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Tailored Therapies

Tailored Therapies

Making Radiation Therapy More Patient-Centric

Over the decade that Kimmel Cancer Center radiation oncologist Jean Wright, M.D., has been practicing, medicine has become increasingly patient-centered.

“Therapies are being tailored to the individual,” she says. “Treatment protocols have changed to make them more convenient and tolerable for patients, without sacrificing their efficacy.”

Wright, who heads the Kimmel Cancer Center’s breast radiation oncology program and practices at its Sibley Memorial Hospital location, says that for select breast cancer patients, her field is offering more and more options to treat this disease over a shorter course, and with techniques and technology that can help spare healthy tissue.

Wright’s radiation oncology colleague Sara Alcorn, M.D., M.P.H., who practices on the Kimmel Cancer Center’s East Baltimore campus, says radiation therapy for women in the early stages of breast cancer would traditionally entail daily treatments for six weeks or more. Now, it is often possible to cut that course in half.

“These shorter courses are more convenient for patients,” Alcorn says. “It also lowers their cumulative radiation dose, which can help lessen the negative side effects that can accompany radiation therapy.”

By giving greater attention to patient preferences and quality of life, we can tailor our approach in a way that reduces the burdens of cancer therapy while still providing effective care.

- Sara Alcorn, M.D., M.P.H.

Wright says research has shown that simple changes in patient position can also significantly reduce radiation exposure to healthy tissue. For patients with left-sided breast cancers who need radiation directed at the lymph nodes that cluster near the underarm, unnecessary exposure to the heart has long been a concern.

However, asking patients to take and hold a deep breath during treatment pushes the heart back from the chest and downward, away from the radiation beam.

“We now use that technique commonly for the majority of our patients with left-sided breast cancers,” Wright says.

The Johns Hopkins National Proton Therapy Center, set to open in the fall of 2019 at Sibley, provides more opportunity to spare healthy tissue. Protons can be tailored so that they penetrate only a selected depth through tissue. Consequently, Wright explains, radiation stops at the tumor, preserving healthy, non-cancer tissue beneath.

The most novel development in patient-centered radiation therapy, says Alcorn, is the potential to omit radiation entirely. For postmenopausal patients with less aggressive, early stage breast cancers, the decision to administer radiation often falls into a gray zone. The Kimmel Cancer Center is currently participating in a study to determine whether select patients can successfully avoid radiation. Alcorn is also leading efforts to design a tool to help patients and their physicians decide together whether to proceed with radiation therapy based on preferences concerning side effects and values.

“By giving greater attention to patient preferences and quality of life,” she says, “we can tailor our approach in a way that reduces the burdens of cancer therapy while still providing effective care.”

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