Message from the Executive Director


StuartKlein.pngClinical care and clinical research are essential to the UF Health Proton Therapy Institute’s mission. Our purpose is to give patients the best quality cancer treatment. Careful planning and attention to detail goes into every single patient treatment, beginning with the development of treatment protocols and clinical trials. We invest heavily in research because we want to see a day when all patients with cancer are cured and none are burdened with side effects of treatment.

Since opening in 2006, our clinical researchers have published more than 130 articles in peer-reviewed journals. The best available evidence in the field of proton therapy is presented in the current issue of the International Journal of Radiation Oncology Biology Physics. Among more than 70 articles accepted for publication in the issue, only 20 deal with actual treatment outcomes, including six UF Health Proton Therapy Institute articles reporting patient outcomes following proton therapy for five types of cancers – stage IIA - IIIB breast cancers; sinonasal cancers such as olfactory neuroblastoma, squamous carcinoma and adenoid cystic carcinoma; chordoma and chondrosarcomas of the sacrum, cervical spine and thoracolumbar spine; stage III non-small cell lung cancer; and stage T1 - T3 prostate cancers.

Our investment is paying off. Meaningful data is being generated that helps us understand the effect of proton therapy on many kinds of cancer and how patients’ bodies respond to the treatment. We are encouraged that proton therapy is able to meet or exceed standard treatment cure rates, often with a reduced risk of side effects. These discoveries lead to more exploration and will continuously improve patient treatment for years to come.


Stuart L. Klein

Patient Spotlight: Sophia Gall

Australian teen packs positive attitude in dealing with osteosarcoma

By Theresa Edwards Makrush

IMG_5504.JPG A positive attitude has taken 14-year-old Sophia Gall far. Even through a tough year of cancer diagnosis and treatment, Sophia continues smiling and is determined to find the good in a bad situation.

Her desire to make others aware of proton therapy and encourage other cancer patients, especially teens, prompted her to start a YouTube channel. She has posted several videos since the first week of January 2016 that describe her medical journey.

 “A lot of people go through stuff like this. And people don’t know what to expect and I want to show others about it,” she said following one of her last proton therapy sessions for osteosarcoma. “When you’re dealing with cancer, it doesn’t just stop you. You still get good things that happen.”

Because of the location of the tumor in her pelvis, Sophia was not a candidate for surgery. Her treatment option was a combination of chemotherapy and radiation therapy.

Sophia’s dad began researching radiation therapy options and discovered the benefits of proton therapy. Unfortunately, it is not available in Australia where the family lives, so he sent Sophia’s records to six proton therapy centers around world to get their opinion on whether they would accept her for treatment and estimates for the cost of treatment. Sophia’s radiation oncologists recommended that he include UF Health Proton Therapy Institute and Dr. Daniel J. Indelicato in the review. The physicians were comfortable with Dr. Danny and the program at the Institute – the treatment and the facility.

At the same time, he wrote to the Health Minister and other elected officials to petition support of expediting review of Sophia’s case by the health agency that could approve funding for proton therapy abroad. Time was critical since the window to begin radiation following chemo was limited.

According to her parents Linda Fleming (Gall) and Mark Gall, their daughter spent seven months in hospital for 22 rounds of chemotherapy that took a significant toll. Prior to her illness, Sophia was physically active, playing soccer and swimming competitively. She was involved in the theatre arts dancing and acting. The chemotherapy left her very weak and she either walked with support or was transported by wheelchair. She was on a feeding tube for six months and bedridden for four months. Her weight dropped to 87 pounds, which for her height of 5’10” was quite low.

Things started to turn for the better in early October after Sophia began a new steroid medication to control the persistent nausea and her pain medication was better managed. She started gaining weight, regaining her strength and feeling more like her usual self. Even more reason for optimism, scans confirmed that the tumor was responding to the chemo.

She flew from her home in Australia on January 18 to the United States for proton therapy in Jacksonville, Fla., at UF Health Proton Therapy Institute.

“If someone with cancer was coming here, I would tell them don’t worry about anything,” said Sophia. “Everyone is so amazing. You make friends for life. It’s almost like when you come here, everyone has been through the same thing. People get it.”

Her mom Linda added “There’s just no stress. You don’t have to worry about anything.”

While in Jacksonville, Sophia enjoyed shopping at the St. Augustine Premium Outlets, the St. Johns Town Center, the Avenues Mall and the shops in San Marco, which was within walking distance of the apartment they rented. Sophia remarked that she enjoyed being outdoors and even walked to her appointments at Nemours Children’s Specialty Care.

Ten weeks after arriving in Jacksonville, Sophia headed back home on March 27, looking forward to seeing her brother, friends and school. She is especially anticipating the eight-week school trip to Chiang Mai, Thailand, that they have been planning since she was five years old. Her mom Linda said, “The school principal told us even if he had to carry Sophia on his back, Sophia would go.” Indeed, Sophia’s positive attitude is taking her far.

Large-scale proton therapy study confirms long-term survival, quality of life for prostate cancer patients

UF Health Proton Therapy Institute reports excellent tumor control rates, low incidence of gastrointestinal or urologic toxicity

By Theresa Edwards Makrush

prostate_research_300x300.jpgA large-scale study of men treated with proton therapy for prostate cancer confirms proton therapy is a highly effective treatment for low-, intermediate-, and high-risk prostate cancer. The cohort of 1,327 men was treated at the University of Florida Health Proton Therapy Institute between 2006 and 2010 with median follow-up of five-and-a-half years.

Researchers report that 99 percent, 94 percent and 74 percent of men with low-, intermediate-, and high-risk prostate cancer, respectively, have no signs of cancer recurrence after five years of follow-up. Less than one percent (0.6 percent) in the cohort experienced serious gastrointestinal side effects and approximately three percent (2.9 percent) experienced serious urologic side effects.

“This study is the largest published series to date documenting the efficacy of dose-escalated proton therapy for localized prostate cancer with prospectively collected patient-reported quality of life and toxicity data,” reported lead researcher Curtis Bryant, M.D., M.P.H., UF Health Proton Therapy Institute radiation oncologist, in the article Five-Year Biochemical Results, Toxicity, and Patient-Reported Quality of Life Following Delivery of Dose-Escalated Image-Guided Proton Therapy for Prostate Cancer.1  The study is published in the International Journal of Radiation Oncology Biology Physics (IJROBP), the main journal of the American Society of Radiation Oncology (ASTRO).

The primary goal of the study was to find out if the results from three benchmark clinical trials2 with prospectively reported data by UF Health Proton Therapy Institute could be replicated in a larger population of unselected consecutive patients treated in a similar fashion. The researchers also wanted to identify factors that could predict either disease recurrence or urologic toxicity.

Proton therapy is a form of external beam radiation therapy that uses the positive-charged particles of atoms, protons, to deliver targeted treatment in cancerous tumors.

Tumor control data

The new study confirms similar results as the benchmark study for rate of tumor control in low-risk (both 99 percent) and high-risk prostate cancer (74 percent in the new study vs. 76 percent in the benchmark study). Intermediate-risk prostate cancer tumor control was slightly lower in the new study – 94 percent vs. 99 percent in the benchmark study. The reason for the difference in patient outcomes in intermediate-risk is unclear, researchers say, though may be related to a larger, broader sample of patients in the larger study. Overall, the presence of more than one intermediate-risk or high-risk factor may predict whether the disease will recur following treatment.

Toxicity data

Toxicities were graded using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4). Incidence of serious urologic toxicity in the larger series study is 2.9 percent vs. 1 percent in the benchmark study. Incidence of serious gastrointestinal toxicity in the larger series study is consistent with the benchmark study, 0.6 percent and 0.5 percent, respectively.

The risk of developing a serious urologic toxicity  appears to be higher in men who have one or more of the following predictive factors: a large prostate volume, pretreatment use of alpha blockers, pretreatment prostate reductive (TURP) procedures, diabetes, or a higher volume of bladder tissue receiving a dose of 30 Gy (RBE).

Quality of life data

Patient-reported quality of life scores following proton therapy for prostate cancer were good for urinary and bowel function, but significant decreases were seen in sexual function. Comparing pretreatment scores with scores at five years after treatment, the median baseline International Prostate Symptom Score remained unchanged. Similarly, the median and mean EPIC summary scores for bowel, urinary irritative/obstructive, and urinary incontinence domains remained relatively stable. The only significant change reported was in sexual function scores. Between baseline and 5 years, mean scores in patients not receiving hormone therapy declined from 67 to 53 and median sexual summary scores fell from 75 to 55.

Comparative effectiveness

Currently there are no published prospective clinical trials comparing proton therapy with other forms of external beam radiotherapy that use X-rays to treat prostate cancer, intensity modulated radiotherapy (IMRT) and 3-dimensional conformal photon radiation (3DCRT). A few retrospective studies comparing proton therapy and IMRT have been published in recent years, however, the reliability of the study conclusions is limited since the studies had short follow-up, lacked treatment-related information (e.g., radiation dose, field size), lacked toxicity grading and reporting, or lacked quality-of-life patient-reported outcomes. “Prospective comparative studies are needed for definitive comparison of proton therapy with IMRT,” concluded Bryant.

About prospective clinical trials

Prospective studies have an advantage over retrospective studies because they are prospectively designed to answer a specific study question. In addition, participants must meet specific criteria for inclusion and exclusion in order to reduce the chance that results will be confused by confounding variables. Finally, specific times and methods of collecting the information on cancer control and problems related to treatment are defined. These factors improve the quality of the data and potential reliability of the conclusions associated with these studies.

About proton therapy

Proton therapy is a type of radiation treatment that uses particles of an atom, protons, to deliver radiation. Protons have the potential to improve the therapeutic ratio in patients: delivering more curative dose in the tumor while delivering little or no dose to surrounding healthy tissue, thereby increasing the chance for cure and reducing the risk of side effects. Until recently, only a handful of academic medical centers in the U.S. were equipped with proton therapy. Today, 23 facilities offer proton therapy in the U.S, but access remains limited. Approximately one million people are treated with some form of radiation annually in the United States.3   Proton therapy accounts for an estimated one percent of those treated.

1. Bryant C, Smith TL, Henderson RH, Hoppe BS, Mendenhall WM, Nichols RC, Morris CG, Williams CR, Su Z, Li Z, Lee D, Mendenhall NP. Five-Year Biochemical Results, Toxicity, and Patient-Reported Quality of Life Following Delivery of Dose-Escalated Image-Guided Proton Therapy for Prostate Cancer. International Journal of Radiation, Oncology, Biology, Physics. 2016; 2016;95(1):435-43.

2. Mendenhall NP, Hoppe BS, Nichols RC, Mendenhall WM, Morris CG, Li Z, Su Z, Williams CR, Costa J, Henderson RH. Five-year outcomes from 3 prospective trials of image-guided proton therapy for prostate cancer. International Journal of Radiation, Oncology, Biology, Physics. 2014;88:596-602.

3. Statistics About Radiation Therapy. Last modified June 13, 2013. Accessed April 18, 2016.

Vendors selected for expansion, upgrades project

By Theresa Edwards Makrush

photo.JPGThe University of Florida Health Proton Therapy Institute has announced vendor selections for its $39 million expansion and upgrades. The project is being managed by the University of Florida Planning, Design & Construction Division.

UF Health Proton Therapy Institute has signed an agreement with IBA (Ion Beam Applications S.A.) to install the proton therapy equipment manufacturer’s compact Proteus®One system. The single-room treatment system is the centerpiece of the multiphase project announced earlier this year. IBA will also install advanced treatment technologies to the existing proton therapy system.

The construction manager selected for the 10,000-square-foot expansion is Gilbane Building Company. The company’s Jacksonville office will oversee the project. Gilbane has extensive experience in building hospitals and health care facilities, including multiple proton therapy facilities in the United States.

The architectural firm chosen to design the expansion is Walker Architects, Inc. Based in Gainesville, Florida, recent projects include the renovation and expansion of the University of Florida’s J. Wayne Reitz Union.

Save the date for annual fundraiser


The 12th Annual Play Golf. Fight Cancer.® Classic is scheduled for October 9 and 10. Mark your calendar and plan to join us at the World Golf Village, St. Augustine, Florida, for a fun event to raise money for the research program at UF Health Proton Therapy Institute. Sponsorships are available. For information contact




Patient-created artwork for sale; proceeds benefit the arts-in-medicine program

IMG_5490.JPGBy Theresa Edwards Makrush

Every day in the UF Health Proton Therapy Institute main lobby, patients and their caregivers wield brushes, pencils, crayons, and knitting needles to paint, draw, color, knit, and sew their way to their daily proton therapy appointment. They are gently and expertly guided through art exploration by Pamela Gardener and Barbara Fryefield who are each professional artists.

Earlier this year, the artists-in-residence organized the patients in a group effort to create an art exhibit for display in the room where weekly patient luncheons are held. The theme of the exhibit is water. As noted on an exhibit description, water is everywhere in Jacksonville, and bodies of water can change color and appearance depending on the time of day, angle of light, or effects from other elements. “Our artists were asked to look at the water as they travel in and around Jacksonville. Here is what they saw.”

The water exhibit patient-created artwork is being sold to raise funds for art supplies. For more information, contact Development Director Molly Dworkin,; 904-588-1519.

Message from the Executive Director


The global reach of proton therapy is accelerating with new facilities under construction or in planning stages on nearly every continent. For patients, especially those for whom conventional therapies are not possible due to the location of their tumor or their age, more access to proton therapy will save lives. Many patients travel great distances, some essentially relocating to a new country for several months, for a radiation treatment that will give them the best chance to restore their health. We at UF Health Proton Therapy Institute consider it a privilege and a responsibility to help people overcome cancer and go on to live life to the fullest, whether they are from our neighborhood or from across the ocean. Our international program is one of the largest in the U.S. and we have treated patients from 30 countries. Through direct patient care, published prospective clinical research, and programs to train the next generation of radiation oncologists, we are committed to making a positive contribution to end cancer worldwide.


Stuart L. Klein

Executive Director

Survivor Spotlight: Lauren Foster

Teen proton alum Lauren Foster and her family returned to Jacksonville to reconnect and offer encouragement

By Theresa Edwards Makrush


A sweet smile lit up 14-year-old proton alum Lauren Foster's face as she talked about her plans for the future. "Going through treatment made me want to go into nursing. Knowing that you're helping somebody get better makes you feel quite happy," she said softly.

Her parents' smiles beamed brightly as they added, "She's taking all the subjects that will hopefully get her into university to do nursing," said mom Emma Allsop. While dad Steve Foster remarked, "Lauren choosing this path is unusual since she does not like the sight of blood, has a fear of needles and doesn't like to see medical procedures even on TV. Her choice shows just how determined she is and has the strength of direction for nursing."

It's the same strength and determination Lauren has displayed during the last four years as she has dealt with treatment for a rare tumor called rhabdomyosarcoma, a type of tumor that occurs in soft tissue. Because of her age and the location of the tumor on the muscle at the back of her palate, she was not a candidate for surgery, and her physicians in the United Kingdom recommended her for proton therapy combined with chemotherapy.

On March 17, four years to the day when they first landed in America for Lauren's proton therapy, Lauren, her parents and her sister, Holly, returned to UF Health Proton Therapy Institute for a follow-up visit with Dr. Danny Indelicato. "We really looked forward to thanking the staff for what they've done for Lauren," said her dad Steve. Lauren added, "I'm looking forward to experiencing everything in America being well."

It was a much different experience than when they were here originally. The fear of the unknown, never having been in the United States before, and being away from their support system of friends and family for cancer treatment was overwhelming at first. 
“The culture of things. Knowing more about the way of life would have set our minds more at ease,” said Emma. After getting over the uncertainty of driving on the right side of the road, adjusting to the way Americans eat and discovering how friendly all the people were, the family began to settle in. 

 Initial fears about the medical facilities and treatment were relieved once they arrived. At Wolfson Children’s Hospital they were pleasantly surprised to have a private room. This allowed the family to stay with Lauren in comfort as she had procedures to implant fiducial markers to aid in positioning for daily proton therapy and a port for her chemotherapy. At the Institute, the family went on an orientation tour prior to Lauren’s first treatment. She was able to see, touch and feel what it was like to lie on the treatment table, allowing her to overcome her anxiety and have her treatment without daily anesthesia. 

Lauren said that proton therapy was not painful. “You don’t feel anything. It’s not as scary as you think it is” she said. “After you’ve done it once, you can do it again,” Lauren said.

They also wanted to encourage others who are facing a similar journey. “No one wants this to happen to their child. But that’s the good that can come out of it. You can share and pass along your experience to help others,” said Steve. Emma agreed. “We would love to have met up with people who were two or three years out. So many questions you want to ask and some you don’t want to ask the doctors,” she said. 

The family was pleasantly surprised by the friendliness of everyone, even people who were complete strangers. Steve told the story of how the entire staff of the hotel where they stayed during the nine-and-a-half-week treatment became like family. As an example, every morning they had breakfast in the hotel dining room and the staff noticed how much the youngest member of the family, Holly, loved to make her own waffles every day. At the end of their stay, the staff presented the gift of an industrial waffle maker to the family. Later as the family prepared to leave for the airport, the entire hotel staff gathered in the lobby to wish them well, cheering and applauding.

An act of kindness in the middle of a big-box store remains a vivid memory for Steve. While Lauren was being treated, she was quite sick and it was a struggle to do many outside activities. One day the family was shopping for some necessities and Lauren became fatigued. Steve found a seat in the middle of the store for Lauren to rest. A woman who was shopping noticed Lauren and asked about her condition. After learning from Steve what was happening, the woman asked if she could say a prayer for Lauren. “I said yes thinking that she would go home and say a prayer later. But she got down on her knee in the store and held Lauren’s hand and said a prayer right there. People just continued shopping and walked by without a second thought.” The fact that the woman cared enough to stop and show her concern was surprising enough. Even more surprising was that people didn’t stop and stare and make a spectacle of what was happening. 

They are making new memories on their return trip. Reconnecting with the people and places in Jacksonville they remember fondly and charting new territory as they visit Orlando and the many theme parks. And each family member will get their favorite taste of America while they’re here: Olive Garden for Emma, Chick-fil-a for Steve and Holly and Denny’s for Lauren.

Today, Lauren is cancer-free. She fills her days with school, sports like gymnastics, trampoline, and badminton, and watching her favorite TV shows The Big Bang Theory and Charmed, which she and her family came to know and love while in America.

IBA Proton Therapy Pioneer

By Theresa Edwards Makrush


IBA, the world’s leading manufacturer of proton therapy systems, presented the IBA Proton Therapy Pioneer award to UF Health Proton Therapy Institute during the annual gathering of the IBA global user group this month in Trento, Italy. The award recognizes institutions and teams that have played an extraordinary role in the development of proton therapy’s use as a powerful tool in the treatment of cancers for their patients.

Accepting the award on behalf of the Institute were Zuofeng Li, DSc, director of physics, and Daniel J. Indelicato, MD, director of the pediatric program and William and Joan Mendenhall Endowed Chair of Pediatric Radiotherapy.

The award was presented by IBA Founder and Chief Research Officer Yves Jongen. In his remarks, Jongen acknowledged the contributions of the Institute to the field of proton therapy and radiation oncology.

“In the 10 years that UF Health Proton Therapy Institute has been treating patients, the team has been a role model for the proton therapy community throughout the world. Not only has the team treated one of the largest volumes of patients with the highest standard of quality, including the most pediatric patients of any other center in the world, the team also significantly advanced the science by publishing more valuable research results than all or most other facilities in the world. Dr. Nancy Mendenhall’s launch of a proton therapy journal has been another great gift to the proton therapy community,” said Jongen.

Since opening in August 2006, the Institute has treated more than 6,200 cancer patients, including more than 1,000 children. The clinical research program has generated 127 published articles in medical journals including the International Journal of Radiation Oncology Biology Physics, published by the American Society for Radiation Oncology (ASTRO); Cancer; Oncology; American Journal of Clinical Oncology; Journal of Urology; and Acta Oncologica. UF Health Proton Therapy Institute Medical Director Nancy Mendenhall, MD, spearheaded the effort to create the International Journal of Particle Therapy that publishes research done in the field of particle therapy including proton therapy and carbon ion therapy.

National Doctors Day

Happy Doctors Day.jpg

March 30 is National Doctors Day, a day set aside to show our appreciation for the dedication, professionalism and compassion physicians commit to healing patients. The radiation oncologists at UF Health Proton Therapy Institute exemplify all that is best about the medical profession. Their leadership in advancing the field of radiation oncology through proton therapy is improving the health outcomes of thousands of cancer patients today and in the future.

A simple way to show appreciation is to tell others about your experience with your physician. You may wish to share your experience with a review on our Facebook page or Google Plus page or take a brief nine-question survey on Click on the physician's name below to launch the survey:

Julie A. Bradley, MD

Curtis M. Bryant, MD, MPH

Roi Dagan, MD, MS

Randal H. Henderson, MD, MBA

Bradford S. Hoppe, MD, MPH

Daniel J. Indelicato, MD

Nancy Price Mendenhall, MD

William Mendenhall, MD

R. Charles Nichols, Jr., MD

Ronny Rotondo, MD, CM, FRCPC

Michael Rutenburg, MD, PhD


About This Newsletter

The Precision Newsletter is an electronic-only publication that is distributed by email. Each issue is sent monthly to patients, alumni patients and friends of the University of Florida Health Proton Therapy Institute. As the official newsletter of the Institute, the content is compiled and prepared by our communications representative and approved by the editor Stuart Klein, executive director of UF Health Proton Therapy Institute. Special bulletin newsletters may occasionally be prepared when timely topics and new developments in proton therapy occur. If you would like to send a Letter to the Editor, please click here.


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