting the dose in layers, a millimeter thick, through your target. You can put high doses in some spots, and lower doses in other spots.
●Particle therapy is no longer a boutique treatment that is only available in one place or two places in the world. Different manufacturers are making the machines, including companies like Hitachi, and as a consequence machines are becoming less expensive. The cost for proton treatment is getting closer to the cost of X-ray (IMRT) therapy.
“Developments in Radiation for Cancer Care” (Carl Rossi) [#57] ●Despite the advantages of proton therapy described above, IMRT is still and will be for the immediate future the standard of care due to limited access of proton facilities; limited acceptance by insurance companies, specifically the cost disadvantage; limited head-to-head study comparisons with IMRT; and limited urologic community acceptance and public awareness.
The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action.
You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.
“Developments in Radiation for Cancer Care” (Carl Rossi) [#57] Meeting Notes The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab/Prostate Cancer Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action.
You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health. Discussion Outline ●Dr. Rossi introduction. 0:00 ○Dr Rossi is an expert in proton therapy and all matters related to radiation oncology. ○When does it make sense ●Radiotherapy and treatment of metastatic disease.
2:56 ○Treating solitary metastasis or a few metastases. ○Target for radiotherapy is dna. ○Empirically, radiation is a toxin. ○Radiotherapy delivery technologies and radiation physics.
atters related to radiation oncology. ○When does it make sense ●Radiotherapy and treatment of metastatic disease. 2:56 ○Treating solitary metastasis or a few metastases. ○Target for radiotherapy is dna. ○Empirically, radiation is a toxin. ○Radiotherapy delivery technologies and radiation physics. ●Radiological use of fast protons. 8:29 ○The role of protons in delivering radiation.
○Radiological use of fast protons. ○Making proton therapy more accessible with smaller facilities. ○New 3D printing technology. ●The importance of multimodality. 13:12 ○Importance of multimodality imaging in prostate and other cancers. ○Prostate and pelvic lymph nodes. ○Recent published data on treating intact Proton-based prostate cancer. ○Comparison of proton and hormonal therapy. ●Proton vs.
Imrt. 18:51 ○Treating the pelvis in prostate cancer. ○Treatment of lung cancer with 3D-conformal x-ray therapy and imrt. ○Intra-prostatic boosting for metastatic prostate cancer. ○Red line patients with vocal boosts. ●Hormonal therapy vs. Stereotactic radiotherapy for prostate cancer. 25:19 ○Hormone therapy and stereotactic radiotherapy for prostate cancer.
○Progression-free survival with hormone therapy alone. ○Prolonged normal serum testosterone and quality of life. ○Proton therapy for heavily pretreated prostate cancer. ●How do you get an ablative dose into the spinal cord? 30:40 ○Treatment of the T6 vertebral body. ○Cost of particle therapy is becoming more expensive. ●Proton therapy and prostate cancer risk.
33:21 ○Higher doses of radiation are important. ○Dr Rossi's case study with MRR.
“Developments in Radiation for Cancer Care” (Carl Rossi) [#57] ○Tolerability of proton-based therapy to lumbar spine and thoracic spine. ○Toxicities of VMAT vs proton therapy. ●Proton therapy vs. MRI-guided radiotherapy. 39:30 ○New endocrine component of prostate cancer. ○Proton therapy vs MR-guided radiotherapy. ○Cost of proton therapy for prostate cancer. ○Cost of imrt vs 3D conformal.
●Do we have any head-to-head clinical trials of MR guidance vs. proton therapy. 44:59 ○No head-to-head trials yet on MR-guided linac vs proton therapy. ○Advantages of MR-guidance vs ct-guided ○Ionizing radiation for imaging. ○Salvage treatment of the prostate bed after recurrence. ●Differences between protons vs. x-rays in treatment. 49:12 ○Comparing proton plan to x-ray plan.
○Proton vs x-rays for pelvic lymph nodes. ○Is proton beam therapy being used for bone marrow transplants. ○Why protons are used in pediatrics. ●Diet and Radiation side effects of consolidation. 53:36 ○Ketogenic diet for prostate cancer. ○Research on diet to mitigate radiation side effects. ○No GI toxicity during the treatment. ○Dr. Rossi, thank you for being my doctor.
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