Pelvic Cancers & Tumors Treatment Overview
As the only National Cancer Institute-Designated Comprehensive Cancer Center in Georgia, Winship is at the forefront in the treatment of pelvic cancers, conducting innovative research and clinical trials that are transforming 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, medical oncology, gastroenterology, gynecology, gynecologic oncology, radiology, pathology, supportive oncology, dieticians, social workers, physical therapy, and cancer rehabilitation. Your radiation oncologist will work closely with these other specialists to customize your treatment plan and coordinate your care. We can also partner and coordinate with a patient’s existing care team, whether they are across town or around the world.
Proton Therapy for Pelvic Cancer
Cancer of the pelvis 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 supportive care using the most advanced treatments available. Proton therapy may be a more precise radiation option for treatment of your cancer to help protect the function of important nearby organs like the bowels, bladder, and genitals, as well as reducing the risk of developing a future cancer. Our cancer specialists will work with you to develop a personalized treatment plan which aims for fewer side effects and improved quality of life.
Pelvic Proton Radiation Oncologists
Dr. Sunil Dutta
Dr. Ashesh Jani
Dr. Mark McDonald
Dr. Pretesh Patel
Dr. Sagar Patel
Dr. Soumon Rudra
In treatment of pelvic 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 frequent urination or stinging or burning with urination during treatment, or of chronic urinary problems after treatment.
- Reduced risk of nausea and diarrhea during treatment.
- Reduced risk of diarrhea and rectal soreness (proctitis) during treatment and of chronic rectal problems after treatments such as rectal bleeding or ulceration.
- Reduced risk of skin and mucosal irritation of sensitive tissues during radiation and of chronic problems after treatments such as vaginal dryness or narrowing (stenosis).
- Reduced radiation to the bone marrow and circulating lymphocytes, which may help support the function of the immune system in taking on cancer.
- Reduced risk of low blood counts (anemia, neutropenia) which may support the body’s tolerance of chemotherapy.
- Other normal tissues. Reducing or avoiding radiation to normal tissues reduces the 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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What to Expect With Proton Therapy
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 one to three weeks or six weeks of therapy. 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 a comprehensive plan of care.
Like other types of radiation, proton therapy treatments are invisible and painless. Most pelvic tumor treatments average 30 minutes each day in the treatment room.
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 Pelvic Cancer
Our team has identified these studies as examples of the clinical benefits of proton therapy in pelvic cancer.
Pencil Beam Scanning Proton Beam Chemoradiation Therapy With 5-Fluorouracil and Mitomycin-C for Definitive Treatment of Carcinoma of the Anal Canal: A Multi-institutional Pilot Feasibility Study
This prospective pilot study explored the feasibility of using pencil-beam scanning proton therapy combined with chemotherapy to treat anal cancer. Previous clincal trials in anal cancer using x-ray radiation reported that 48% of patients developed a severe (grade 3) skin irritation during treatment. The goal of this trial was to determine if the risk could be reduced with proton therapy. The trial treated 25 patients and found that 24% developed a severe skin irritation, and that the cancer responded completely in 88%. These encouraging results have prompted further trials to evaluate the role of proton therapy in anal cancer.
Clinical Implementation of Preoperative Short-Course Pencil Beam Scanning Proton Therapy for Patients With Rectal Cancer
This retrospective study reported on 11 patients who received proton therapy for rectal cancer prior to surgery. Compared to Xx-ray based radiation plans, treatment with pencil beam scanning proton therapy significantly reduced unnecessary radiation to the small and large bowel, bladder and the femoral bones (hip bones). Reducing radiation to the bowel may reduce the risk of nausea and diarrhea, while reducing radiation to the bladder may reduce the risk of urinary symptoms or problems. All patients completed the treatment with minimal side effects. Additional trials are needed to more fully evaluate the role of proton therapy in rectal cancer.
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 rectal, anal, and gynecologic 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.
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.
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.
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.
Jill was diagnosed with salivary gland cancer and referred to Winship Cancer Institute of Emory University. She needed surgery, chemotherapy, and radiation therapy. A team of Winship experts worked together to coordinate her care, including proton therapy at the Emory Proton Therapy Center. Jill credits her care team for having the expertise and the necessary tools to give her the best cancer care possible.
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.