Lung Cancer Treatment

The aim of modern cancer treatment is to provide patients with the maximum chance of cure while minimizing treatment-related side effects. This can be achieved with proton therapy.

Proton radiotherapy is a gentle cancer treatment method with minimal side effects. It allows for accurate targeting of the proton beam to the target area (at the location of the original tumor) in the lung, thus minimizing exposure of surrounding tissues and organs to radiation.

Proton therapy is used to treat non-small cell lung carcinoma (NSCLC).

Proton therapy is also suitable for those patients who have developed a secondary tumor after previous irradiation, such as for breast cancer, in previous years.

In order to achieve the maximum cancer treatment effectiveness for lung cancer, it is vital to irradiate the tumor with high doses of radiation. Nonetheless, this goal is not often achieved in standard irradiation due to possible damage to the surrounding tissues (healthy tissue toxicity).

That is why our physicians and physicists started using a unique procedure – deep inspiration breath-hold technique. This method allows breathing movements to be minimised and thus the tumor to be irradiated with a high dose with maximum accuracy. At the same time, proton therapy minimises exposure of healthy parts of the lung, the second lung, the heart, cardiac vessels and other organs in the mediastinum to radiation. In this way, proton therapy significantly increases the ratio between the chance to control the tumor, i.e. enhanced treatment effect, and the reduction of possible serious adverse effects.

Benefits Of Proton Therapy

Proton therapy:

• allows for increasing the overall radiation dose with lower toxicity meaning less strain on critical organs;
• allows for decreasing the radiation dose affecting the healthy tissue of the lungs thereby reducing the risk of emergence of respiratory complaints and the development of pulmonary fibrosis;
• reduces the radiation dose affecting the cardiac muscle thereby reducing the risk of heart disease;
• reduces the risk of the development of swallowing difficulties or loss of appetite;
• allows for enhancing the quality of the patient's life;
• allows for the use of fewer therapeutic fractions.

You can send your medical documentation for assessment of the suitability of proton therapy by e-mail to patient@ptc.cz. Alternatively, you can contact our treatment coordinators, who are prepared to answer all of your questions related to proton therapy. You can call them at +420 222 999 000.

The only thing YOU need to do is to come to US in time. WE are ready to help you.

In order to select the optimal treatment, it is imperative to get comprehensive and comprehensible information. Ask not only about the most advanced treatment methods but also treatment-related side effects. They may significantly affect the quality of your life during and after treatment.

If radiation is considered as part of your treatment, inquire about all the options available. Our physicians have many years of experience in radiotherapy. Moreover, they are experienced in both standard (photon) and proton radiation therapy; therefore, they will be able to answer all your questions pertaining to your decision on your treatment.

I Know My Chances Of Healing And Treatment Options

• What treatment has my attending physician recommended?
• Has the physician informed me about the risks and complications associated with currently used treatments?
• Has the physician informed me about proton therapy?
• Has the physician informed me about the risks and complications associated with standard radiation methods?

Advantages Of Proton Therapy Over Conventional Radiotherapy

Proton therapy:

• allows for increasing the overall radiation dose with lower toxicity meaning less strain on critical organs;
• allows for decreasing the radiation dose affecting the healthy tissue of the lungs thereby reducing the risk of emergence of respiratory complaints and the development of pulmonary fibrosis;
• reduces the radiation dose affecting the cardiac muscle thereby reducing the risk of heart disease;
• reduces the risk of the development of swallowing difficulties or loss of appetite;
• allows for enhancing the quality of the patient's life;
• allows for the use of fewer therapeutic fractions.

Proton therapy reduces complications to a minimum. The goal of irradiation is to deliver the required dose to the tumor while protecting healthy tissues.

Our physicians’ experience, our technology, excellent results, and professional attitude give you the maximum chance of being cured.

Based on worldwide experience and long-term results in treated patients, it is clear that patients after proton treatment have a higher quality of life compared to those who have undergone conventional (photon) radiotherapy.

Did you know that the benefits of proton irradiation are based on the physical principles and properties of protons?

Protons target the tumor directly, which allows us to protect healthy tissues and organs from adverse effects.

Unlike conventional radiotherapy, which uses photons for tumor cell irradiation and destruction, proton therapy is more advanced and uses protons.

The commonly used photon beam goes through the body and emits a significant portion of its energy in the regions in front of and behind the tumor. Protons have a certain physical property called the Bragg peak, which means they emit significantly lower amounts of energy on their way to the tumor, thus minimising their impact on healthy tissues behind the tumor. The greatest advantage of proton therapy is that, unlike common radiotherapy, it is precise and able to protect healthy tissues.

Proton therapy reduces complications to the minimum. In the treatment of non-small cell lung carcinoma at a certain stage, radiotherapy may be established as a single therapeutic method or may be combined with chemotherapy. Proton radiotherapy is one of the most advanced technologies of current radiotherapy.

In order to achieve the maximum treatment effectiveness for lung cancer, it is vital to irradiate the tumor with high doses of radiation. Nonetheless, this goal is not often achieved in standard irradiation due to possible damage to the surrounding tissues.

Initial Assessment

In order for our medical team to assess a patient for suitability, we require some medical information from you. Your treatment coordinator will inform you of exactly what information we require. Usually, we will also request to see scans, such as an MRI, CT or PET scan. This information can be requested from the hospital or clinic and is often given to the patient on a CD. We can provide you with login details to upload the CD to our secure server. Alternatively, you can mail it to us.

Any information you already have about your diagnosis and previous treatments is very helpful and it is a good idea to provide us with as much information as possible in your initial enquiry. Your case will then be reviewed by our medical team at the daily indication board meeting. Your treatment coordinator will get back to you with the outcome, or possibly a request for more information if the oncologists require it to make their final decision.

You do not need to travel to Prague for the assessment.

Treatment Planning

When you come to Prague for treatment, you will first have a consultation to discuss the side effects and outcomes of treatment in your specific case, as well as the concrete treatment plan. The doctor also explains what to expect during and after the treatment. Finally, all of your questions are answered.

The first stage of treatment involves the diagnostic scans here at the Proton Therapy Center (MRI and/or CT, preparation of the fixation device, etc.). Precise treatment planning is crucial for treatment success. Therefore, a team of clinical physicists and physicians prepares a radiation plan tailored to each patient according to which proton therapy will take place. The irradiation plan also determines from which directions and with what intensity the proton beam will irradiate the tumor. This process is very complex and it typically takes one week to finalise before treatment can commence.

The treatment is outpatient, and you come to the Proton Therapy Center for radiation and regular check-ups during treatment. One visit takes about 60 minutes while the radiation is a matter of a few minutes. Prior to each radiation session, we carefully check your position using X-ray scans and carry out certain other checks necessary to commence irradiating. At least once a week, you undergo check-ups with the physician who will go through the treatment progress with you and check your condition.

Individual treatment doses are given each day, Monday to Friday. Treatment cannot be interrupted except for serious health reasons.

We Use The Pencil Beam Scanning Technology

Pencil Beam Scanning (PBS) marks the exact distribution of the proton beam dose and is currently the absolute peak in proton therapy technology. PBS irradiates the target area with millimeter accuracy with minimal damage to surrounding healthy tissues and organs. 

The Controlled Breathing Method

As respiratory movements may impair the correct and precise execution of proton irradiation, in the treatment of lung cancer we also use the method of controlled breathing. Patients whose tumor position changes due to respiratory movements are irradiated using a controlled breathing method. For this, we use the Dyn'R.

The controlled breathing method has been chosen because it is important that the irradiated area of the body and the target volume of the tumor are irradiated the same way during each fraction. Since this irradiated volume varies depending on breathing, we need to ensure that the patient's body is always in the same position. This is best done by holding their breath at a certain level. To determine this level, the patient first undergoes a controlled breathing training (Dyn'R training).

The controlled breathing training is done lying down on the back after being connected to the spirometer, using an antibacterial filter and a mouthpiece. The patient´s nose is held closed by a pin so that all exhaled air flows through their mouth. The patient also wears special glasses, where they see the breathing pattern to follow. The training is conducted by an experienced assistant and the patient has nothing to worry about.

The treatment is outpatient and, in most cases, lasts from 25 to 35 business days, according to the regime determined by the physician on the basis of the initial assessment and other diagnostic tests.

In the Czech Republic, lung carcinoma is the second most frequent type of cancer after malignant tumors of the large intestine, and this trend is constantly growing. The majority of newly diagnosed diseases is detected at an advanced stage (stage III and IV). Due to late detection, five-year survival in both genders reaches slightly above 10%. The fact that in both genders it is the most common cause of death from cancer bears witness to the severity of the disease.

From the point of view of biological properties and therapeutic procedures, lung carcinoma is classified as small cell and non-small cell carcinoma. Proton therapy is suitable for non-small cell lung carcinoma, which accounts for approximately 75–80% of lung tumors. Non-small cell lung carcinoma growth is much slower than that of small cell carcinoma. Therefore, there are better chances of surgical removal, but only provided that the tumor has not already developed metastatic deposits.

Lung Cancer Symptoms

There are no early warning signals that would allow the disease to be detected at the initial stage. Once the disease symptoms occur, the stage of the tumor is advanced. A small tumor may sometimes be detected when another disease is examined.

Lung cancer symptoms may include a newly formed persistent cough or a change in the nature of a chronic smoker’s cough. In lung tumor diagnosis, around 80% of patients suffer from cough. Another symptom is coughing up blood or the presence of traces of blood in the cough sputum. Pulmonary inflammations are also common, they do not recede when antibiotics are administered, or they are recurrent in the same place.

Proton therapy is an increasingly recognized and preferred method in the world. The results of the world's proton centers and the Prague Proton Therapy Center clearly confirm that proton therapy opens up completely new possibilities for the treatment of cancer.

Proton therapy is not a new method. Since 1991, the first exclusively clinical (not academic) workplace located at Loma Linda University, California, USA has treated many tens of thousands of cancer patients using proton therapy. Proton therapy is a technologically mature treatment proven by almost three decades of clinical operation. 

Despite many years of proton radiotherapy being used for the treatment of selected types of cancer, some healthcare professionals are still of the opinion that the higher radiation doses used in standard (photon) radiotherapy to which healthy tissues are exposed do not justify the use of proton beam therapy.

New clinical data is available from extensive studies suggesting that the frequency of acute toxicity (complications monitored for 90 days after initiation of treatment) is significantly lower in proton irradiation than in a comparable group of patients treated with photon radiotherapy.

A team of physicians from the University of Washington monitored almost 1,500 patients with various types of cancer, of whom about 400 underwent proton beam therapy while the rest were irradiated with state-of-the-art photon radiotherapy techniques. All the patients from this group were irradiated and at the same time were administered concomitant chemoradiotherapy. The study researchers focused on the emergence of toxicity at grade III and higher, which already requires hospitalisation and intensive medical treatment and care.

The study has shown that the observed toxicity (the complications associated with irradiation) in patients treated with protons is two-thirds lower than in the group treated with photon radiotherapy.

Specifically, serious adverse complications were reported by 11.5% of patients irradiated with protons as compared with 27.6% of patients irradiated with photons.

*Link: medicalnewstoday.com...