By Theresa Edwards Makrush

During November, advocacy groups turn our attention to two of the deadliest cancers in the U.S. - lung cancer and pancreatic cancer. Symptoms can be mistaken for other more benign illnesses before lung cancer is diagnosed at a more advanced stage. Pancreas cancer is even more challenging since symptoms typically do not occur until the cancer has spread to other organs.

Treatments are usually a combination of surgery, chemotherapy and radiation. Radiation is often used following surgery to destroy any remaining cancer cells. It is sometimes used before surgery to shrink the size of the tumor. For inoperable (unresectable) tumors, radiation is used with curative, or in some cases palliative, intent.

Facts and Stats
Lung cancer is the second most common cancer in American men and women, accounting for 13 percent of all new cancer diagnoses each year and is the leading cause of cancer death.¹ Pancreatic cancer in comparison is less common, accounting for three percent of all new cancer diagnoses each year, yet it is the third most common cause of cancer death in the U.S.²

Early evidence for proton therapy in treating lung and pancreatic cancers suggests that patients can expect similar cure rates to conventional treatment methods, but will experience fewer treatment-related complications. Unlike X-rays, proton beams can be conformed to the size and shape of the treatment area to minimize or avoid damage to surrounding sensitive organs. For lung cancer patients this means a reduced risk of developing treatment-related pneumonia, pain with swallowing, and cardiac disease.³ For pancreatic cancer patients it means a reduced risk of developing treatment-related serious bowel or stomach issues.⁴

Lung cancer treated with protons     

Both small cell lung cancer and non-small cell lung cancer (NSCLC) are the subject of clinical research at UF Health Proton Therapy Institute. Recent published articles in the International Journal of Radiation Oncology Biology Physics, Clinical Lung Cancer and Acta Oncologica reported on early outcomes of patients following proton therapy for stage II & III NSCLC and limited-stage small cell lung cancer. The researchers concluded that the combination of proton therapy and chemotherapy can provide patients with an aggressive treatment that is less toxic than conventional X-ray radiation.^{5, 6, 7}

Clinical trials open for enrollment to eligible lung cancer patients include one for a shorter treatment approach for stage II & III non-small cell lung cancer and another for a shorter treatment approach for stage I non-small cell lung cancer.

For more information about proton therapy and lung cancer, visit our cancers treated page.

Pancreatic cancer treated with protons

One of the important areas of treatment, clinical trials and study at UF Health Proton Therapy Institute is pancreatic cancer. The goal is to improve patient outcomes for a disease that is often challenging to treat successfully. An article published in the International Journal of Particle Therapy reported early outcomes following proton therapy for patients with pancreatic cancer who were not eligible for surgical removal of the disease due to the position of the tumor. ⁸

Patients were treated with both chemotherapy and proton therapy. Significantly, the study reports that patients were able to tolerate the treatment well with no severe gastrointestinal side effects during treatment and in the two years following. This suggests that there is an opportunity to safely intensify the treatment, which may lead to improved survival rates. Two clinical trials are currently open to enroll eligible pancreatic cancer patients: postoperative proton therapy in surgically removed (resected) pancreatic cancers; and preoperative proton therapy in pancreatic cancers that can be partially removed (borderline or marginally resectable).

For more information about proton therapy and pancreatic cancer, visit our cancers treated page.

References

1. Seer Stat Fact Sheets: Lung and Bronchus Cancer. http://seer.cancer.gov/statfacts/html/lungb.html. Retrieved Nov. 11, 2015.

2. Seer Stat Fact Sheets: Pancreas Cancer. http://seer.cancer.gov/statfacts/html/pancreas.html. Retrieved Nov. 11, 2015.

3. Image-Guided Proton Therapy for Lung Cancer and Thymoma. http://www.floridaproton.org/sites/default/files/docs/LungCancerFactSheet.pdf Retrieved Nov. 11, 2015.

4. Proton Therapy for Pancreatic Cancer. http://www.floridaproton.org/cancers-treated/pancreatic-cancer. Retrieved Nov. 11, 2015

5. Hoppe BS, Flampouri S, Henderson RH, Pham D, Bajwa AA, D’Agostino H, Huh SN, Li Z, Mendenhall NP, Nichols RC. Proton therapy with concurrent chemotherapy for non-small-cell lung cancer; technique and early results. Clin Lung Cancer. 2012 Sep; 13(5):352-8.

6. Colaco RJ, Huh S, Nichols RC, Morris CG, D’Agostino H, Flampouri S, Li Z, Pham DC, Bajwa AA, Hoppe BS. Dosimetric rationale and early experience at UFPTI of thoracic proton therapy and chemotherapy in limited-stage small cell lung cancer. Acta Oncologica. 2013 Feb; 52(3): 506-13.

7. Hoppe BS, Henderson RH, Pham D, Cury J, Bajwa AA, Morris CG, D’Agostino H, Flampouri S, Huh S, Li Z, McCook B, Nichols RC. A phase II trial of concurrent chemotherapy and proton therapy for stage 3 non-small cell lung cancer: Results and reflections following early closure of a single institution study. Int J Radiation Oncol Biol Phys. Article in press Nov. 8, 2015.

8. Sachsman S, Nichols RC, Morris CG, Zaiden R, Johnson EA, Awad Z, Bose D, Ho MW, Huh SN, Li Z, Kelly P, Hoppe BS. Proton therapy and concomitant capecitabine for non-metastatic unresectable pancreatic adenocarcinoma. International Journal of Particle Therapy. Winter 2014;1(3):692-701. http://www.theijpt.org/doi/abs/10.14338/IJPT.14-00006.1