Proton Therapy for Esophageal Cancer
Treating esophageal cancer with an adequate dose of radiation can be difficult because of the close proximity of the esophagus to critical structures, such as the heart, lungs and spinal cord. Because protons deposit their highest dose of radiation at the tumor or area of concern, proton therapy can be an excellent choice for treating patients with esophageal cancer.
Proton therapy offers patients and their doctors a unique option for effectively treating esophageal cancer while reducing radiation exposure to surrounding organs and tissues. The MD Anderson Proton Therapy Center is one of the few centers of its kind treating esophageal cancer with proton technology.
What is the course of treatment for esophageal cancer patients typically like?
The standard of care for esophageal cancer is chemotherapy and radiation together followed by surgical evaluation. The course of radiation is five days a week, for five and half weeks. Patients will return 6-8 weeks later with repeat scans and scope to ensure there is no progression of the disease before they are evaluated by the surgeon.
What are the benefits of esophageal cancer patients being treated with protons?
The heart and lung, including the liver, is spared from doses of radiation that is scattered by X-ray radiation. Protons have little to no exit dose, so the dose of radiation stays confined to the tumor and the surrounding normal organs like the heart, lung, and liver, are preferentially spared, thereby reducing potential side effects.
What side effects are avoided?
Side effects from radiation come from stray radiation hitting normal organs. For the heart, the blood vessels and the cardiac muscles have microinjury from radiation which can have long-term consequences at the time of surgery or even after years of completing radiation.
Lungs can be inflamed or scarred which can cause loss of breathing capacity. The liver, depending on the health of the liver, could be impacted by destroying healthy liver cells that are vital for detoxifying the blood and food that are being digested.
How does esophageal cancer usually develop?
There are several causes for esophageal cancer, but the most common is due to chronic reflux disease, leading to adenocarcinoma. Other common causes are from smoking, alcohol, or ingestion of hot liquids, that with repeated injury to the lining of the esophagus over time can lead to a cancer called squamous cell carcinoma.
MD Anderson is currently doing research to make advances for future treatment. Patient participation in clinical trials or research study help improve cancer care for our patients in the future.
Esophageal cancer caregiver: I’m grateful we came to MD Anderson
My husband, Gary, had been healthy and active before he began complaining of a backache at age 67. Then he started having trouble swallowing. Food just wouldn’t go down.
A doctor in our hometown of Russellville, Arkansas, ordered an endoscopy to examine Gary’s esophagus.
After reviewing the results, the doctor pulled me aside. "It’s not good,” he said. “Your husband has esophageal cancer.”
The tumor was at the end of his esophagus, the tube that carries food from the throat to the stomach. That explained Gary’s backaches and swallowing problems.
I struggled to comprehend his words. Things went fuzzy. “What?” I thought. “He can’t have cancer.”
The doctor offered little hope. He told us to go home and focus on Gary’s comfort.
For a few days, I grieved. I struggled to adjust to the changes that came along with Gary’s diagnosis. The tumor had grown so large that he was unable to eat solid food. He’d have to stick to diet of purees and soups.
“Just breathe, Mama, breathe,” my oldest daughter kept saying to me.
Esophageal cancer experts gave us confidence with specialized treatment plan
I decided to take action. I called MD Anderson. That turned out to be the best decision ever. We were given an appointment, and within a few days, we were in Houston.
As soon as we walked through the doors of MD Anderson on June 11, 2018, we felt hope.
Radiation oncologist Stephen Chun, M.D., was the first doctor we met. He was brilliant and positive, and put us at ease. He told us about proton therapy, a type of radiation therapy that uses a beam of protons to deliver radiation directly to the tumor, destroying cancer cells while sparing healthy tissues. Dr. Chun believed proton therapy, along with chemotherapy, could shrink Gary’s tumor, making it easier to surgically remove.
Each doctor we met was so confident and supportive. Thoracic and cardiovascular surgeon Ara Vaporciyan, M.D., sketched Gary’s tumor in my notebook and showed us how he planned to remove the tumor with a surgery called a transthoracic esophagectomy. First, he’d remove the cancerous portion of the esophagus. Then, through a second incision, he’d pull Gary’s stomach up into his chest and connect it to the remaining upper-third of the esophagus.
“This is doable!” I remember him saying with a smile. “Go get the proton therapy and chemotherapy and plenty of rest. Then we’ll do surgery.”
“What? You mean you can help him?” I thought. “Oh, my! Praise God!”
My husband’s esophageal cancer treatment
For six weeks, Gary underwent proton therapy Monday through Friday, and chemotherapy every Wednesday. He typically suffered from nausea after chemotherapy. An MD Anderson dietitian taught us about foods that would help him feel full without upsetting his stomach.
During this time, we stayed in Houston at a nearby condo, driving back to Arkansas only a few times. Our three adult children called and texted us frequently to check in, and our six grandchildren sent us handmade artwork to lift our spirits.
After Gary completed chemotherapy and proton therapy, we returned home to Arkansas for two months to rest and prepare for his surgery. On Oct. 24, 2018, Dr. Vaporciyan successfully performed the transthoracic esophagectomy. After Gary’s seven-day hospital stay, we moved to an apartment near MD Anderson. We stayed there for 48 days while Gary recovered.
Helping my husband with his feeding tube
During this time, I gave Gary his liquid meals and medicine through a feeding tube. I was initially nervous. I’m a retired school teacher, not a nurse. But I took classes for caregivers at MD Anderson and learned how to do it.
Whenever I had questions or needed help, Gary’s care team took my calls and walked me through the steps. It didn’t matter if it was 2 a.m. to 5 p.m.
Once when Gary had extreme nausea, I reached out to his care team. They explained that he was likely dehydrated, and walked me how to give him water through an IV attached to his feeding tube. We saw immediate changes to Gary’s nausea level.
Then, just before Christmas, we received the best news. Gary was cancer-free, and we could return home.
One day at a time
Looking back, we got through that period one day at a time. After Gary had had his feeding tube removed, he was gradually able to begin eating regular foods.
The journey wasn’t easy for Gary or for me as his caregiver, but it was certainly worthwhile. And none of it would have been possible if we hadn’t made that call to MD Anderson.
Request an appointment online at MD Anderson or by calling 1-877-632-6789.
Metastatic melanoma survivor: Why not me?
In 2012, my dermatologist in South Carolina noticed a bump on my cheek. A biopsy showed that I had stage IV melanoma.
We’d heard immunotherapy had proven successful in treating certain types of melanoma. But because I had an autoimmune disease, I was not eligible for this treatment at the time. Researchers still needed to figure out how to safely administer immunotherapy to patients with autoimmune conditions.
So, I had the cancerous tissue removed through Mohs surgery. This type of surgery uses precise measurement techniques that leave healthy tissue intact. My wife, Pam, and I felt positive after my successful surgery.
By 2014, I learned the cancer had returned and metastasized to both my lungs. My daughter had recently gotten engaged, and it was hard to hear I may not live until her wedding. I decided not to give up, so I sought another opinion.
My metastatic melanoma diagnosis and treatment
My wife and I came to MD Anderson, where we met with melanoma experts in the Melanoma and Skin Center. They referred me to thoracic surgeon Dr. Wayne Hofstetter. I underwent two thoracotomies with lung resections -- one on each lung. I was overjoyed to recover in time to walk my daughter down the aisle.
During a routine scan in 2016, I found out that more tumors had appeared. This time, radiation oncologist Dr. Quynh-Nhu Nguyen performed stereotactic body radiation therapy (SBRT). This eliminated the tumors. I was in remission once again.
But in 2018, I started having difficulty swallowing certain foods. My gastroenterologist in South Carolina performed an endoscopic ultrasound. The results showed a tumor on a lymph node next to my esophagus. After sending the results to MD Anderson, we made plans to return to Houston. Dr. Hofstetter removed the tumors through a robotic surgery. This type of surgery was effective in removing these hard-to-reach tumors.
Treating my latest melanoma recurrence with immunotherapy and proton therapy
In July 2020, I was supposed to return to Houston for my check-up at MD Anderson. But due to COVID-19, I did not want to travel, so my MD Anderson care team allowed me to have scans done in South Carolina. On July 7, I had my PET/CT, MRI and endoscopic ultrasound. The results showed the tumors had returned. And one was eroding into my esophagus. I made plans to return to Houston for treatment. On July 15, I met with my care team at MD Anderson. They decided my best treatment option was a combination of pencil beam proton therapy and immunotherapy, which I now qualified for, thanks to research advances.
Finding hope during proton therapy at MD Anderson
I started proton therapy on July 27. I received 25 treatments to my esophagus. Proton therapy caused me the least amount of side effects of any treatment that I have had. Recovery from surgery may have been the hardest, but even that was short-term. Dr. Nguyen and the staff at the Proton Therapy Center helped make the treatments painless. Seeing the staff made my treatments an event that I looked forward to each day.
I had some mild discomfort when swallowing certain foods and juices following my proton therapy. I also experienced indigestion. To remedy this, I would take an antacid and eat softer foods. For me, the benefits of proton therapy outweigh any temporary discomforts.
My immunotherapy treatment
On July 24, I received two intravenous injections of the immunotherapy drug Keytruda.
I will continue this treatment every six weeks for the next two years. The only immunotherapy side effect I’ve experienced so far has been neuropathy.
I felt safe at MD Anderson during the COVID-19 pandemic
Though I’d initially avoided traveling to MD Anderson for my scans in early July, the precautions MD Anderson has taken to protect its patients from COVID-19 reassured me. Every employee and patient I saw wore a medical-grade face mask, and there were hand sanitizer stations everywhere.
As a survivor with reduced lung capacity, I am very conscious and aware of safety measures. That’s why I was thrilled that MD Anderson takes patient safety so seriously. Even the ancillary facilities, like the Rotary House, required visitors to wear masks and practice good hand hygiene.
I was also very happy to see MD Anderson limiting the number of people on its campus. That reduced my safety concerns even more.
Helping other cancer patients become survivors
When I first came to MD Anderson in 2014, I learned that I was a cancer survivor the day I was diagnosed. That has impacted my life in many ways.
MD Anderson has a wonderful mission of not just treating cancer, but ending cancer.
To support this mission, my wife and I created the Wilkes Family Cancer Autoimmune Research Fund in 2014. Our goal was to help make immunotherapy treatment an option for cancer patients with autoimmune diseases. We donated $1 million to support MD Anderson’s research into immunotherapies for autoimmune patients.
Now I advise other survivors not to harbor “Why me?” feelings. Instead, modify that to “Why not me?” I want to use the moment to bring hope, comfort and love to other survivors -- and to remind them to enjoy every second celebrating life.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.