Selected Podcast
Proton Therapy and its Benefits in Cancer Care
Dr. Gayar (Medical Director for the McLaren Proton Therapy Center) talks about proton therapy and its benefits in cancer care. Dr. Gayar explains what proton beam therapy is, the forms of cancer that can be treated with this therapy, and who is a good candidate for it.
Featuring:
Learn more about Hesham Gayar, M.D.
Hesham Gayar, M.D.
Hesham Gayar, M.D., a board certified radiation oncologist, is Medical Director for the McLaren Proton Therapy Center, part of the Karmanos Cancer Network. He also serves as Vice President for the Particle Therapy Co-Operative Group (PTCOG) -North American Chapter and as a board member and Steering Committee member for PTCOG worldwide.Learn more about Hesham Gayar, M.D.
Transcription:
Amanda Wilde (Host): Proton therapy is a cutting edge cancer treatment that's more precise and has fewer side effects. Today, we'll talk about proton beam therapy with Dr. Hesham Gayar, Medical Director for the McLaren Proton Therapy Center. This is McLaren's In Good Health, the podcast from McLaren. I'm Amanda Wilde. And Dr. Gayar, thank you for your time. So a proton beam sounds like a very space age way to treat illness. Is it as advanced as it sounds?
Dr Heshram Gayar: Thank you for inviting me. So yes, proron therapy is different from the conventional standard radiation. It is subatomic particles, very tiny particles, cannot be seen even with the best microscope that is delivered to lay energy when it reaches a certain depth at the target and stops, unlike conventional radiation where it goes through. So you can imagine you can paint with a tiny, tiny brush, the dose you need in a three-dimensional way in a target in the body where the beam explodes or gives the energy when it reaches the target at a limited few millimeter spots and stops completely. No radiation goes to normal tissue, no exit dose. This saves the body unnecessary radiation, spares the organs that don't need to be treated. And unlike conventional radiation, which goes through the body, that's how we get x-rays by shooting the beam and receiving it from the other end of the body, everything gets irradiated. This doesn't happen with proton therapy. And hence, the radiation going to normal tissue in organs that are sensitive, the radiation is completely avoided and those organs are sometimes completely spared or except for very, very few millimeters around the target are spared.
Amanda Wilde (Host): So we can say that this therapy has fewer side effects. And in what other ways does it benefit the patient?
Dr Heshram Gayar: Yes. We can say that this treatment, because of the precision and sparing the normal tissue around the target, does spare the organs. For example, if I'm treating a target in the abdomen, let's say the pancreas has cancer, I can treat the pancreas and completely spare the kidneys, the stomach, the bowels, even the intestine right around the pancreas can be spared unnecessary radiation. So the patient doesn't get sick during the treatment.
And also it helps by reducing late effects. Sometimes radiation coming to organs, a child, for example, you treat the brain for tumor, any spilled lower dose of radiation outside the target gets unnecessary side effects that can cause compromise in quality of life. Education, IQ can drop. And radiation can be damaging even in small doses when it goes to normal tissue and the brain is a higher real estate. You want to spare every part of the brain any radiation you can.
Proton therapy puts the treatment where it belongs, and it's been proven that children treated with proton therapy compared to standard radiation have better performance at school, better IQs, better memory and development is not altered either. And the same can happen for young adults. And for adults with organs that are critical, like the heart, for example, can be spared when you're treating somebody with lymphoma in the chest or breast cancer, or treating the esophagus. And sparing the heart any radiation reduces the risk of problems later in life and the risk of ischemic heart disease, like heart attacks is reduced because even low doses of radiation can cause damage. So simply proton therapy is putting the radiation in the form of tiny particles where it belongs and that reduces illness and toxicity during treatment. It reduces late effects and problems after the treatment and it improves quality of life for the patients when they survive cancer.
Amanda Wilde (Host): So this sounds like a giant leap forward in cancer treatment. What forms of cancer can you treat with the proton beam?
Dr Heshram Gayar: Proton therapy can be delivered to any part of the body, but we put it, especially when it makes more sense to protect the organs. So if somebody has cancer in the leg, for example, or the arm, proton therapy is not as much of value as if it's in the head or the skull base or the brain, or the head and neck area, the swallowing parts or the heart, or the spinal cord or pancreas, rectum, bowels. It makes more sense to protect those organs when the cancer is close to it. So anytime you have cancer close to a critical organ or an important structure, not to say that any part of our body is not important, but it can be applied anywhere in the body for any malignancy, but there are diseases that will benefit more than others. And we evaluate each patient and decide which one can be treated or should be treated with proton therapy.
So to list some of the indications, it can be used in the pancreas. It can be used in brain cancer. It can be used in cancer of the base of skull, cancers of the head and neck, tonsils, throat, and so on. It can be used for cancers in the mediastinum or in the chest, that's the compartment between the two lungs. It can be used in certain lymphomas. It can be used in esophagus cancer. It can be used in breast cancer. It can be used in lung cancer. It can be used in pancreatic cancer, in some special recurrent cancers in the pelvis, certain rectal cancers, colon cancer in special locations. Liver cancer actually benefits significantly from proton therapy. It can be used in prostate cancer. It can be used in some kidney tumors. So these are some of the examples, just for mentioning or listing, not really listing all of them, but these are examples of where there can be benefit.
Amanda Wilde (Host): You mentioned children who benefit greatly from proton therapy. Who is a candidate for proton beam therapy?
Dr Heshram Gayar: Especially young people, children, and young adults, and people who have long expectancy because of the savings of late effects and the quality of life, it makes more sense to use it for those patients. So any child with cancer that requires irradiation, it's well known and covered by all insurances that proton therapy is a better treatment.
Why? Because this child is going to live for many years and you want to reduce that late toxicity that happens from unnecessary radiation. So is the case for teenagers, people in their 20s, 30s, 40s, 50s, young adults will benefit from proton therapy more than others because of the many years they have to live, especially if the cancer is cured. So we're talking here about the quality of life during treatments. We're talking about the longevity and the effectiveness of normal function, like growth development, intellectual functions in the brain, some organ limitations. And risk of second cancers too is reduced with proton therapy. Yes, younger people will benefit more, and pediatrics and young adults especially.
Amanda Wilde (Host): Is proton therapy a readily available treatment? Is it out there?
Dr Heshram Gayar: Yes, it is. And there are two centers in Michigan. Of course, there are demands on the proton center facilities and we're the largest facility in Michigan and have the highest technology available. And yes, we are available and we accept patients. And insurance does cover the disease also. So it is covered by Medicare. It's covered by all insurances. And for the right indications and the patients that are appropriate selections for particle therapy, we don't have much problems getting coverage.
Amanda Wilde (Host): Now, I understand yours was just the second such treatment center in the state. Do you participate in clinical trials and research?
Dr Heshram Gayar: Actually, being part of Karmanos Cancer Institute, which is an NCI-designated national cancer Institute designated center, participating in clinical research is very high in our list. Actually, about 17 to 20% of our patients are in clinical trials, and this is available in proton centers countrywide. There's about 42 proton centers in the US and two in Michigan. And we are ranked among the highest enrollers in research and clinical trials. We have clinical trials for many body sites that are open right now and we're opening more.
Amanda Wilde (Host): What impact have you seen the center have since it's opening?
Dr Heshram Gayar: Since we opened the proton center, we have patients coming from outside the region, other parts of the states, from other states, also from outside the country and from other continents. We've had patients from Asia, from the Middle East, one patient from Europe. We have had patients from Canada coming here and getting their treatments at our facility. So it became like a destination for cancer treatments. Our cancer program in Flint, Michigan has become a hub for Karmanos Cancer Institute in providing proton therapy and many cancer specialties, special surgeries, medical oncology. All the cancer-related services have been enhanced in the area since we started having the proton center. We have a beautiful hospitality house adjacent to the proton center to accommodate patients traveling and the use is significant and the patients are very happy with the experience.
Amanda Wilde (Host): It's so thoughtfully put together. And with patients coming in from all over the world, can you share a success story or two that you've seen?
Dr Heshram Gayar: Oh, I can list many, but the first that comes to my mind is a patient that is from the Port Huron area that was being treated down in Detroit. And they couldn't treat her for a tumor that is in the orbit next to the eye globe, pushing the eye to the side. And treating that patient with conventional radiation would've definitely ruined that eye and lost vision. I treated the patient, successfully controlled the tumor, no evidence of cancer and kept her eyesight complete. Even peripheral vision was preserved, which is amazing.
Another 39-year-old lady with a large tumor in her pelvis, the tumor has grown and extended along the nerves into the tailbone, was not candidate for surgery. It was too advanced to be resected. I treated the tumor and its branches inside the bone along the nerves, gave it a high dose enough to cure it, sparing the adjacent pelvic structures, the uterus, the rectum, the bladder, the organs were spared successfully. She has no evidence of disease three years now and negative PET CT. And luckily, she did not have any cancer spread either. So that's another success story.
I can go on and on, but I don't want to take your time. We have multiple head and neck cancer patients like tonsillar cancer that had the treatment with minimal side effects. And those usually are significant with the standard conventional radiation. I have patients with prostate cancer that were treated, completed the course of treatment, and don't have any side effects. They go play golf after the treatment. Very well-tolerated course of radiation, compared to the conventional radiation is definitely better quality of life.
Amanda Wilde (Host): Amazing. Lost causes getting cured. doctor, this is fascinating and encouraging. I'm really looking forward to following how proton beam therapy progresses into the future. Thank you.
Dr Heshram Gayar: Oh, you're welcome. Thank you for having me.
Amanda Wilde (Host): For more information, please visit mclaren.org/gayar. That's M-C-L-A-R-E-N.org/G-A-Y-A-R. if you found this podcast helpful, please share it on your social channels. Check out the entire podcast library for additional topics of interest. And thanks for listening to McLaren's in Good Health, a podcast sponsored by McLaren Health. I'm Amanda Wilde. Be well.
Amanda Wilde (Host): Proton therapy is a cutting edge cancer treatment that's more precise and has fewer side effects. Today, we'll talk about proton beam therapy with Dr. Hesham Gayar, Medical Director for the McLaren Proton Therapy Center. This is McLaren's In Good Health, the podcast from McLaren. I'm Amanda Wilde. And Dr. Gayar, thank you for your time. So a proton beam sounds like a very space age way to treat illness. Is it as advanced as it sounds?
Dr Heshram Gayar: Thank you for inviting me. So yes, proron therapy is different from the conventional standard radiation. It is subatomic particles, very tiny particles, cannot be seen even with the best microscope that is delivered to lay energy when it reaches a certain depth at the target and stops, unlike conventional radiation where it goes through. So you can imagine you can paint with a tiny, tiny brush, the dose you need in a three-dimensional way in a target in the body where the beam explodes or gives the energy when it reaches the target at a limited few millimeter spots and stops completely. No radiation goes to normal tissue, no exit dose. This saves the body unnecessary radiation, spares the organs that don't need to be treated. And unlike conventional radiation, which goes through the body, that's how we get x-rays by shooting the beam and receiving it from the other end of the body, everything gets irradiated. This doesn't happen with proton therapy. And hence, the radiation going to normal tissue in organs that are sensitive, the radiation is completely avoided and those organs are sometimes completely spared or except for very, very few millimeters around the target are spared.
Amanda Wilde (Host): So we can say that this therapy has fewer side effects. And in what other ways does it benefit the patient?
Dr Heshram Gayar: Yes. We can say that this treatment, because of the precision and sparing the normal tissue around the target, does spare the organs. For example, if I'm treating a target in the abdomen, let's say the pancreas has cancer, I can treat the pancreas and completely spare the kidneys, the stomach, the bowels, even the intestine right around the pancreas can be spared unnecessary radiation. So the patient doesn't get sick during the treatment.
And also it helps by reducing late effects. Sometimes radiation coming to organs, a child, for example, you treat the brain for tumor, any spilled lower dose of radiation outside the target gets unnecessary side effects that can cause compromise in quality of life. Education, IQ can drop. And radiation can be damaging even in small doses when it goes to normal tissue and the brain is a higher real estate. You want to spare every part of the brain any radiation you can.
Proton therapy puts the treatment where it belongs, and it's been proven that children treated with proton therapy compared to standard radiation have better performance at school, better IQs, better memory and development is not altered either. And the same can happen for young adults. And for adults with organs that are critical, like the heart, for example, can be spared when you're treating somebody with lymphoma in the chest or breast cancer, or treating the esophagus. And sparing the heart any radiation reduces the risk of problems later in life and the risk of ischemic heart disease, like heart attacks is reduced because even low doses of radiation can cause damage. So simply proton therapy is putting the radiation in the form of tiny particles where it belongs and that reduces illness and toxicity during treatment. It reduces late effects and problems after the treatment and it improves quality of life for the patients when they survive cancer.
Amanda Wilde (Host): So this sounds like a giant leap forward in cancer treatment. What forms of cancer can you treat with the proton beam?
Dr Heshram Gayar: Proton therapy can be delivered to any part of the body, but we put it, especially when it makes more sense to protect the organs. So if somebody has cancer in the leg, for example, or the arm, proton therapy is not as much of value as if it's in the head or the skull base or the brain, or the head and neck area, the swallowing parts or the heart, or the spinal cord or pancreas, rectum, bowels. It makes more sense to protect those organs when the cancer is close to it. So anytime you have cancer close to a critical organ or an important structure, not to say that any part of our body is not important, but it can be applied anywhere in the body for any malignancy, but there are diseases that will benefit more than others. And we evaluate each patient and decide which one can be treated or should be treated with proton therapy.
So to list some of the indications, it can be used in the pancreas. It can be used in brain cancer. It can be used in cancer of the base of skull, cancers of the head and neck, tonsils, throat, and so on. It can be used for cancers in the mediastinum or in the chest, that's the compartment between the two lungs. It can be used in certain lymphomas. It can be used in esophagus cancer. It can be used in breast cancer. It can be used in lung cancer. It can be used in pancreatic cancer, in some special recurrent cancers in the pelvis, certain rectal cancers, colon cancer in special locations. Liver cancer actually benefits significantly from proton therapy. It can be used in prostate cancer. It can be used in some kidney tumors. So these are some of the examples, just for mentioning or listing, not really listing all of them, but these are examples of where there can be benefit.
Amanda Wilde (Host): You mentioned children who benefit greatly from proton therapy. Who is a candidate for proton beam therapy?
Dr Heshram Gayar: Especially young people, children, and young adults, and people who have long expectancy because of the savings of late effects and the quality of life, it makes more sense to use it for those patients. So any child with cancer that requires irradiation, it's well known and covered by all insurances that proton therapy is a better treatment.
Why? Because this child is going to live for many years and you want to reduce that late toxicity that happens from unnecessary radiation. So is the case for teenagers, people in their 20s, 30s, 40s, 50s, young adults will benefit from proton therapy more than others because of the many years they have to live, especially if the cancer is cured. So we're talking here about the quality of life during treatments. We're talking about the longevity and the effectiveness of normal function, like growth development, intellectual functions in the brain, some organ limitations. And risk of second cancers too is reduced with proton therapy. Yes, younger people will benefit more, and pediatrics and young adults especially.
Amanda Wilde (Host): Is proton therapy a readily available treatment? Is it out there?
Dr Heshram Gayar: Yes, it is. And there are two centers in Michigan. Of course, there are demands on the proton center facilities and we're the largest facility in Michigan and have the highest technology available. And yes, we are available and we accept patients. And insurance does cover the disease also. So it is covered by Medicare. It's covered by all insurances. And for the right indications and the patients that are appropriate selections for particle therapy, we don't have much problems getting coverage.
Amanda Wilde (Host): Now, I understand yours was just the second such treatment center in the state. Do you participate in clinical trials and research?
Dr Heshram Gayar: Actually, being part of Karmanos Cancer Institute, which is an NCI-designated national cancer Institute designated center, participating in clinical research is very high in our list. Actually, about 17 to 20% of our patients are in clinical trials, and this is available in proton centers countrywide. There's about 42 proton centers in the US and two in Michigan. And we are ranked among the highest enrollers in research and clinical trials. We have clinical trials for many body sites that are open right now and we're opening more.
Amanda Wilde (Host): What impact have you seen the center have since it's opening?
Dr Heshram Gayar: Since we opened the proton center, we have patients coming from outside the region, other parts of the states, from other states, also from outside the country and from other continents. We've had patients from Asia, from the Middle East, one patient from Europe. We have had patients from Canada coming here and getting their treatments at our facility. So it became like a destination for cancer treatments. Our cancer program in Flint, Michigan has become a hub for Karmanos Cancer Institute in providing proton therapy and many cancer specialties, special surgeries, medical oncology. All the cancer-related services have been enhanced in the area since we started having the proton center. We have a beautiful hospitality house adjacent to the proton center to accommodate patients traveling and the use is significant and the patients are very happy with the experience.
Amanda Wilde (Host): It's so thoughtfully put together. And with patients coming in from all over the world, can you share a success story or two that you've seen?
Dr Heshram Gayar: Oh, I can list many, but the first that comes to my mind is a patient that is from the Port Huron area that was being treated down in Detroit. And they couldn't treat her for a tumor that is in the orbit next to the eye globe, pushing the eye to the side. And treating that patient with conventional radiation would've definitely ruined that eye and lost vision. I treated the patient, successfully controlled the tumor, no evidence of cancer and kept her eyesight complete. Even peripheral vision was preserved, which is amazing.
Another 39-year-old lady with a large tumor in her pelvis, the tumor has grown and extended along the nerves into the tailbone, was not candidate for surgery. It was too advanced to be resected. I treated the tumor and its branches inside the bone along the nerves, gave it a high dose enough to cure it, sparing the adjacent pelvic structures, the uterus, the rectum, the bladder, the organs were spared successfully. She has no evidence of disease three years now and negative PET CT. And luckily, she did not have any cancer spread either. So that's another success story.
I can go on and on, but I don't want to take your time. We have multiple head and neck cancer patients like tonsillar cancer that had the treatment with minimal side effects. And those usually are significant with the standard conventional radiation. I have patients with prostate cancer that were treated, completed the course of treatment, and don't have any side effects. They go play golf after the treatment. Very well-tolerated course of radiation, compared to the conventional radiation is definitely better quality of life.
Amanda Wilde (Host): Amazing. Lost causes getting cured. doctor, this is fascinating and encouraging. I'm really looking forward to following how proton beam therapy progresses into the future. Thank you.
Dr Heshram Gayar: Oh, you're welcome. Thank you for having me.
Amanda Wilde (Host): For more information, please visit mclaren.org/gayar. That's M-C-L-A-R-E-N.org/G-A-Y-A-R. if you found this podcast helpful, please share it on your social channels. Check out the entire podcast library for additional topics of interest. And thanks for listening to McLaren's in Good Health, a podcast sponsored by McLaren Health. I'm Amanda Wilde. Be well.