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Study Shows Proton Therapy Improves Overall Survival in Patients with Chordoma and Chondrosarcoma

Chordomas and chondrosarcomas are difficult to manage using conventional cancer treatment methods. Areas of the body frequently affected by this type of cancer include the spine, skull, pelvis, hip, and shoulder.

Effective treatment of these tumours using surgical resection is not usually achievable due to neurovascular involvement. As a result, recurrence of the tumour when surgery is used in isolation poses a significant risk for both chordomas and chondrosarcomas. Due to the low risk of metastasis and relative chemoresistance, the use of definitive radiotherapy or perioperative radiotherapy is very important in maintaining local control.

Previous research has shown proton therapy to be beneficial in treating these types of tumours. Using protons, health professionals are able to treat chordoma and chondrosarcoma with higher doses of radiation due to the increased accuracy of proton therapy.

A 2019 study published in the journal ‘Cancer’ entitled: The role of dose escalation and proton therapy in perioperative or definitive treatment of chondrosarcoma and chordoma has shown that proton therapy improves overall survival for those with these forms of cancer.

This study analysed a total of 863 patients with chondrosarcoma and 715 patients with chordoma treated with proton or conventional radiation therapy. The primary endpoint of overall survival (OS) was evaluated, and clinical features, including age, sex, grade, clinical stage, and Charlson‐Deyo comorbidity index, were compared.

This study found that for chondrosarcoma, a high radiation dose of proton therapy was associated with improved OS at 5 years.

For chordoma, proton therapy was associated with improved OS at 5 years and a high dose for chordoma was significant for improved OS.

The authors concluded that in the largest retrospective series to date, dose escalation and proton radiotherapy were associated with improved overall survival in patients with chondrosarcoma and chordoma. Evidence continues to accumulate in support of improved outcomes with high‐dose proton therapy in the treatment of chordoma and chondrosarcoma with acceptable toxicity.

If you or a loved one are suffering with chordoma or chondrosarcoma, the Prague Proton Therapy Center oncologists are available for consultation.

Associated Resources:

DEGRO. Stellungnahme zur Strahlentherapie mit Protonen in Deutschland Juni 2015.

T. F. DeLaney, N. J. Liebsch, F. X. Pedlow et al., “Phase II study of high-dose photon/proton radiotherapy in the management of spine sarcomas,” International Journal of Radiation Oncology∗Biology∗Physics, vol. 74, no. 3, pp. 732–739, 2009.

E. B. Holliday, H. S. Mitra, J. S. Somerson et al., “Postoperative proton therapy for chordomas and chondrosarcomas of the spine: adjuvant versus salvage radiation therapy,” Spine, vol. 40, no. 8, pp. 544–549, 2015.

B. Rombi, T.F. DeLaney, S.M. MacDonald, et al. “Proton radiotherapy for pediatric Ewing’s sarcoma: initial clinical outcomes” Int J Radiat Oncol Biol Phys, 82 (2012), pp. 1142-1148

Prostate Cancer Studies

Extreme hypofractionated proton radiotherapy for prostate cancer using pencil beam scanning: Dosimetry, acute toxicity and preliminary results
https://www.ncbi.nlm.nih.gov/pubmed/31486267

Quality of life and toxicity from passively scattered and spot-scanning proton beam therapy for localized prostate cancer
http://www.ncbi.nlm.nih.gov/pubmed/24139077

Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate
http://www.ncbi.nlm.nih.gov/pubmed/20124169

Comparison of high-dose proton radiotherapy and brachytherapy in localized prostate cancer: a case-matched analysis
http://www.ncbi.nlm.nih.gov/pubmed/21470787

Dose-volume comparison of proton therapy and intensity-modulated radiotherapy for prostate cancer
http://www.ncbi.nlm.nih.gov/pubmed/17904306

Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer
http://www.ncbi.nlm.nih.gov/pubmed/21093164

Erectile function, incontinence, and other quality of life outcomes following proton therapy for prostate cancer in men 60 years old and younger
http://www.ncbi.nlm.nih.gov/pubmed/22253020

Five-Year Outcomes from 3 Prospective Trials of Image-Guided Proton Therapy for Prostate Cancer
http://www.redjournal.org/article/S0360-3016(13)03310-5/abstract

Hypo-fractionated passively scattered proton radiotherapy for low-and intermediate-risk prostate cancer is not associated with post-treatment testosterone suppression
http://www.ncbi.nlm.nih.gov/pubmed/23477360

Long-term quality of life outcome after proton beam monotherapy for localized prostate cancer
http://www.ncbi.nlm.nih.gov/pubmed/21621343

Management of complications of prostate cancer treatment
http://www.ncbi.nlm.nih.gov/pubmed/18502900

Patient-reported long-term outcomes after conventional and high-dose combined proton and photon radiation for early prostate cancer
http://www.ncbi.nlm.nih.gov/pubmed/20233822

Urinary functional outcomes and toxicity five years after proton therapy for low-and intermediate-risk prostate cancer: results of two prospective trials
http://www.ncbi.nlm.nih.gov/pubmed/23477359

Long-term Efficacy and Toxicity of Hypofractionated Salvage Radiation Therapy for Biochemically Recurrent Prostate Cancer
https://www.redjournal.org/article/S0360-3016(15)01755-1/fulltext

Prague Proton Therapy Center Study Shows Proton Therapy Greatly Reduces the Risk of Side Effects Compared with Conventional Radiotherapy

Patients who undergo conventional radiotherapy treatment are exposed to a far greater amount of unnecessary radiation to healthy tissue, in comparison to patients undergoing proton therapy treatment. As a more targeted treatment modality, proton therapy spares a greater quantity of healthy tissue. Treatment plans using proton radiotherapy reduce radiation exposure by 50% compared to conventional radiotherapy treatment.

The Prague Proton Therapy Center Medical Team published their treatment plan comparison findings for patients with advanced prostate carcinoma in the December 2019 edition of Radiation Protection Dosimetry, entitled ‘Low dose bath from IMPT vs IMXT for the pelvic area when treating advanced prostate cancer‘. This study compared treatment plans for patients undergoing Intensity Modulated Proton Therapy (IMPT) with patients undergoing conventional Intensity Modulated X-Ray Therapy (IMXT) for advanced prostate cancer.

Existing studies have already shown that cancer patients receiving proton therapy experience a significantly lower risk of unnecessary side-effects from radiation therapy in comparison to patients receiving traditional photon radiation. Cure rates remain however essentially identical between the two groups.

The results of this study confirm these existing findings, demonstrating the clear superiority of proton therapy over conventional x-ray (photon) radiotherapy. Proton therapy treatment was shown to halve the amount of dangerous radiation exposure to the abdominal cavity and rectum (50% less radiation to healthy tissue). This thereby reduces the risk of side-effects and offers patients a greater chance at maintaining a higher quality of life during and after their cancer treatment.

Proton therapy was also shown to use a significantly lower number of treatment fields for the same target dose coverage, when compared to conventional photon (x-ray) treatment techniques. The authors state that proton therapy treatment ‘irradiates just half of the tissue volume with a low dose compared to conventional x-ray treatments without compromise in target volume coverage’. In this way the risk of secondary cancer development and other possible complications is also greatly reduced.

Optimum proton dose distributions can be achieved with intensity modulated proton therapy. Currently, proton therapy is undergoing transitions that will move it into the mainstream of cancer treatment. For example, proton therapy is now reimbursed, there has been rapid development in proton therapy technology, and many new options are available for equipment, facility configuration, and financing.

Proton therapy might be an appropriate treatment option for you or a loved one that is suffering from cancer. Please contact us if you would like to find out more.

Associated Resources:

B. Glimelius, U. Isacsson, E. Blomquist, E. Grusell, B. Jung, and A. Montelius, “ Potential gains using high‐energy protons for therapy of malignant tumors,” Acta Oncol. 10.1080/028418699431537 38, 137– 145 (1999)

B. Glimelius et al., “ Number of patients potentially eligible for proton therapy,” Acta Oncol. 10.1080/02841860500361049 44, 836– 849 (2005)

R. Flynn, D. Barbee, T. Mackie, and R. Jeraj, “ Comparison of intensity modulated x‐ray therapy and intensity modulated proton therapy for selective subvolume boosting: A phantom study,” Phys. Med. Biol. 10.1088/0031‐9155/52/20/001 52, 6073– 6091 (2007)

L. Haisen, H. Romeijn, H. Fox, J. Palta, and J. Dempsey, “ A computational implementation and comparison of several intensity modulated proton therapy treatment planning algorithms,” Med. Phys. 10.1118/1.2836954 35, 1103– 1112 (2008)

A. J. Lomax et al., “ A treatment planning inter‐comparison of protons and intensity‐modulated photon therapy,” Radiother. Oncol. 10.1016/S0167‐8140(99)00036‐5 51, 257– 271 (1999)

Luca’s Craniopharyngioma Story

Luca is a young boy who was diagnosed with craniopharyngioma. His mother, Mariana, has decided to share their journey.

When I found out about Luca’s craniopharyngioma I started researching all the possible treatment opinions both in my country, Romania, and abroad. At that time, there were three neurosurgeons in America with whom I corresponded and they recommended surgical removal of the tumor followed by proton therapy. It was the first time I heard of such therapy.

Two surgeries were performed in the hospitals in Bucharest and the tumor was completely removed along with the pituitary gland. The doctors hoped that everything would go well and we would not need proton therapy. Shortly after, however, we realised that it was not the case and the doctors gave us two options: we could repeat the surgeries whenever the tumor recurred or we could do proton therapy. We chose proton therapy. We had to decide which of the centres in Europe to go to. A Romanian student who was studying in Prague recommended us the Proton Therapy Center (PTC). He recommended PTC as it is one of the newest centres, therefore with the latest technology, but also with a lot of experience and well trained doctors. Thus Prague became our home for two months. We didn’t imagine that treating such a disease could go so smoothly!

Before going to Prague for Luca’s treatment, I had never left Romania. I didn’t know any foreign language but Susanna, the treatment coordinator who was assigned to our case, helped us with all the details. Susanna found the accommodation most suitable for us, she informed us in detail and patiently explained each step of the process, always making sure we understood. Moreover, the PTC organised for a car to pick us up at the airport as well as take us back to the airport at the end of Luca’s treatment.

Luca loves the Proton Therapy Center and the people here. He didn’t experience any side effects, hair loss, or nausea. In addition Luca began to love walking because of the many beautiful places Prague has to offer!

Easter Traditions in the Czech Republic

Easter, known as Velikonoce, in the Czech Republic is a celebration of the arrival of spring. Celebrated on Monday, not Sunday, Easter has many unusual traditions that may vary depending on the region. Some of the most popular Easter traditions and symbols include:

Kraslice (Easter eggs) – girls decorate Easter eggs using a variety of techniques. The eggs will be given to the boys on Easter Monday.

Pomlázka (Pussywillow) – it is thought that by whipping someone with pussywillow twigs you bring them health and youth. Boys will collect twigs and braid them to create whips, which will then be used to whip the girls while reciting a short Easter poem. The girls reward the boys with candy, a painted egg or a ribbon to tie around his whip.

Lamb shaped cake – a staple of any Czech Easter meal. Other dishes that are common for Easter include potato salad, gingerbread and in many households, slivovice which is homemade plum brandy.

The colour red – symbolising the energy of new life, which is what spring brings. Many people will dye their eggs red or wear a red outfit during Easter.

The warning off of Judas – during holy week, for three days, boys will travel around their village shaking wooden rattles to scare off Judas. On Saturday, the third day, the boys will make their rounds to houses where they will make noise with their rattles until they are given a present.

Proton Beam Therapy vs Intensity-Modulated Radiation Therapy for Locally Advanced Oesophageal Cancer

Radiation therapy has become an important component in the curative management of oesophageal cancer worldwide. Since most of the oesophageal cancers seen in the Western hemisphere (i.e., Europe and the United States) are located in the mid- to distal-oesophageal locations, heart and lungs invariably receive significant radiation doses. Much of the normal tissue exposure could be reduced with the utilisation of advanced radiation technologies such as intensity modulated proton therapy. Proton beam therapy (PBT) provides the ability to reduce normal tissue exposure (compared to conventional treatments) due to its lack of exit dose, which enables medical teams to provide clinically meaningful benefits to oesophageal cancer patients.

A Randomized Trial of Proton Beam Therapy Versus Intensity-Modulated Radiation Therapy for Locally Advanced oesophageal Cancer found that proton beam therapy was associated with less toxicity and similar progression-free survival vs intensity-modulated radiation therapy in patients with locally advanced oesophageal cancer.

In the trial, 145 patients were randomly assigned to proton beam therapy or intensity-modulated radiation therapy. Median follow-up was 44.1 months. The posterior mean total toxicity burden was 2.3 times higher in the intensity-modulated radiation therapy group vs the proton beam therapy group. The mean postoperative complication score was 7.6 times higher in the intensity-modulated radiation therapy group vs the proton beam therapy group (2.5, 95% highest posterior density interval = 0.3–5.2). At 3 years, overall survival was 51.2% vs 50.8% and median overall survival was 42.1 months vs 73.6 months.

The investigators concluded: “For locally advanced oesophageal cancer, proton beam therapy reduced the risk and severity of adverse events compared with intensity-modulated radiation therapy while maintaining similar progression-free survival.”

Treating oesophageal cancer with an adequate dose of radiation can be difficult because of the close proximity of the oesophagus to critical structures, such as the heart, lungs and spinal cord. Because protons deposit their highest dose of radiation at the tumor or area of concern, proton therapy can be an excellent choice for treating patients with oesophageal cancer.

Proton therapy offers patients and their doctors a unique option for effectively treating oesophageal cancer while reducing damage to other critical organs and tissues. The Prague Proton Therapy Center is one of the few centres of its kind treating oesophageal cancer with proton technology.

Latest proton therapy study shows hypofractionated proton therapy as safe and effective for patients with low-risk prostate cancer

A study published in August 2019 in the International Journal of Particle Therapy by Dr. Slater and his team, highlights the results of their latest phase I/II hypofractionated proton therapy study at Loma Linda University Hospital.

Prostate cancer is the most commonly diagnosed cancer in men, and many of these patients have low-risk, early disease. Prostate cancer at these stages remains highly treatable with local control rates over 90% and very low rates of late morbidity commonly reported for a variety of treatment modalities. The focus then turns to the avoidance of unnecessary negative treatment-related side effects that can occur, particularly through the use of conventional treatments such as surgery and x-ray (conventional) radiotherapy.

Proton radiation therapy has demonstrated itself to be an excellent option for low-risk prostate cancer as it delivers high control rates with very little toxicity. Proton beam thereby enhances the physician’s opportunity to minimise risks for the patient.

Hypofractionation is the process of delivering higher doses of radiation per fraction, but using fewer daily fractions. Doctors and physicists at Loma Linda University have successfully used hypofractionated proton therapy for several diseases, including cancers of the breast, lung, and liver. In each instance, control and survival rates have been maintained and unwelcome side effects have not increased. This experience prompted the medical team at Loma Linda to investigate hypofractionation for prostate cancer.

The purpose of the study was to determine whether a hypofractionated proton radiotherapy regimen can control early-stage prostate cancer while maintaining low rates of side effects similar to results obtained using standard-fraction proton radiotherapy.

A cohort of 146 patients with low-risk prostate cancer (Gleason score 7, prostate-specific antigen 10, tumor stage of T1–T2a) received 20 fractions of proton therapy (3.0 Gy per fraction over 4 weeks). Patients were evaluated at least weekly during treatment, at which time documentation of treatment tolerance and acute reactions was obtained. Follow-up visits were conducted every 3 months for the first 1 years, every 6 months for the next 3 years, then annually. Follow-up visits consisted of history and physical examination, PSA measurements, and evaluation of toxicity.

The 3-year biochemical progression-free survival rate was 99.3%, and the 5-year biochemical progression-free survival was 97.9%.

In conclusion, this study showed that hypofractionated proton therapy (60 Gy in 20 fractions) was safe and effective for patients with low-risk prostate cancer. A prospective multi-institutional randomised study is currently being conducted to confirm these results.

Sources:

Kil WJ, Nichols RC Jr, Hoppe BS, Morris CG, Marcus RB Jr, Mendenhall W, Mendenhall NP, Li Z, Costa JA, Williams CR, Henderson RH. Hypofractionated passively scattered proton radiotherapy for low- and intermediate-risk prostate cancer is not associated with post-treatment testosterone suppression. Acta Oncol. 2013;52:492–7

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. Int J Radiat Oncol Biol Phys. 2014;88:596–602

Mendenhall NP, Li Z, Hoppe BS, Marcus RB Jr, Mendenhall WM, Nichols RC, Morris CG, Williams CR, Costa J, Henderson R. Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2012;82:213–21

Shipley WU, Verhey LJ, Munzenrider JE, Suit HD, Urie MM, McManus PL, Young RH, Shipley JW, Zietman AL, Biggs PJ, Heney NM, Goitein M. Advanced prostate cancer: the results of a randomized comparative trial of high dose irradiation boosting with conformal protons compared with conventional dose irradiation using photons alone. Int J Radiat Oncol Biol Phys. 1995;32:3–12

Slater JD, Rossi CJ Jr, Yonemoto LT, Bush DA, Jabola BR, Levy RP, Grove RI, Preston W, Slater JM. Proton therapy for prostate cancer: the initial Loma Linda University experience. Int J Radiat Oncol Biol Phys. 2004;59:348–52

Slater JD, Rossi CJ Jr, Yonemoto LT, Reyes-Molyneux NJ, Bush DA, Antoine JE, Miller DW, Teichman SL, Slater JM. Conformal proton therapy for early-stage prostate cancer. Urology. 1999;53:978–84

Slater JD, Yonemoto LT, Rossi CJ Jr, Reyes-Molyneux NJ, Bush DA, Antoine JE, Loredo LN, Schulte RW, Teichman SL, Slater JM. Conformal proton therapy for prostate carcinoma. Int J Radiat Oncol Biol Phys. 1998;42:299–304

Slater JM, Slater JD, Kang JI, et al. Hypofractionated Proton Therapy in Early Prostate Cancer: Results of a Phase I/II Trial at Loma Linda University. Int J Part Ther. 2019;6(1):1–9. doi:10.14338/IJPT-19-00057

Zietman AL, Bae K, Slater JD, Shipley WU, Efstathiou JA, Coen JJ, Bush DA, Lunt M, Spiegel DY, Skowronski R, Jabola BR, Rossi CJ. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from Proton Radiation Oncology Group/American College of Radiology 95-09. J Clin Oncol. 2010;28:1106–11

Proton Therapy for Central Nervous System Leukaemia

The guidelines issued by the International Lymphoma Radiation Oncology Group (ILROG) open up new opportunities for the use of proton radiotherapy in leukaemia.

ILROG’s recommendations newly apply also to patients with initial involvement of CNS (positive finding in the cerebrospinal fluid) or patients with a relapsed disease related to CNS who are planned for allogeneic transplantation or have CNS involvement and do not respond to chemotherapy or biological treatment. If patients diagnosed with leukaemia have infiltration of their central nervous system (CNS) or extramedullary involvement (myelosarcoma) and their attending hematologist-oncologist recommends radiotherapy, proton therapy is a suitable choice. This is confirmed both by the newly updated recommendations of the international expert group ILROG, and dosimetric comparisons of the existing forms of available radiotherapy.

In such cases, proton radiotherapy has substantial benefits when compared with other forms of radiotherapy. These include no radiation strain on organs in front of vertebral bodies and minimal systemic toxicity (reduced occurrence of nausea, vomiting, diarrhoea). Proton radiotherapy is suitable for highly pre-treated patients (patients after a few rounds of chemotherapy) with necessary reduction of the dose to which the lungs, intestinal villi, heart and other organs are exposed.

Interview with Dr Kateřina Dědečková on the possibilities of treatment of hematologic diseases with proton radiotherapy

According to the latest recommendations of the International Lymphoma Radiation Oncology Group (ILROG), radiotherapy is also suitable for some patients diagnosed with leukaemia. Which patients specifically?

ILROG is very active in raising awareness on the benefits of radiation in the treatment of hematological malignancies, i.e. blood tumours. Over the past few years, ILROG has issued recommendations for the use of radiation in most haematologic cancers such as lymphomas, leukemias, myelosarcomas, myelomas, and others. For leukemias, in particular patients with central nervous system (CNS) involvement, it is now recommended to use radiation more frequently and to a greater extent.

Why is it now advisable to irradiate the central nervous system (CNS) also in patients with leukaemia?

The CNS (i.e. brain and spinal cord) is separated from the bloodstream by a safety barrier, called blood–brain barrier (BBB), which prevents materials from the blood from entering the brain. Thus, some molecules, including drugs, reach the CNS with limited or no effect. For this reason, in some cases, the CNS may be a source of disease recurrence because part of the cells escape the effects of chemotherapy or biological therapy, leading to a re-spread of cancer cells in the body.

What benefits do patients have from using proton radiotherapy?

Due to the limited possibilities of systemic treatment, irradiation of the entire CNS area is advantageous. This consists of the irradiation of the brain, spinal cord, spaces where cerebrospinal fluid circulates, and craniospinal axis. The aim is also to get to the hard-to-reach leukaemia cells, as well as those that are no longer sensitive to chemotherapy or biological therapy.

Patients who benefit the most from proton radiotherapy are the ones who, despite intensive systemic treatment, have a positive finding of leukemic cells in the cerebrospinal fluid, a positive cerebrospinal fluid at the time of diagnosis, or leukemic lesions in the brain or spinal cord. Also, patients who are at risk of involvement of the central nervous system future.

Therefore, according to the new recommendations, these patients should preferably be irradiated in the whole area of ​​the craniospinal axis.

Is radiotherapy commonly indicated in these patients or is it a new recommendation?

Previously, because of the high toxicity, it was preferable to irradiate only the skull area. However, thanks to the use of proton radiotherapy instead of classical radiation, it is possible to reduce the adverse effects of treatment that previously impaired quality of life, such as nausea, vomiting, fatigue, swallowing pain, and aphthae in the oral cavity. Therefore, radiotherapy has not been commonly used in these patients and, if so, less extensive exposure has been used, mainly because of concerns about toxicity associated with older exposure techniques, as I have mentioned. Irradiation of the CNS as a risk area has been found to improve the outlook for cure in risk patients. According to the new ILROG recommendation, groups of patients have already been identified who will benefit from the inclusion of craniospinal axis irradiation in their treatment plan.

How does the treatment work?

The patient is placed in supine position with their arms along the body, while the head is fixed with a special thermoplastic mask. A CT scan is done over the entire irradiation range, i.e. the entire head and spine to the coccyx. These CT images then show the areas that are the target of radiation and also the areas that we want to protect from radiation, called organs at risk (OAR). Then, the doctors and physicists collaborate to carefully calculate the irradiation plan. This plan is then checked multiple times, as well as directly in the gantry to confirm its accuracy. Then, the actual treatment begins. Leukaemia is typically treated in 9 to 12 sessions (fractions), applied to the entire craniospinal axis. In some patients, we also irradiate the riskiest areas, such as apparent tumor lesions, up to a total of 15-18 fractions. Irradiation takes place every weekday and may be associated with mild swallowing difficulties, fatigue and a decrease in the number of blood cells.

Is there a difference if a patient is irradiated with photon or proton techniques?

Yes, the difference is that when using proton radiotherapy, the patient is less exposed to radiation. There is less irradiation to the organs in front of the tumor, minimal irradiation to lungs, heart, oesophagus, intestinal loops, kidneys, liver, and bladder, which significantly reduces the possibility of late toxicity of these organs. The patient also better tolerates irradiation of the craniospinal axis.

Do you have any recent experience with this form of treatment? If so, how did the patients tolerate the treatment?

At the Proton Therapy Center in Prague we already have experience with this irradiation technique for hematological malignancies, although there has been a relatively small number of patients (around 10 so far). Our experience so far has so far been very positive, both in terms of toxicity and preliminary treatment outcomes. In some of these patients, radiotherapy was the last treatment option and even here we managed to successfully destroy CNS tumor cells. From our point of view this is a very promising method of treatment, but a longer follow-up of patients and evaluation of a larger group of patients will be required.

Dr Kateřina Dědečková

In 1998-2001 Dr Dědečková worked at the radiotherapy department of the District Hospital in Jičín. Then, from 2001 to 20017, she worked at the Institute of Radiation Oncology of the University Hospital Na Bulovce. In 2009 Dr Dědečková gained specialised competence in the field of radiation oncology. Since 2012, she has been working as a radiation oncologist at the Proton Therapy Center in Prague. Since 2019, Dr Dědečková also leads the interdisciplinary Center of Excellence for Proton Radiotherapy of Malignant Lymphomas at the Proton Center in Prague.

Dr Dědečková specialises in radiation treatment of malignant lymphomas and other hematological tumours, urological tumours and head and neck tumours. She has participated in international clinical trials with independent quality control of radiotherapy (GHSG, ESTRO Equal, QARC) in the treatment of malignant lymphomas and head and neck tumours. Dr Dědečková is a member of the Council of the International Lymphoma Radiation Oncology Group (ILROG) and a member of the Lymphoma Sub-Committee of the Particle Therapy Co-Operative Group (PTCOG). Dr Dědečková publishes professional medical press and lectures at congresses, both domestically and internationally. Dr Dědečková is co-author of the “Diagnostic and Treatment Guidelines in Patients with Malignant Lymphoma” of the Lymphoma Cooperative Group (chapter on lymphoma radiotherapy). Dr Dědečková deals with new techniques of lymphoma radiotherapy, such as proton radiotherapy of mediastinal lymphomas using the pencil beam scanning technique in maximum inhalation.

Gergana’s Osteosarcoma Cancer Story

Hello everyone!

My name is Gergana Mihaylova, but all my friends and family call me Gerry. I was born in Sofia, Bulgaria, on April 26, 1981 – it was Easter Sunday! I had a happy and healthy childhood, surrounded by love and attention. As I grew older, I learned that I could do anything with a lot of hard work and faith. I never give up! I love the beauty and music of life. I believe in miracles and that good things always come. I say all this because I think it is of great importance to the story that I am about to tell you.

It all started in the spring of 2017. A small swell appeared in my right temple. I thought it was a consequence of being hit. I had no complaints, but decided to consult it with a doctor anyway. And so my “adventure” began.
The various examinations I did showed that there was a problem, but I didn’t know how serious it was until the swelling started to increase in size to the point it “poured out” and changed the shape of my head.
My first surgery was performed in July by the neurosurgeons at Tokuda Hospital in Sofia. They removed a tumor that showed to be malignant. I was recovering very fast, all my examinations at that point were good, and I felt healthy. I sought the advice of a number of specialists and so I decided to go to Turkey for treatment. I was prescribed radiotherapy there. I passed this ordeal with the support of my family, friends and colleagues. My follow-up examinations showed that there was no trace of the tumour. So, after months of “walking through the pain”, I went back to work. Life went on!

But fate, or Providence, had prepared for me a nightmarish sequel.
In March 2019, during an MRI check, the radiologists noticed that something was out of place compared to my previous MRI. So it all started again from the beginning…
Two months of consultations, research, and a second operation in May – this time I chose Memorial Hospital in Istanbul. The histology report confirmed the diagnosis: osteosarcoma (a type of bone cancer).
I am grateful for the attention and attitude of the entire team and personally of Prof. Dr. Gökhan Bozkurt. It was him and Prof. Fazilet (radiology) who advised me to continue my treatment as soon as possible with proton therapy. Unfortunately, they did not have this technology. In Bulgaria, neither.

As soon as I got back to Sofia I started looking for information. I had all the necessary medical documentation translated to several languages, which I then sent to numerous European proton centres.
Naturally, I also continued with my control examinations. In less than three months the radiologists saw again a new “thing” growing.
An urgent third surgery followed and, a week later, a fourth smaller nasal aeration. Back in Turkey. Back in the same clinic. And again the same recommendation: EMERGENCY PROTON THERAPY!

My friend Vlado (Vladimir) was at the hospital with me all the time. His support has been fundamental and helped me maintain my composure and continue to follow my path optimistically.

Vlado and I started looking again, translating more documents and sending inquiries to all the countries we found to be performing proton therapy. We have received responses from several clinics, but one in particular stood out to us: the Proton Therapy Center in Prague. They always answered the fastest and in the most organized way. Not only via email, but also via phone: they always picked up the phone, which was of great importance to me because there was no TIME.

In early December, I visited the Proton Therapy Center for my initial consultation. From the meeting I had there with Dr. Haas, I realized that there was an opportunity to start proton therapy very quickly. However, I first had to obtain the S2 funding (I could not afford the treatment as self-payer). Both Czech Republic (where the clinic is located) and Bulgaria (where I come from) are EU members and the Bulgarian Health Insurance Fund is able to pay for treatment under this agreement.
I immediately submitted the necessary documents to the National Health Insurance Fund (NHIF) for the allocation of funds for treatment abroad. I had to submit, in addition to all my medical records, an offer from the relevant medical institution regarding the costs and duration of treatment. Again, all necessary documents were provided to me very quickly and accurately by the Proton Therapy Center.

I have received the approval for the S2 funding during Christmas! How not to believe in miracles!

Vlado and I arrived to Prague just before New Year’s. We were met at the airport by a car sent from the Proton Therapy Center. Prior to beginning treatment, it was necessary to prepare the radiotherapy plan, fixation mask, etc. This happened on 12/30/2019.
During this time, we met Petra and Susi – the girls who coordinated the whole process. I received information from them on everything, even about things beyond treatment! For example, I was invited to attend a gala evening organized by the Nadační Fond Onkologie. There were doctors, patients and healthcare professionals from the Czech Republic. I went with Petra and we had a lot of fun!

And so my treatment began …
The treatment sessions are short and painless, made with the latest and most modern equipment in the world. I had no side effects except for a slight skin redness in the irradiated area. Every week I had a check-up with Dr. Haas, who took care of me during the whole treatment. Every week I also had a control MRI which allowed the doctors to follow my progress very closely.
Dr. Haas always kept me up to date with my progress. I also had a meeting with Dr. Matz, physicist, who helped me better understand the treatment. He also showed me my treatment plan!

In conclusion, I can say that the extremely fast and adequate response I have received from the Proton Therapy Center, as well as the kindness of all people who took care of me there, definitely met my needs! One feels at ease here. In addition, Prague is a city full of fabulous beauty, which is a treat in its own!

Superior Intellectual Outcomes After Proton Radiotherapy Compared With Photon Radiotherapy for Pediatric Medulloblastoma

Proton Radiotherapy Preserves Intellectual Function in Children suffering from Medulloblastoma – New study shows that children treated with Proton Therapy have superior intellectual outcomes, compared to children treated with conventional photon/x-ray radiotherapy.

Radiotherapy is essential for treating children’s brain tumours – however conventional radiotherapy treatment increases the risk of permanent cognitive impairment. Memory problems, learning problems, global IQ decline, and other serious cognitive impairments can occur. A new study published in the Journal of Clinical Oncology on the 27th November 2019 has demonstrated the superiority of proton therapy over traditional x-ray/photon radiotherapy in treating paediatric Medulloblastoma.

Medulloblastoma is an invasive, rapidly growing form of tumour, and the most commonly occurring type of brain cancer in children. This study showed that the use of proton therapy in treating these cancers (instead of conventional photon/x-ray radiotherapy) resulted in significantly improved long-term intelligence outcomes in children.

This study provides the strongest evidence to date that proton therapy preserves the intellectual function of children with medulloblastoma – as opposed to traditional x-ray radiation which can cause damage and result in a lower quality of life for children following treatment. The authors of the study concluded:

“Even in the context of CSI (craniospinal irradiation), patients treated with PRT (Proton RadioTherapy) exhibited stable intellectual outcomes in most domains and experienced significantly better long-term outcomes in global IQ, perceptual reasoning, and working memory compared with patients treated with XRT (conventional x-ray radiotherapy).”

These results expand on previous research suggesting an intellect-sparing benefit of proton therapy in the treatment of paediatric brain tumors, reported Lisa S. Kahalley, PhD, of Texas Children’s Hospital (TCH) in Houston, and colleagues in the Journal of Clinical Oncology.

“It’s getting very difficult to argue that there isn’t a very strong clinical benefit associated with proton, so now it really becomes an access issue. We have to think really hard about ways to improve access to families that aren’t located near proton centres.”

The Proton Therapy Center in Prague has considerable experience treating children’s brain tumours with protons, and has treated many children suffering from medulloblastoma – including British child Ashya King, who received proton therapy at the Prague Proton Therapy Center after an international manhunt in 2014. Ashya’s story received widespread public attention, and his successful proton therapy treatment in Prague resulted in him having less risk of cognitive problems following treatment.