I would like to welcome Mrs. Esther Lombrozo who is in the city of Guadalajara, in the beautiful state of Jalisco. How are you, Esther?

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1 Treating Cancer with Proton Therapy Webcast March 2011 Host: Jaime Méndez Ester Lombrozo Marc Delclos Please remember the opinions expressed on Patient Power are not necessarily the views of MD Anderson Cancer Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That s how you ll get care that s most appropriate for you. MD Anderson Cancer Center uses one of the best groundbreaking therapy systems known as Proton therapy. We re going to talk about that type of therapy and find out why it is suitable for so many patients. We have two guests today to talk specifically about that, Mrs. Esther Lombrozo, who was treated at MD Anderson Cancer Center, and Dr. Marc Delclos, Associate Professor in the Department of Radiation and Oncology, is also here to explain to us what this is all about. I would like to welcome Mrs. Esther Lombrozo who is in the city of Guadalajara, in the beautiful state of Jalisco. How are you, Esther? Fine, thank you, how are you? Very well, thank you. Esther, I understand that 2007 you found out that you had a small lump on your neck. You were very worried; you went to see a doctor. Tell me a little about that. In October of 2007 I have always been a very healthy person and I never imagined when I found the lump in my neck, I felt very scared. I thought it had something to do with the thyroid. I went to see a doctor and when they referred me to an oncologist I just couldn t believe this was happening to me, because I never thought that it could be cancer. They performed a biopsy, and the result indicated that I had Hodgkin s lymphoma. Thank God it was curable. I began my treatment in Houston with Dr. Luis Campos. I had chemotherapy. After chemotherapy they referred me to MD Anderson Cancer Center to receive proton therapy, which was the greatest blessing I could have had. Before talking about that stage of therapy you received, I would like you to tell me one thing. You re in Guadalajara, you find out that you have a small lump on your neck, and as you said, you felt very worried. You try to find out what will be the best treatment, what is the solution, what is it, how serious it may be, is this curable or not? How do you get from Guadalajara to Houston, to MD Anderson Cancer Center?

2 At first I was petrified, I didn t know where to start, because you feel that the world is falling apart, and you don t know how to start solving the problem. Because whenever you hear the word cancer you imagine there is no solution, and that you re going to die. At first it was very difficult to face the problem because, how was I going to tell my children, how was I going to tell my parents, how can I tell them what I have? How are they going to take it? So, it s like a deep internal concern on how to face the problem, but at the same time, how to face the problem with your family, how are they going to take it? But the fact is that you get such strong support from your friends, from your relatives that it gives you an amazing strength. My family started investigating and deciding on the best option. In Houston there are several cancer specialists, you have MD Anderson Cancer Center, that specializes in cancer and we went there to for a second opinion. This happened on a Thursday, and on Tuesday I was already in Houston. That was quick! It was very quick. Thank God through friends I started hearing that this doctor is very good, go here, go there. They sort of guide you and definitively God makes the moves so that you end up where you have to go, and it was a blessing for me to decide to travel to Houston first. But you have to leave your home in Guadalajara it s as if the world had stopped turning. I want to talk about that. To be treated far from your own house, where you re surrounded by the loved ones, can also be something very difficult and complicated. I would also like to point out that Dr. Campos is in Houston right now, is that correct? So, you came to Houston and he told you MD Anderson Cancer Center is the best place to be treated. Was it like that? 2

3 Yes, I arrived in Houston with Dr. Luis Campos. He wouldn t let me go back because he told me that it was important to begin the treatment right away. He decided that every 15 days I would need chemotherapy and he told me, You can go back, then return. You can receive chemotherapy there, whatever you decide we will support you. I decided to travel every 15 days to Houston. It was very hard. Sure, but it s your health and your health should be put first. Esther, the treatment you received was chemotherapy, but you also received radiation and specifically the type of therapy we were mentioning at the beginning, proton therapy, right? That s right. Okay, and to talk about that, no one could be better than the person who treated Esther, Dr. Marc Delclos, whom we said is Associate Professor in the Department of Radiation Oncology and has been at MD Anderson Cancer Center, since Dr. Delclos, how are you? Fine, thank you and a pleasure to meet you and to be here to answer questions about proton therapy. I wasn t the doctor who treated Esther but I m very pleased to be here to be able to help. However, you do have a great deal of experience and you are very familiar with proton therapy. We understand that proton therapy, instead of damaging different tissues that are not affected by cancer, is targeted on the exact point where the tumor or the type of cancer that has to be treated is. Could you please explain to us a little about how it works? The conventional radiation treatment, which we have all heard about when someone close to us is treated with radiation, that is the conventional radiation. Proton therapy is a type of radiation that has recently been used in such a way that you can treat the tumor with higher doses, in a more precise and powerful way, minimizing the damage to the tissues and organs surrounding the tumor, and as a result there are fewer side effects. 3

4 So, in fact, proton therapy is a powerful treatment against cancer with fewer side effects. It s remarkable because of the capability of administering high doses of radiation precisely to where the tumor is, and at the same time minimizing the effects of those high doses to the surrounding healthy tissues and organs. For this reason, we have the potential to minimize the side effects of radiation compared with conventional radiation. So, when a patient is a candidate to receive this therapy, it s a very good advantage. When you say that a patient is a candidate to receive the therapy, does that mean that some types of cancer can benefit from proton therapy more than other types of cancer? Yes, in fact, the important issue with cancer is to be able to individualize the treatment for each person. That is to say, you have to establish first if a person is a candidate, if the tumor that is affecting him can benefit from protons. Nowadays, more and more types of cancers can be added to that list, especially due to the technological advances with protons. So, we can see that the list is growing, and more and more candidates can be included in it for different types of cancers that maybe were not so common before. And this is closely related to the technological advances, the way in which the proton therapy is administered, and the specialists we have at The University of Texas MD Anderson Cancer Center. Where I believe you can find the most advanced treatment and the best specialists. Could you tell me how long MD Anderson Cancer Center has been using this technology? Yes, MD Anderson is not the only place that uses protons. There are several other centers in the United States. In the United States there are eight centers, but MD Anderson, here in Houston, Texas, is the only one in the Southwest and it is the closest one to Mexico. We have been using proton therapy at MD Anderson since Sure, but the geographic proximity to Latin America makes it much more convenient. Absolutely. Esther, you were telling us about your trip every two weeks to receive treatment. Tell me something about that process. How did you feel during that period? 4

5 It was very difficult because as soon as you start feeling well after the treatment, you have to leave the comfort of your home again to get on a plane, return to Houston and receive the treatment again. It was quite tiresome, but in the end I had the will, the strength and I knew I had to get back on my feet no matter how and I didn t care if I was tired or anything, my goal was to beat the disease. Absolutely. And there are some patients that choose to stay in Houston during that time to be close by, but in your case you had the chance and the means to be able to travel back and forth to Guadalajara. Tell us something about the benefits you received from proton therapy. After I finished my treatment, the proton therapy was completely different. I want to tell you how fantastic MD Anderson Proton Therapy Center was for me. I thought I was in a luxury hotel, because it s something so amazing, they were so kind to me that you think, It s not possible that I have come here to receive therapy for my disease. I mean, you feel as if you were going on holiday. It s such a pleasant place, the people are so kind, it s like a family, that s the way I described it. At one point, I had to stay in Houston for six weeks because the proton therapy was daily, with the exception of weekends, when they let you rest. But I had to have it every day, so I had to move to Houston for six weeks. Coming to that Center was marvelous; I had never imagined something like that. I never felt any pain, I didn t feel tired. They explain everything that s going to happen to you. They tell you the worst thing that can happen to you and the best thing that can happen to you. So, you know exactly what is going to happen and that calms you down and makes you feel confident. I felt I was in the best luxury hotel with the best family in the world, because the kindness is remarkable. And precisely, in times when you re so concerned, as Esther was mentioning, she was thinking about her three kids, she s thinking about her husband, her friends, and loved ones, I think that one of the things she shouldn t be worried about is the place where she is, who s looking after her and all that, so I believe that a warm welcome is the best thing you can get, and it s something she received at the MD Anderson. Doctor, I want you to tell me exactly what type of cancers are suitable for proton therapy, and where are these cancers located? 5

6 Nowadays, with the technological advances in the administration of proton therapy, you can use it for different kinds of cancers that it was not used on before. For example, prostate cancer, lung, liver, esophageal, and brain cancer, lymphoma, cancer in children and in some tumors that are more unusual. Before, we only used protons for the unusual ones and for brain cancer treatment and that sort of thing, including children cancers. But nowadays, with the technological advances it is used for a wider variety of cancers. I was also noticing that proton therapy is maybe more appropriate for cancer in younger people, and in children. Why is this? Yes, proton therapy has been used for decades and there are several centers in the United States and other places around the world where it is being used. Historically, it was used for tumors near the spinal cord or in children, because children were more prone to the effects, which requires high doses of radiation to destroy the tumor. But at the same time you have to be very careful with the organs and tissues that surround the tumor, and in the case of the spinal cord or the brain, those tissues are very susceptible to radiation. So protons were ideal for this and also for different types of rare tumors where the treatment required high doses for the tumor but maybe the organ or the type of tissue that surrounded the tumor was very susceptible to harm and you had to be very precise. Therefore proton therapy provided that advantage. Now, in recent years, especially during the last decade, they have developed a type of technology where proton therapy can be administered by radiologists. Our colleagues have developed a new technology that allows the administration of these protons to other types of cancers. So, this list of candidates that can receive proton therapy is much longer. It s not just for tumors, or for children as I have already mentioned. We can now include, prostate, lung, liver, that's something - and determine, in those groups who are also candidates and include them in the list also And I think that if there are more types of cancers that can be treated in this way, obviously there will be more people looking for this type of treatment. And MD Anderson Cancer Center is the one with the best specialists and one of the first ones, it seems that people would want to go there. Is there a waiting list? The University of Texas MD Anderson Cancer Center in Houston is the only one in the Southwest. It s the closest one to Mexico and Central American and South American countries, and therefore it s the most convenient one. But don t think there is such a long list in that sense. In fact, it s very easy to get in touch with the Proton Therapy Center, we have a phone number, we also have a website and in fact the people can contact them through their referring doctors or the patient 6

7 himself can do it in a very easy way. In fact, many patients obtain an appointment within a week or two, less than two weeks. And if the therapy is appropriate for them, they get an appointment for the preparation session and the treatment will start in less than two weeks. Just two weeks? In many cases, in most of the cases, I should say. The truth is that the process to make an appointment is quite simple. And this is just like Esther s experience because she was telling us at the beginning that when she found out what she had, she immediately took action and I believe that the last thing you would want is to wait, so it s very good news to know that at MD Anderson you can make an appointment very easily. Esther, from the patient s point of view, were you able to receive the therapy soon? And what happens after the treatment? When I finished, something very strange happened to me because I had become so attached to the staff. When I was discharged, which is a very nice ceremony, they give you your diploma, you ring a bell as if you were saying I m back to life, it s a period of time you will never forget but it s over and you have to turn the page. I really felt sad that I had to leave, it was very strange. I spoke with all the staff, with the doctors, and I told them, I never thought that when this moment arrived I would feel sad, because you become so attached to them, they make things so pleasant for you and they are so kind and humane, that you feel sorry to leave. However, you have to turn the page and start your life again. The truth is that you see life in such a different way, you treasure every moment from the minute you wake up until you go to bed, and you value things in a different way. When you take your daily routine for granted, wake up, go to work, do everything as if you were a machine, then you stop and say, No, I was close to death once and I have to see life in a different way. I have to breathe differently, I have to smile, I have to thank God, my friends, my family and in the end, you see this as a blessing God sent you so that you can appreciate every day of your life. And this is the way I m trying to live my life, to see things in a different way, to see the nice things in life and to always see the good side of things. How nice and your words are inspiring. Because sometimes our daily routine makes us forget to appreciate the good things in life. 7

8 That s right. Doctor, I suppose you see other patients that have had experiences like Esther s, when they go back to their normal life, they appreciate it much more. Yes, no doubt. When you have a good experience, just like Esther had, that s a very important part of the treatment. Having a good experience is important for the moral welfare of a person, for their feelings, they are able to cope better with the treatment. And I think that in general all doctors think that it is important that they have a good experience, something that helps to improve everyone s attitude. Going back to MD Anderson, Esther seems to be very attached to the staff. Why don t you tell me something about the staff at the Center? The University of Texas MD Anderson Cancer Center, not just the Proton Therapy Center, but also the Institute as a whole, is very special in terms of their history, in the sense that it is fully dedicated to cancer. There is a multidisciplinary treatment team, meaning that they treat cancer with a variety of disciplines, that the different disciplines and the different specialized doctors have to work as a team when they treat a patient. In the treatment of cancer specifically, it s very important to know that there are multiple disciplines, methods and weapons we use against cancer. Proton therapy is an example of that, of a more advanced treatment at least in the radiation field. So, I think that that specific area, the history of the place and it s striving for the excellence in its treatments, combined with and focusing on the human side of patients. The experience she had when she rang the bell is a tradition we have here at the Radiation Center and at the Proton Therapy Center. When patients finish with the radiation sessions they ring that bell and that means a lot, it s their treatment graduation, that could have lasted weeks, and it indicates that life begins again. This was a patient s idea many years ago who brought the bell for us and put the bell there so that when patients finish their treatment they could ring that bell. It s a moment to celebrate, so that human aspect combined with the professionalism, the experience of the center, makes it a special place. That is why I love to work here and as a doctor you feel satisfied when you hear a patient talking about an experience like the one we just heard. 8

9 It must give you great satisfaction. I think that many, many bells will be ringing in the future. And talking about the future, Doctor, what are the studies that are being conducted now? Because technology advances but it does not stop here, it continues developing, right? Yes, in fact there are so many different studies and protocols that are being carried out for several kinds of treatments, not just in the radiation and proton field, but also in the chemotherapy field. This is an institution which is very used to treating people, not only from the region, from the United States and Texas, but it also has many patients from Mexico, Central America, South America and from all over the world. In fact, since 2006 around 2500 patients have been treated with proton therapy, and a high percentage of those patients were from abroad. So, MD Anderson has an international group that deals with patients, they are very used to speaking Spanish, it s multicultural, multilingual and they are always trying to facilitate the patient experience, especially for those who come from abroad. Thank you very much, Dr. Delclos. Esther, is there anything you would like to tell the doctors from MD Anderson Cancer Center? I want to thank them, especially to Dr. James Cox, he was the doctor who treated me and I also want to thank all the therapists, the nutritionist, I want to thank the entire staff for the kindness, for their empathy and for making things more tolerable during the difficult times. And I would also like to tell all the people that are going through these difficult times that sometimes you don t know how to handle, that to be able to share the experiences we ve had is the best thing that can do because we have all been through it, and this is how we can help other people. Every time I know someone is going through these times, I try to offer my support, my help, I tell them my story so that they see me today, with all my hair, healthy and that shows them that you can get back on your feet. Thank you. Thank you both, Esther and Dr, Marc Delclos. Please remember the opinions expressed on Patient Power are not necessarily the views of MD Anderson Cancer Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That s how you ll get care that s most appropriate for you. 9

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