Cancer is scary, as are many of the tools and techniques we use to fight it.
Surgery is invasive. Chemotherapy is cytotoxic. Immunotherapy puts our body’s natural defenses into an offensive state and turns them into aggressive mode. All of these modalities, taken together or individually, can be very effective at halting the progression of the disease.
Radiation is a natural phenomenon. We are exposed to low doses of radiation in our daily lives through the air around us, the food we eat and the buildings we live in. When focused on treatment and delivered in higher doses than we are naturally exposed to, radiation kills cancer cells and shrinks tumors. Like other methods, radiation is the mainstay of curative and palliative cancer treatment.
We’ve been using radiation to kill cancer for over 100 years, and we’ve made huge leaps in that time. Since the middle of the last century, we have seen the emergence of linear particle accelerators with 3D computed tomography and other powerful new imaging techniques to guide treatment. All of these help us fight cancer more effectively.
this Working in the field of radiation oncology is a particularly exciting time. We may be on the verge of another major breakthrough and accomplish something elusive in the past. We may finally be able to deliver a powerful fight against cancer while reducing the risk of damage to surrounding healthy tissue.
Dosage Dilemma
We’ve known for decades that if we can increase radiation doses, we increase the likelihood of a cancer cure, but increase the risk of damage to the healthy tissue surrounding the tumor.
The sweet spot between achieving cancer cure without unacceptable normal tissue toxicity is based on decades of observational experience. We stick to the dose that works for most patients with minimal side effects for many years. But patients have varying degrees of radiation tolerance, and some patients would benefit from higher doses. Today, we lack the ability to adequately treat patients based on their individual radiation sensitivity or tolerance.
This may be about to change. An investigational treatment that could help us move beyond the limits of normal tissue tolerance to radiation is clinically feasible for the first time. If successful, it could lead to profound changes in cancer treatment and prolong the lives of patients battling the most intractable forms of the disease. Ideally, patients would live longer, healthier lives with fewer side effects associated with treatment.
flash effect
this University of Maryland School of MedicineI conduct direct research in the field of radiology and am one of many clinical partners of a pioneering radiation therapy company Varian. The company is testing an approach that looks and sounds like science fiction. Research points to success where previous approaches fell short.
Flash therapy* is radiation therapy delivered at radiation rates several orders of magnitude higher than those currently used in conventional clinical radiation therapy. This approach produces a flash effect, in which radiation reduces the tissue toxicity associated with conventional radiation therapy, while still maintaining and/or improving local tumor control.
The Flash effect has been demonstrated in preclinical experiments using proton and electron radiation. Since electrons are used to treat superficial tumors such as skin cancer, while protons can treat deep tumors throughout the body, it is likely that electron flash and proton flash will one day have different complementary clinical indications.
Varian’s ProBeam proton therapy (which my team and I are using) uses a high-definition “pencil beam” to achieve the kind of precision that radiologists oncology have wanted for decades. Protons deliver most of their energy in the body at prescribed, programmable distances, called the Bragg peaks, thus delivering high doses to tumors and less energy to healthy tissue. This means that patients are likely to experience fewer side effects, improve long-term outcomes and improve their quality of life.
There is still a lot of work to be done, but early signs suggest that we may be entering a new era of cancer treatment.This is the idea of the middleman FlashForward Alliancea global group of institutions that designs research and shares research protocols to advance the science and clinical translation of Flash therapy*.
Making progress against cancer often involves taking risks. But in order to achieve good results, we try to reduce the risk as much as possible. This is especially true in the fight against cancer. We hope to improve survival in the short and long term. We want to restore people’s quality of life. But we need to avoid creating new problems as we do so.
This is especially true in the field of radiation oncology, where there is an urgent need to reduce the risk of damage to surrounding tissue—especially when tumors occupy sensitive areas such as the lungs. I have spent years studying the effects of fibrosis and pneumonia on healthy tissue, risks that we must avoid anytime, anywhere.
For cancers that impair quality of life in the long term, patients need and deserve the best treatment options. It’s exciting to be on the cusp of a potential breakthrough that will help us offer one of the most effective options, but with far less risk.
about Dr. Isabelle Lauren Jackson
Dr. Isabelle Lauren Jackson
Dr. Isabel Lauren Jackson is the Marlene and Stewart Greenebaum Associate Professor of Radiation Oncology and Chair of the Department of Translational Radiology at the University of Maryland School of Medicine. Dr. Jackson’s expertise spans radiation-induced damage to normal tissue, drug development to treat radiation-related health effects, and medical preparedness for nuclear and radiological events.
She is a consultant to Partner Therapeutics (Boston, MA), PureTech Health (Boston, MA), Cellphire Therapeutics (Rockville, MD), Myelo Therapeutics (Berlin, Germany), and Kallyope (New York, NY), and has worked at Humanetics Corporation ( Edina, Minnesota) Scientific Advisory Board.
photo: Varian
