Johns Hopkins Proton Therapy Center Medical Director Christina Tsien, a leading brain and central nervous system tumor expert, brings a wealth of expertise to her new role.

Tsien comes to Johns Hopkins from Washington University School of Medicine in St. Louis, Missouri, where she was chief of the Central Nervous System Service, director of clinical research for radiation oncology, and co-medical director of stereotactic radiosurgery and the gamma knife center.

Her mission for the Johns Hopkins National Proton Center is to ensure patients receive outstanding individualized care, provide the very best training opportunities for faculty and staff members, and maintain an active clinical and translational research program.

“We are bringing world-class cancer care and cutting-edge research to patients here and around the world,” says Tsien.

The Johns Hopkins Proton Therapy Center is committed to providing pediatric and adult patient-centered clinical and research programs, she says. “In collaboration with Children’s National, we will have a strong focus on improving outcomes for pediatric patients and reducing short-term and long-term treatment side effects,” says Tsien. This includes using proton therapy to reduce treatment-related impact on growth and cognition, and the risk of secondary cancers later in life, she says.

“For adults, the potential impact of proton therapy can also be substantial,” Tsien says. “Radiation therapy is an integral component of cancer care, with over half of all patients diagnosed with cancer receiving radiation therapy as part of their treatment.”

Tsien and colleagues are excited by the possibilities of using proton technology to improve radiation treatment of tumors next to critical organs. Tsien notes that the Proton Therapy Center has state-of-the-art pencil beam technology with image guidance, which affords physicians the ability to deliver highly precise and conformal proton therapy.

“Johns Hopkins physicians are world-renowned experts in the treatment of cancer, and they are committed to clinical trials and translational research to improve the quality of life and outcomes for cancer patients, providing evidence on how proton therapy can reduce long-term radiation side effects,” says Tsien. This includes protecting the heart for breast cancer patients and reducing short- and long-term effects on normal swallowing, dry mouth, taste changes and weight loss in head and neck patients, she says.

“Treatment of brain tumors will also be a key area of cancer care progress because of the potential to preserve vision, hearing, memory, and vital brain stem, pituitary and neuro-cognitive function,” says Tsien.

Tsien adds that proton therapy is an exciting opportunity for patients who otherwise might be excluded from radiation therapy because of prior radiation treatments.

“Proton therapy is an incredibly complex and precise tool, and there is still much to be done for experts to harness its full potential,” she says. “We are working to develop advanced imaging techniques to monitor treatment changes in real time, allowing us to adapt radiation treatment plans. We are building better motion management tools, and we want to improve our understanding of radiation tumor biology to further increase the effectiveness of proton therapy in combination with systemic therapies.”

Tsien is eager to study proton therapy in combination with immunotherapy, systemic therapy and targeted drug therapies — treatments that work to zero in on specific molecular alterations that drive cancer growth and spread.

“Combining proton therapy with other cancer treatments may help prevent cancer recurrence, and this will be an active area of preclinical and clinical translational research in the Johns Hopkins Proton Therapy Center,” Tsien says. “Our purpose is to figure out how to improve cancer survival, and often the best way to do that is to use different cancer therapies in combination to deliver high radiation doses to the tumor while minimizing dose to the surrounding normal tissues.”

Among the strategies Tsien wants to research is the use of ultrafast flash radiation therapy with proton therapy to maintain high doses of radiation to tumors while reducing dose to normal tissues. “This would ultimately enable us to substantially shorten the length of treatment from several weeks to several days,” she says.

Radiation oncologists now have many different cancer-fighting tools at their disposal, and Tsien stresses the importance of selecting the right treatment plan for each patient. “Proton therapy will not be suitable for everyone, and we are committed to ensuring patients receive the best and most suitable treatment,” says Tsien.

“One of the most rewarding things for me is the opportunity to work as a treatment team, to give every patient a second look to make sure nothing has been missed and that we’ve explored every possible avenue and every treatment option,” she says. “We need to identify patients who will benefit the most from proton therapy and learn more about its impact on tumors and normal tissues. We also need to go into the laboratory to reveal the cellular mechanisms that can answer questions like why a specific treatment may work in one patient but not in another.”

Tsien says Johns Hopkins Proton Therapy Center experts will work closely with colleagues throughout the Johns Hopkins system as well as with colleagues at other organizations such as the National Institutes of Health. “We are aiming to provide the very best patient care and to be on the forefront of innovative proton research,” she says.

As Tsien looks ahead, she also thinks back to her own diagnosis, as a young medical student, with a rare type of sarcoma. It led her to pursue a career in radiation oncology. Proton therapy was not available at that time, and her experience reminds her of the continuing need to advance cancer therapies. She understands cancer on a professional and personal level and chose to come to the Johns Hopkins Proton Therapy Center, she says, because of the opportunities uniquely set up to pursue novel clinical and laboratory studies using state-of-the-art proton therapy with the aim of transforming patient care.

“I am excited to be here,” says Tsien, “and what I’m most excited about is helping patients everywhere get the best care, and that means we are always looking to the future and always moving forward. Our goal is to eliminate cancer.”