Returning guest, Dr. Edward Soffen, MD, from the ProCure Proton Therapy Center in Somerset, NJ, discusses all forms of radiation therapy to treat breast cancer. He also talks about the benefits of Proton Therapy for breast cancer versus the traditional radiation therapy.
Dr. Soffen treats patients at the ProCure Proton Therapy Center in Somerset, NJ, and through Princeton Radiation Oncology. He is a leading expert in the treatment of cancers of the genitourinary tract, particularly prostate cancer. He offers extensive experience in all forms of radiation therapy for prostate cancer, including not only proton therapy but also high dose and low dose rate brachytherapy (radiation implant). He was one of the researchers involved in a pivotal study establishing the use an absorbable hydrogel spacer to further improve the safety of radiation treatment for prostate cancer.
Neal Howard: Welcome to Health Professional Radio, I’m your host Neal Howard. Our guest is returning guest Dr. Edward Soffen, he’s from ProCure Proton Therapy and he’s joining us on the program as a returning guest to talk about proton therapy for breast cancer and talk about the benefits of proton therapy versus traditional radiation therapy. Welcome back to the program Edward, how have you been?
Dr. Edward Soffen: Very well, thanks. And Neal, thanks for having me back it’s particularly relevant because Breast Cancer Awareness month is coming up in just two days and I think it’s great to get the word out to raise people’s awareness, not only about screening and diagnosis but what their treatment options would be.
Neal: Now normally, I guess the first one of the most common treatment options is radiation therapy. Is that correct?
Dr Soffen: Yes. A number of years ago, multiple studies were done that showed that women who have small tumors solitary breast cancers can undergo breast preservation by having a lumpectomy and then having their breast and sometimes the lymph nodes treated as well. And that has the same cure rate, the same recurrence rate as a mastectomy so now radiation plays very highly into women who have both early and more advanced stage breast cancer.
Neal: Well when it comes to some of the options, let’s talk a bit about a proton therapy. Now you’re from ProCure Proton Therapy Center, for our listeners who may not be familiar from the last time you were here with us,give us a bit of background about ProCure proton therapy.
Dr Soffen: Right. Well a proton or proton therapy is a type of radiation. Unlike conventional x-rays which go into the tissue and go through it and out the other side like any kind of x-ray, a proton is a highly energetic particle and we can create beams of these particles that travel at almost the speed of light and they stop, they can be focused and targeted right into the tumor or in the case of breast cancer, right into the breast or right into the lumpectomy cavity. And what’s fascinating about protons is that they stop so when they come to a stop in the target, they give off all of their energy and destroy the tumor cell. So it’s different from conventional radiation because it doesn’t irradiate as much of the normal tissue around the target. Particularly in breast cancer, it spares lung and it’s spares heart and it can spare the nerves under the arm.
Neal: What do you think about a person that’s decided to do the radiation thing and then becomes aware of proton therapy? I’m not familiar with how radiation, the regimen, operates or the frequency – I guess it’s determined by the severity I guess of the disease. I guess that makes sense.
Dr Soffen: Right.
Neal: But why do you think it’s important that women be aware of proton therapy even if they’ve leaned toward radiation?
Dr Soffen: Right. Well it is a form of radiation but it’s important to know about protons. There are fewer than 30 facilities in the country so not every woman knows and has access to physicians who are aware of protons but protons can treat almost every woman with breast cancer to varying degrees of importance over conventional radiation. But once a woman is diagnosed and it’s staged, she really needs to meet with a group of physicians who understand about all the treatment options and can determine whether protons really will have a benefit to them over conventional radiation. You have to understand protons and have experience with it to really understand the benefits and that’s why I think it’s great that we can get this information out on the air wave.
Neal: Is there somebody a patient who’s not a good candidate for proton therapy or is this something that can benefit anyone with this type of cancer?
Dr Soffen: Right, that’s a great question. Well I would say most women can be treated with proton. Now, some women will have more benefit over others. Now when I talk about benefit, the cure rate is the same as conventional radiation when it comes to breast cancer but what we’re really trying to do is minimize the side-effects and the long-term toxicity so women for example who have left-sided breast cancer as opposed to breast cancer on the right side will benefit a little bit more from protons because the heart is on the left side and can be spared much more than conventional radiation. Women who have lymph node-positive disease stage 2 or stage 3 will also benefit more from protons because the radiation treats not only the breast but the lymph nodes under the arm and under the clavicle. So in those women who have lymph node positive or even left-sided breast cancer there’s even more of a benefit to protons. And the last candidate that I want to mention are women who have previously had radiation to the breast or to the chest wall if they’ve had a mastectomy and now in that unusual event had a recurrence either in the breast or on the chest wall. They really can’t get conventional radiation again. I’ve had a number of women who we treated 15-20 years ago with conventional radiation, they recur in their breast and then we can sometimes offer protons in lieu of or to replace a mastectomy. So women who have had radiation can then sometimes get protons to salvage a recurrence without having to lose their breast.
Neal: Being able to reduce the radiation to the heart and the lungs and other unaffected areas, what about some of the long-term side effects that aren’t present with proton therapy as with traditional radiations?
Dr Soffen: Right, well so yeah that’s the big thing. We want to cure women but we want them to be alive and well 5, 10, 15, 20 years from when we treat them. We don’t want them to experience heart disease or lung disease as a result of their treatment. We don’t want the cure to be worse than the disease. Now when it comes to treating breast cancer, the lung is right under the breast and the heart is right under the left breast and we have shown in multiple studies and the data continues to emerge and is growing rapidly, that protons offers a significantly lower dose to these critical structures and that translates into less heart disease, lower incidence of myocardial infarction or heart attack and a lower incidence of lung scarring. Also in women who have a prosthesis or a tissue expander, the pencil beam scanning which is a type of proton beam irradiation where we paint little points of protons that can curve and carve around critical structures, we can treat women who have tissue expanders or implants with much less scar tissue and fibrosis because we can literally dance the protons around the expanders without having to treat them.
Neal: Would you say that’s part of the overall patient experience there ProCure?
Dr Soffen: Well the patient experience starts from the minute they walk in the door. We have a concierge service, we have a team of nurses and therapists who really care about the patient. We have a physics team, dosimetry and physicians who are highly skilled and trained in protons. But you know what, the whole experience is one of caring, empathy, communication so not only are patients treated with the most sophisticated type of radiation, but it’s a warm, caring environment that I think patients really appreciate. On Wednesdays, we have a graduation ceremony for patients who finish their treatments that week and we have people coming back who have been treated five, six, seven years ago who continue to come back for graduation to tell their story to embrace and encourage those who are starting their journey, who are finishing their journey and it really becomes almost like a club of people, survivors who have been cured with proton.
Neal: Where can we get more information about ProCure and get in contact with you as well?
Dr Soffen: Right. Well you can look up ProCure on the internet or go to procure.com/New-Jersey-Contact and get our phone number. Give us a call and our intake of people, intake nurses will get you in with a physician probably within 24 or 48 hours.
Neal: Dr Soffen, thank you so much for coming back and speaking with us. It’s been a pleasure as always and let’s do it again as soon as we can.
Dr Soffen: Absolutely. Thanks so much for the invite Neal and take care.
Neal: You as well. You’ve been listening to Health Professional Radio, I’m Neal Howard your host in conversation with Dr. Edward Soffen returning guest from ProCure Proton Therapy Center in Somerset, New Jersey. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm. You can subscribe to this podcast on iTunes, listen in and download at SoundCloud and be sure and visit our Affiliate Page at hpr.fm