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Abdominal Cancer & Tumor Treatment Overview

As the only National Cancer Institute-designated Comprehensive Cancer Center in Georgia, Winship is at the forefront in the treatment of liver, pancreatic, and other abdominal cancers. Our staff conduct innovative research and clinical trials that transform how these cancers are identified, treated, and survived.

The radiation oncologists at Emory Proton Therapy Center work with the multidisciplinary cancer teams at Winship, which includes experts in surgical oncology, gastroenterology, hepatology, transplant, medical oncology, radiology, interventional radiology, pathology, supportive oncology, dieticians, social workers, physical therapy, and cancer rehabilitation. Your radiation oncologist will work closely with these and other specialists to customize your treatment plan and coordinate your every step. We can also partner and coordinate with a patient’s existing treatment team, whether they are across town or around the world.

Proton Therapy for Abdominal Tumors and Cancers

A cancer in the liver or abdomen can be one of the biggest challenges you and your family will ever face. Our team is dedicated to helping you meet that challenge through compassionate care, and using the most advanced treatments available. Proton therapy is a more precise radiation option for treatment of your cancer that also helps to protect the function of important nearby organs like the stomach, bowels, kidneys, and normal liver tissue. Our cancer specialists will work with you to develop a personalized treatment plan that aims for fewer side effects and improved quality of life.

What We Treat

  • Hepatocellular carcinoma
  • Cholangiocarcinoma
  • Liver cell cancer
  • Liver metastases
  • Pancreatic cancer
  • Adrenal metastases
  • Abdominal lymph node metastases
  • Re-irradiation

Abdominal Proton Radiation Oncologists

Sunil W. Dutta MD

Dr. Sunil Dutta

About
Mark McDonald, MD

Dr. Mark McDonald

About
Pretesh Patel MD

Dr. Pretesh Patel

About
Soumon Rudra MD

Dr. Soumon Rudra

About

Benefits of Proton Therapy

In treatment of abdominal and gastrointestinal tumors, proton therapy can reduce or avoid radiation to surrounding healthy tissue and organs. 

Depending on the tumor location and type, proton therapy may achieve the following benefits:

  • Reduced risk of inflammation of the heart (pericarditis) and future heart problems like hardening of the arteries (atherosclerosis), stiffening of the heart muscle (fibrosis, cardiomyopathy), and heart attacks.
  • Reduced risk of new or worsening problems with liver function (radiation- induced liver dysfunction). This is relevant for patients with large liver tumors and/or small remaining size of normal liver, for those with poor liver function (liver cirrhosis), or who have had prior radiation treatments including prior liver radioembolization (Y90).
  • Reduced risk of nausea and diarrhea.
  • Reduced risk of new or worsening kidney function.
  • Reduced radiation to the bone marrow, spleen, and circulating lymphocytes may help support the function of the immune system in taking on fighting cancer.
  • Reduced risk of low blood counts (anemia, neutropenia) which may support the body’s tolerance of chemotherapy.
  • Reduced risk of developing a future second tumor or cancer, which is most relevant in younger patients, those with a good prognosis and a long life expectancy, and those patients who may have genetic conditions putting them at higher risk for developing other cancers.

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Proton Therapy Research Studies

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The first step in your care is a consultation. During consultation, we review your medical history, perform a physical exam, decide if any additional tests are needed, discuss all radiation options that may be appropriate for your treatment plan, make recommendations, and answer questions.

To plan your treatment, you will undergo a “simulation” or planning session. During this visit our radiation therapists will help position you the way you will be treated each day. A CT scan will be done to create a picture of you in the treatment position to design your radiation plan. Some patients also undergo an MRI during this visit to help identify the target for treatment. It normally takes 10 days for the team to design the proton treatment plan and perform the quality assurance checks before treatment begins.

Depending on the type of tumor and stage, proton therapy may be delivered over 1-3 weeks or 6 weeks.  Typically, radiation is given once daily during the weekdays, Monday through Friday. For those receiving five treatments or fewer, proton therapy may be delivered every other day. While some situations are treated with radiation alone, proton therapy is often integrated with surgery, chemotherapy, immunotherapy, or other cancer treatments as part of an all-encompassing plan

Like other types of radiation, proton therapy treatments are invisible and painless. Most abdominal treatments average 30 minutes each day in the treatment room. Some tumors in the abdomen move significantly while breathing. During your radiation planning process, your team will identify the most appropriate methods to manage tumor motion. 

Patients are seen by the radiation oncology physician team weekly during treatment to monitor progress, answer questions, address concerns, and manage any side effects from treatment. Your radiation oncologist will discuss a plan to assess response to treatment and for long-term follow-up after therapy.

Studies on Proton Therapy in Abdominal Cancers

Our team has identified these studies as examples of the clinical benefits of proton therapy in abdominal cancers.

Randomized Clinical Trial Comparing Proton Beam Radiation Therapy with Transarterial Chemoembolization for Hepatocellular Carcinoma: Results of an Interim Analysis

This randomized clinical trial was conducted in patients with hepatocellular carcinoma who were candidates for liver transplantation. Patients were randomized (flip of a coin) to receive either proton therapy or transarterial chemoembolization (TACE) to control the tumor while waiting for transplant. While TACE was considered a standard treatment for patients with hepatocellular carcinomas, the trial was designed to determine whether non-invasive proton therapy may be superior. The trial is not yet complete, but this interim analysis showed a trend toward improved 2-year local tumor control (88% vs 45%) for proton therapy versus TACE. Patients treated with proton therapy were less likely to have an unplanned hospitalization after treatment.

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Proton Beam Radiotherapy vs. Radiofrequency Ablation for Recurrent Hepatocellular Carcinoma: A Randomized Phase III Trial

This randomized clinical trial was conducted in patients who had previously been treated for hepatocellular carcinoma but later developed 1 or 2 recurrent tumors, each no more than 3 cm in size. Patients were randomized (flip of a coin) to receive either proton therapy or radiofrequency ablation (RFA). While RFA was considered the standard treatment for small recurrent hepatocellular carcinomas, the trial was designed to determine whether non-invasive proton therapy was as effective as RFA. At 2-years after treatment, proton therapy was successful in treatment for 95% and RFA for 84%. Short-term serious side effects were seen in 16% of patients treated with RFA and 0% in those treated with proton therapy. Patients treated with RFA had an average hospital stay of 3 days, while proton therapy was delivered in the outpatient setting. Another finding of the study was that proton therapy was technically feasible in more patients than RFA.

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Image-Guided Proton Therapy for Elderly Patients with Hepatocellular Carcinoma: High Local Control and Quality of Life Preservation

This retrospective study reported on 81 patients who were 80-years-old or older and who received proton therapy for hepatocellular carcinoma. At 2 years post- treatment, the likelihood of treated tumor control after proton therapy was 88%. One patient developed a significant skin irritation after radiation. Patients reported no worsening in quality of life at 1 year after treatment. The study authors suggest that proton therapy is an attractive option for elderly patients who are more likely to have other medical problems and be at higher risk for surgical complications.

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A Phase 2 Study of Image-Guided Proton Therapy for Operable or Ablation-Treatable Primary Hepatocellular Carcinoma

In this prospective clinical trial, 45 patients with hepatocellular carcinoma were treated with proton therapy. These patients had tumors thatwhich were candidates for removal by surgery or candidates to be treated with radiofrequency ablation, but the patients declined those options in favor of proton therapy as a non-invasive treatment. At 5 years post- treatment, the likelihood of treated tumor control after proton therapy was 92%. There were no serious side effects during treatment, and one patient had a radiation-related serious worsening of their liver function. Patients reported no worsening in quality of life at 1 year after treatment while their emotional and social functioning scores improved at 1 year.

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Phase 1 Trial of Preoperative Image-Guided Intensity Modulated Proton Radiation Therapy with Simultaneously Integrated Boost to the High-Risk Margin for Retroperitoneal Sarcomas

This clinical trial was performed in patients with initial or recurrent retroperitoneal sarcomas who received radiation prior to planned surgery. The trial used proton therapy to investigate the safety and feasibility of delivering a higher dose of radiation than normal to the portion of the tumor where surgery is most likely to leave behind tumor cells, in an effort to reduce the risk of future recurrence The trial was able to increase the dose from the standard 50 Gy to 63 Gy without increasing any toxicities.

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Comparative Effectiveness of Proton vs Photon Therapy as Part of Concurrent Chemoradiotherapy for Locally Advanced Cancer

This retrospective study examined nearly 1500 patients receiving chemotherapy and radiation for curable cancers of different disease sites, including pancreas and liver cancers. A technique called propensity score weighting was used to account for differences in patient characteristics (patients treated with proton therapy tended to be older and to have a greater number of other serious health problems) and to minimize selection bias. Patients treated with proton therapy were significantly less likely to have a serious side effect in the first 90 days after treatment, and less often experienced a decline in their overall condition (performance status) during treatment. Patients treated with proton therapy were less likely to have an unplanned hospitalization.

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Patient Stories

Stephen, a 36-year old father from Columbus, Georgia, is one of the almost 2000 patients who have been treated at the Emory Proton Therapy Center since it opened in December 2018. He completed six weeks of proton therapy to treat a brain tumor.

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Stephen
patient, brain tumor

Dusty was diagnosed with prostate cancer, an uncontrolled growth of cells in the prostate gland. Upon further consultation and research, he was treated with proton therapy and is excited to see an advanced form of radiation therapy is available at the Emory Proton Therapy Center.

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Dusty
patient, prostate cancer

Proton therapy gave Zack his best shot at treating a spinal tumor that had come back. Zack was one of the first patients treated at the Emory Proton Therapy Center after it opened in 2018. The treatments, every weekday for six weeks, took less than one hour of his day and gave Zack the greatest odds of a long life with his wife and children.

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Zach
patient, spinal tumor

Tony was diagnosed with prostate cancer in 2019 and sought care from experts at Emory Proton Therapy Center. He’s confident that the advanced radiation therapy gave him the best cancer treatment possible and says the comfort and care he got from Winship doctors and staff were unmatched. “There were many great solutions here in Atlanta, but the best to me was Emory Proton Therapy Center,” says Tony.

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Tony
patient, prostate cancer