Precision. The kind of care required.

Transcription

1 Precision. The kind of care required.

2 At the Indiana University Health Proton Therapy Center, formerly Midwest Proton Therapy Institute (MPRI), we believe helping cancer patients and their physicians select the right treatment option is crucial. The intent of this guide is to update you on the advancements in proton beam therapy one of the most precise forms of radiation treatment available today and to share with you the unique way in which we deliver proton therapy. Application of Proton Therapy Proton beam therapy is revolutionizing the treatment of cancer by delivering the precise dose of radiation needed to destroy cancer cells while sparing surrounding healthy tissue and organs just a millimeter away. As a result of such precision, proton therapy patients tend to experience minimal treatment-related side effects. At the IU Health Proton Therapy Center, a team of internationally recognized experts use state-of-the-art planning and treatment delivery systems to treat a wide range of localized cancers, including rare lesions of the central nervous system and spinal cord, brain tumors, pediatric malignancies and prostate cancer. Our board-certified and credentialed radiation oncologists and medical physicists have extensive experience treating patients with proton therapy. Our licensed nurses and radiation therapists provide personalized, compassionate care to our patients. Our administrative staff members provide extraordinary support with insurance, billing, transcription and patient support services. This expertise enables us to treat unusually complex cases, including cancer recurrences. Our treatment team also has access to a myriad of resources: The IU Health Proton Therapy Center is affiliated with IU Simon Cancer Center Indiana s only National Cancer Institute-designated cancer center and Indiana University Health, ranked among America s elite medical centers by U.S.News & World Report for 13 consecutive years. The IU Health Proton Therapy Center physicians and medical physicists are affiliated with Indiana University School of Medicine and are involved in both clinical patient care and research. The IU Health Proton Therapy Center is the only U.S. proton center associated with a university-based proton therapy technology research group via Indiana University Cyclotron Operations. Patients from around the world have chosen the IU Health Proton Therapy Center in Bloomington, Ind., for proton therapy and have found Bloomington to be the perfect home away from home. The city of Bloomington complements the support services we provide by offering patients and their families affordable housing options, a strong sense of community and easy access to the amenities of Indiana University. When you choose to refer patients to us, you can be assured that we are committed to controlling their disease, improving their quality of life, and providing them and their caregivers with the best possible personal, professional and compassionate care. We look forward to working with you. The Physicians and Staff of the IU Health Proton Therapy Center

3 Application of Proton Therapy The IU Health Proton Therapy Center, formerly MPRI, is the only proton therapy center in the U.S. that employs a technologically advanced uniform-scanning beam for dose delivery. This reduces peripheral and neutron production, which is an advantage over the double-scattering beam used in the great majority of treatments delivered at other U.S. proton therapy facilities. Application of Proton Therapy Unlike the photons used in traditional X-ray radiation therapy, protons release energy within a well-defined range of penetration. As protons enter the body, they release a low dose of radiation at the surface followed by a sharp burst of radiation as they near the end of the range a phenomenon called the Bragg Peak. Relative Dose Proton Bragg Peak at 208 MeV Co-60 Gamma Rays 20 MeV Electrons By modulating where the Bragg Peak will occur, our treatment team is able to deliver a precise dose of energy throughout the tumor, with minimal dosage to healthy tissue in front of the tumor Depth (cm) and negligible dosage beyond the tumor. In addition, the penumbra of a proton beam is sharper than a traditional X-ray beam. For even greater targeting accuracy, our treatment planning team is able to contour the proton beam to conform to the exact shape of the tumor. As a result, proton beam therapy: Minimizes entrance dose and eliminates exit dose Cuts with a sharper penumbra compared to typical X-rays or electrons Delivers higher doses of radiation directly to the tumor Spares more healthy tissue and organs from radiation Reduces side effects Treatment Planning Our physicians are involved in every step of the patient s care, approving not only the overall treatment plan but also the daily setup and delivery of each treatment field. Once a patient is evaluated and accepted as a patient at the IU Health Proton Therapy Center, treatment planning may begin. Preparation for treatment planning is individualized to each patient s case and often includes implantation of fiducial targeting markers and creation of custom immobilization devices (a body mold for prostate patients or a mask for head and neck patients). While immobilized in the treatment position, the patient is imaged with computed tomography, often in combination with magnetic resonance and positron emission tomography scanning. The IU Health Proton Therapy Center physicians use these images to create a three-dimensional reconstruction of each tumor and its relationship to surrounding structures. After mapping the tumors, physicists and dosimetrists create a treatment plan calculating the dosage and angles at which proton beams will enter the patient. Based on these plans, special devices to contour the beam (compensators and apertures) are engineered on site and custom made to replicate the shape of the treatment site. We have a rigorous quality assurance program in place to ensure the accuracy of these devices prior to patient treatment.

4 Treatment Delivery Once treatment devices and plans are approved, we prepare for the start of the patient s treatment. Patients will have one set-up planning session (their V-Sim appointment) to simulate their treatment placement in their immobilization equipment and to make a final verification of their beam-shaping devices. Typically, patients have their V-Sim appointment the day before their treatment course commences. Application of Proton Therapy Once patients are immobilized and placed in treatment position, X-ray images are taken and compared to the treatment planning images for each radiation field. Using three-dimensional alignment with bone landmarks and the fiducial markers, the patient is maneuvered to within millimeters of the original planning position, which is verified by an IU Health Proton Therapy Center physician prior to every treatment field. The proton beam is invisible, painless and delivered within a minute. Actual set-up and treatment time varies depending on prescription and disease site and is outlined in each section of this brochure. Patients are treated in one of three treatment rooms, including one fixed-beam room and two rooms with rotating gantries. The IU Health Proton Therapy Center is the first proton center in the country to offer a robotic patient positioning system, capable of moving the patient in six different directions to facilitate precise alignment. Patient-specific apertures (brass) and compensations (lucite) allow us to contour the beam to the exact shape of the treatment area, and to deliver the highest dosage directly to the tumor.

5 Precise cancer treatment is vitally important when treating tumors in sensitive locations. The unique nature of proton therapy makes the treatment ideal for brain tumors, inoperable brain lesions and tumors located next to the spinal cord or brain stem. Central Nervous System The application of proton therapy to tumors of the central nervous system is impacting both survival and control rates. Proton Therapy: Offers long-term control rates of approximately 85 percent (compared to 50 percent or less for conventional radiation treatment) for chordomas. The location of chordomas at the base of the skull complicates treatment because of their proximity to the brain stem, cranial nerves and the pituitary gland. Proton therapy is able to provide a higher dose of radiation than X-ray treatments like IMRT while preserving function of these critical structures. Offers control rates for benign meningiomas of nearly 95 percent. Because the proton beam can be sharply focused on the tumor site, a high dose of radiation can be delivered to A major consideration for tumors of the central nervous system is patient quality of life during and following treatment. Reduced radiation exposure to healthy tissues and critical structures translates to significant improvements in the daily life of patients and reduced risk of neurocognitive side effects. meningeal tumors, while leaving nearby normal brain and critical structures untouched by radiation. Enables patients with tumors of the spine to be treated with few, if any, side effects. Because no exit dose is delivered beyond the spine, critical tissues and organs are spared from radiation exposure. Offers promise for patients with glioblastomas. Because a minimum of brain volume receives radiation, inflammation is reduced, along with the need for steroid medications. By sparing patients from the side effects of steroid use, proton therapy has an enormous impact on the quality of life for patients with glioblastomas.

6 Treatment Prescription Once a patient is approved for treatment, the treatment planning process begins (see Application of Proton Therapy tab). The number of proton therapy treatments prescribed depends on the tumor type and location and the patient s previous radiation treatments or surgical procedures. Patients generally start treatments within two to four weeks. Critical cases or surgical patients who need to start immediately following resection are often expedited. Treatment typically involves daily sessions, Monday through Friday, over a period of two to three weeks for a boost, or five to eight weeks for a single course. Patients treated for head or neck conditions will be immobilized with a custom mask, and those with spinal conditions may be immobilized with a custom mold. Daily sessions last approximately 45 to 60 minutes, but vary depending on the number of treatment fields and the complexity of the case. Proton therapy treatment may be combined with chemotherapy and as a complement to surgery. Patients who have had multiple surgeries and/or prior radiation treatment are often candidates for proton therapy. Other Conditions Treated at the IU Health Proton Therapy Center Brain Tumors Acoustic neuroma (Schwannomas) Astrocytomas Chondrosarcomas Chordomas Ependymomas Gliomas (brain stem gliomas, gangliogliomas, glioblastomas) Meningiomas (benign, atypical and malignant) Pineal tumors Pituitary tumors Primative neuroectodermal tumors (PNET) Single metastatic sites Skull base tumors Spinal Cord and Paraspinal Tumors Chondrosarcomas Chordomas Ependymomas Nerve sheath lesions Paraspinal soft tissue malignancies Single metastatic sites Spindle cell sarcomas Central Nervous System

7 Proton therapy is ideally suited for children with cancer, whose growing bones, tissue and brain are particularly susceptible to radiation side effects. The IU Health Proton Therapy Center team can deliver treatments specific to the target area, while sparing healthy tissue and bone. Proton therapy also reduces the risk of developmental and growth delays and other complications that can occur with the use of conventional X-ray radiation. Pediatrics By minimizing radiation exposure, proton therapy also reduces the risk of radiation-induced secondary cancers. Studies show that the risk of developing a secondary cancer is 6 to 12 times lower in children treated with protons compared to those treated with X-ray radiation. With extensive experience in both pediatric oncology and proton therapy, the IU Health Proton Therapy Center s medical team is able to treat a wide range of pediatric malignancies. Of equal importance to medical care is emotional care, particularly when it comes to children and their caregivers. Our physicians, therapists and nurses put a great deal of time and effort in to making young patients and their caregivers feel as comfortable as possible. As a result of collaboration with Riley Hospital for Children at Indiana University Health and other leading children s hospitals around the country, the IU Health Proton Therapy Center s pediatric radiation oncologists have treated children from around the world. Our referral base continues to grow as other children s hospitals and pediatric oncologists become knowledgeable of the advantages of proton therapy.

8 Treatment Prescription Pediatrics Once a patient is approved for treatment, the treatment planning process begins (see Application of Proton Therapy tab). The number of proton therapy treatments depends on the tumor type and location, and the patient s previous radiation treatments or surgical procedures. Patients generally start treatments within two to three weeks. Critical cases or surgical patients who need to start immediately following resection are often expedited. Treatment typically involves daily sessions, Monday through Friday, over a period of two to three weeks for a boost, or five to eight weeks for a single course. Patients treated for head or neck conditions will be immobilized with a custom mask. Daily sessions last between 45 to 90 minutes, depending on the need for anesthesia, the number of treatment fields and the complexity of the case. Proton therapy treatment may be combined with chemotherapy and used as a complement to surgery. When necessary, anesthesia services are available. Pediatric patients under the age of six are anesthetized daily prior to treatment. Pediatric Conditions Treated at the IU Health Proton Therapy Center Atypical teratoid rhaboid tumors (ATRT) Craniopharyngiomas Ependymomas Gliomas (brain stem gliomas, gangliogliomas, glioblastomas) Medulloblastoma boosts Neuroblastomas Pituitary tumors Primative neuroectodermal tumors (PNET) Retinoblastomas Rhabdomyosarcomas Sarcoma subtypes

9 With greater than 90 percent control rates and few to no side effects, proton therapy is becoming an increasingly attractive treatment option for men with prostate cancer. Prostate By harnessing the unique qualities of the proton beam including a lack of exit dose and lower entrance dose than conventional X-ray radiation the IU Health Proton Therapy Center s treatment team is able to deliver a full dose of radiation to the prostate and seminal vesicles. While men with prostate cancer can often choose from several treatment options with similar cure rates, what distinguishes proton therapy is fewer side effects. With proton therapy, critical structures and tissue surrounding the prostate are largely spared from radiation exposure. Proton therapy reduces, and in some cases, eliminates the side effects that accompany other treatment options, such as incontinence and severe rectal complications.

10 Treatment Prescription Once a patient is approved for treatment, the treatment planning process begins (see Application of Proton Therapy tab). Prostate cancer treatment typically involves 44 treatment sessions over nine weeks. During the first 28 treatments, the prostate and seminal vesicles are treated, followed by 16 treatments to the prostate alone. Prostate Conditions Treated at the IU Health Proton Therapy Center Initial treatment of a localized prostate cancer Post-prostatectomy with a positive margin and/or rising PSA Recurrent prostate cancer Patients with unilateral hip replacements Prostate Custom body molds are created for patients treated for prostate cancer and a rectal balloon is used with each treatment fraction. The rectal balloon reduces movement of the prostate and protects a larger volume of the rectum from radiation exposure. Daily sessions are administered Monday through Friday and are completed in less than 30 minutes, allowing patients the freedom to pursue activities of their choosing throughout the week in Bloomington. Patients generally start their treatment within three to four weeks. The patient s start date often depends on their personal time frame to begin treatment.

11 Proton therapy is recognized as the most viable way to treat certain rare tumors in sensitive locations, such as the eye, base of the skull and spinal cord where precision radiation is of the utmost importance. Special Treatment Sites Extensive clinical experience in administering proton therapy enables the IU Health Proton Therapy Center staff to treat a variety of rare cancers and complex cases, including: Paranasal sinus tumors proton therapy has increased five-year control rates for patients with paranasal sinus tumors from 25 percent to 85 percent. Ewing s Sarcoma which requires a high dose of radiation that may not be able to be delivered by conventional radiation therapy. Eye tumors specifically tumors in and around the orbit. Single lesions of the liver because treatment of this disease by conventional radiation therapy is often accompanied by significant side effects, which are minimized by proton therapy. Retreatment of metastatic liver cancer treatment and primary pancreatic cancer. Early stage lung cancer located in the upper part of the lung or attached to chest wall. Retreatment of cancer of the pelvic wall. Ongoing research is uncovering additional applications for proton therapy, including for more common malignancies such as lung and breast cancers.

12 Treatment Prescription Once a patient is approved for treatment, the treatment planning process begins (see Application of Proton Therapy tab). The number of proton therapy treatments prescribed depends on the tumor type and location, and the patient s previous radiation treatments or surgical procedures. Patients generally start treatment within two to four weeks. Critical cases or surgical patients who need to start immediately following resection are often expedited. Treatment typically involves daily sessions, Monday through Friday, over a period of two to three weeks for a boost or five to eight weeks for a single course. Patients may need custom immobilization devices for certain treatment areas. Daily sessions last approximately 45 to 60 minutes, but vary depending on the number of treatment fields and the complexity of the case. Proton therapy treatment may be combined with chemotherapy or as a complement to surgery. Patients who have had multiple surgeries and/or prior radiation treatment are often candidates for proton therapy. Other Conditions Treated at the IU Health Proton Therapy Center Gastrointestinal Malignancies Carcinomas of the rectum Hepatocelluar carcinomas Liver (primary and metastatic) Pancreatic carcinomas (select cases) Lung Cancer Early-stage, medically inoperable lung cancer Mediastinal boost (selected cases) Nasal/Sinus Tumors Ethmoid sinus Maxillary sinus Nasopharyngeal carcinomas, including recurrent lesions and retreatment Paranasal sinus carcinomas Ophthalmological Conditions Malignant/benign tumors of the orbit Optic nerve gliomas Retinal tumors Other Conditions Abdomen/Pelvic wall Arteriovenous malformation (AVM) Lymphoma (select cases) Ewing s Sarcoma and other sarcoma subtypes (select cases) Metastatic disease sites (select cases) Special Treatment Sites

13 Proton therapy is ideal and in some cases, a standard of care for localized cancers. With a treatment plan in place, we can fight some of the most complex tumors and look forward to a rewarding outcome. Referring Patients To refer a patient for treatment or to obtain additional information, please call: Toll-Free Local Phone A member of our medical team will speak with you or members of your staff about your patient s care and provide you with information on how protons can be a part of a multifaceted approach to treatment. We assure easy access to our radiation oncologists as well as members of our administrative team to assist with patient coordination. Medical Records and Consultation Referring physicians will need to provide medical records for referred patients. These may include, but are not limited to: Copies of films, CDs and reports from the past three years of radiological exams (i.e. MRI, CT scan, bone scan, X-ray, PET scan). If surgery was performed, please provide pre- and post-surgery films. All previous radiation therapy records (if applicable), including the treatment summary, isodose plan and dose volume histogram. Pathology reports from each surgery related to the disease. Operative reports from each surgery related to the disease. Lab reports from the past six months (PSA, blood counts, kidney function, liver function, endocrine tests thyroid, testosterone). All chemotherapy medications and dates administered (if applicable). Any medical correspondence pertaining to the disease. Medical records can be sent via U.S. Mail or any overnight carrier to: IU Health Proton Therapy Center ATTN: Medical Records 2425 N. Milo B. Sampson Lane Bloomington, IN Scheduling and Communication Once records are received and reviewed, your patient will be scheduled to meet with one of our radiation oncologists. Usually, this will occur within 10 business days and in most cases, within a week. Because of our affiliation with the IU Simon Cancer Center and Riley at IU Health, patients may choose to have their consultation meeting in Indianapolis. You will receive consultation and completion reports on patients you refer to the IU Health Proton Therapy Center. Members of our treatment team are also available to speak with you about your patient s care at any time during planning or treatment. If you have an interest in participating in a treatment session, we invite you to visit us where you can learn more about our facility and the application of proton therapy.

14 If your patient requires surgery prior to treatment, or if the proton therapy prescription is combined with chemotherapy, we will work with you to coordinate schedules so that our treatment plan complements other planned procedures and keeps you and your patient on schedule for their treatment course. Referring Patients Cost And Insurance The cost for proton therapy is dependent on many factors such as insurance coverage, co-payments, deductibles and out-of-pocket requirements. More than 95 percent of our patients are covered by insurance, and most insurance providers have policies regarding the diagnoses covered by proton therapy. It is important for patients to understand their insurance policy. The IU Health Proton Therapy Center s insurance case managers will work with your patient to seek authorization and coverage. In the event coverage is denied, our case managers will take the lead in appealing the decision. We are a Medicare provider and participate with most Blue Cross/Blue Shield programs. For patients without insurance, we can arrange favorable payment plans and can provide discounts similar to those provided to the largest insurers. Most insurance policies do not cover housing, transportation or living expenses associated with treatment. Support Services Our patients receive a highly exact cancer treatment at a facility that gives them exactly the care they need. Our entire staff gets to know every patient, which enables them to sensitively address patients complex medical and social needs and to connect them with available resources. Patients also enjoy exploring the Bloomington community, which combines proximity to a major university with small-town charm and a friendly atmosphere. A unique feature of the IU Health Proton Therapy Center is our Patient Resource Center and the services of a patient concierge. Our patients and their caregivers come to us facing one of the greatest challenges of their lives: fear and anxiety that often accompany a diagnosis of cancer, how to fight the disease, understanding new family roles and even navigating a new town. Whether patients temporarily relocate to Bloomington or commute for treatment, the IU Health Proton Therapy Center is committed to addressing the needs of the whole patient. In addition to extraordinary medical care, we offer patients and their families social, educational, nutritional and spiritual support opportunities. Through multiple housing partners including two facilities dedicated exclusively to our patients (Jill s House and Hoosiers Care) temporary housing facilities are available to patients and their families.

15 For our son Chandler, proton therapy was by far the best treatment option for his brain stem tumor. The IU Health Proton Therapy Center staff, being the best in the business, made this a painless experience for both patient and parents. The staff is awesome! Steve and Debbie H. Indianapolis, Ind. Son, Chandler, cancer survivor (brain stem tumor) I have referred many people to the IU Health Proton Therapy Center in the last five years and continue to do so. My experience was great. Because of the proton treatments, cancer was a non-event in my life. Rick O. Tremont, Ill. Prostate cancer survivor The IU Health Proton Therapy Center staff, in particular the radiation therapists, really made my treatment experience comfortable. Their enduring patience and positive attitudes made my experience one I will always remember. Michael H. Mason, Ohio Prostate cancer survivor Everyone from the receptionists, nurses, technicians and physicians made us feel like it was their personal mission that Johnathan did well. Anthony L. New Castle, Ind. Son, Johnathan, cancer survivor (ATRT) There is no doubt the IU Health Proton Therapy Center decision and experience was correct for me. I did not experience a single side effect from proton therapy either during or after completion of treatment. Robert R. Mequon, Wis. Prostate cancer survivor Proton therapy enabled me to continue to be the person I was before I got sick. Jennifer S. Indianapolis, Ind. Cancer survivor (Meningioma)

16 37 N Arlington Rd. CHICAGO 80 SOUTH BEND IU HEALTH PROTON THERAPY CENTER /46 Bypass W. 17th St. LAFAYETTE 74 INDIANAPOLIS N. College Avenue N. Walnut Street BLOOMINGTON E. 3rd St BLOOMINGTON 65 CINCINNATI 64 LOUISVILLE The Indiana University Health Proton Therapy Center is affiliated with: 2011 IU Health 07/11 HY3192