Category Archives: Uncategorized

2 Key Studies for Seniors with Lung Cancer

With only 1 CyberKnife Treatment needed, you can get back to doing what is important.

At the recent 2017 Multidisciplinary Thoracic Cancer Symposium, there were 2 key studies that will benefit our seniors with lung cancer. 

The first study showed that early stage lung cancer patients treated with stereotactic body radiotherapy (SBRT), like that delivered by CyberKnife, survived just as long as patients with surgery.  SBRT controlled 84.5% of the lung cancers in seniors with stage I lung cancer. 

“Definitive lung SBRT in patients 80 years and older appears to be safe and efficacious,” said lead author Dr. Richard Cassidy III of Emory University in Atlanta. 

In Dr. Cassidy’s study, the average age was 85 years and 40% had adenocarcinoma of the lung while 29% had squamous cell lung cancer. 

The second study reported by Dr. Singh from the Roswell Park Cancer Institute showed that the “one and done” approach with SBRT may be just as good as 3 treatments in 1 week. This means that they only had 1 treatment and no more. Lung cancer patients were selected for the “one and done” SBRT because these patients had small lung cancers at the edge of the lung, minimizing radiation exposure normal lung tissues. 

“Our study is the first to show that 1 fraction of SBRT, a one and done treatment approach, is as good as 3 fractions for early stage lung cancers in terms of survival and toxicity,” said Dr. Singh. This means the patient  only needs to have one 30 minute radiation therapy treatment before they get back to the important things in their life.

The one and done study was a so-called phase II trial so we will need to await the results from the gold standard phase III trial in the future. 

The CyberKnife Advantage 

CyberKnife is the only SBRT machine out there that continuously tracks your lung cancer while you breath-sparing more normal lung tissue.  There’s no incision, no pain, and no hospital stay. 

If you have any questions about your early stage lung cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton 1.  I guarantee that I will see you in consultation within 1-3 days of your phone call.

Can Smokers Kick One Habit but Pick up Another?

I am asking smokers to add another habit to their lives. Only this one is a good habit!

On February 2, 2017 a research letter in the prestigious medical journal JAMA Oncology reported that only 3 to 4% of smokers underwent a low-dose CT scan to find a new lung cancer in 2010.  And the response was much the same in 2015: 3.3% in 2010 versus 3.9% in 2015.

Dr. Jemal, the senior researcher of the JAMA Oncology study, said “We estimated that by 2015 there would be 6.8 million smokers eligible for screening, but only 262,000 were screened.”

CT Scans Can Save Smokers’ Lives

In 2017, lung cancer will kill 160,000 Americans.  Most smokers, about 85% in fact, are diagnosed when their lung cancer is inoperable or has spread to other critical organs, like the liver, brain, or bone.  With stage III or stage IV disease, there is little hope for cure or even survival beyond a few years.  When diagnosed early, lung cancer is highly curable with surgery or with a noninvasive technique called stereotactic ablative body radiotherapy (SBRT), like that delivered by CyberKnife.

In 2011, the National Lung Screening Trial (NLST) showed that screening current or former smokers with low-dose CT scans could save 30,000 Americans each and every year.  But we’re far from that goal. 

Is the Glass Half Empty or Half-Full?

I think a response of 3-4% is actually pretty good.  Why do I say so?  The best marketers out there tell me that a “good response” to direct marketing is just 0.1 to 0.25% – over 20 times lower than the success rate for screening smokers for lung cancer with low-dose CT scans.

Let’s face it.  It is difficult to get people’s attention.  Americans are bombarded by information every day-from TV, newspapers, and the Internet.

In the JAMA Oncology article, Dr. Jemal seemed to point the finger at uninsured patients, Medicaid patients, and even family doctors who may be unaware of the power of low-dose CT scans for screening for early stage lung cancer.

Dr. Jemal said “Screening requires a lot of things. First you have to educate the physicians and the patients and half of your patients are not covered by Medicare,” as reported by AuntMinnie.com

The First Dayton Cancer Care Solution

At First Dayton Cancer Care, a low dose CT scan for screening current or past smokers costs only $99.  And we’ll also see if your insurance covers the cost.  Many private insurance carriers do.

The CT scan is painless-no injections or needles-and takes only a few minutes of your time.

It’s never too late to stop smoking. But I’m asking smokers to kick the habit and take up another. I’m urging them to get in the habit of a yearly screening CT scan for lung cancer.

The response to the Federal Government’s low-dose CT scan screening for lung cancer has been a start, but one that I would not call good.  My conclusion, to paraphrase Prime Minister Nehru, is that our approach needs to be better.

If you have any questions about screening for lung cancer or other cancers, please feel free to call me, Dr. Edward Hughes, at 855-Dayton1.

Prostate Cancer – 3 New Landmark Studies in 2016 You Need to Know about

CyberKnife Iris.tif

The Cyber Knife offers amazing benefits to treating prostate cancer. Better outcomes, fewer side effects, greater quality of life.

1.  Stereotactic ablative body radiotherapy (SABR), like that delivered by Cyber Knife, is just as good for curing early stage and intermediate stage prostate cancer as more traditional radiation options, like IMRT or permanent radiation seed implants. 

Researchers at the University of Texas Southwestern Medical Center (UTSW) in Dallas showed that stereotactic ablative body radiotherapy or SABR resulted in prostate cancer control rates of 98.6% at 5 years.  Importantly, 63.7% of those men had so-called intermediate risk disease and 36.3% had low risk disease.  The study was published in the European Journal of Cancer 59:142-151, 2016.

Only a few patients had moderate side effects, but the specialists at UTSW used a LINAC based radiosurgery, not Cyber Knife.  At First Dayton Cancer Care, our rate of grade 3 toxicity is much lower-   a tribute to our team as well as the Cyber Knife itself.  Cyber Knife is the only stereotactic  radiation system that continuously tracks prostate movement during treatment, thereby minimizing collateral damage to the bladder and rectum.

2. Stereotactic ablative body radiotherapy (SABR), like that delivered by Cyber Knife, is every bit as good as proton therapy, at a fraction of the cost and far less time consuming for the patient. Cyber Knife is done is 1 week versus 6-8 weeks with proton therapy.

In the study of 1,327 prostate cancer patients treated at the University of Florida Health Proton Therapy Institute in Jacksonville, the 5 year PSA control rates were 99% for low risk prostate cancer patients and 94% for intermediate risk patients.  And the side effects were the same as that delivered by Cyber Knife. The study was recently reported in the International Journal of Radiation Oncology, Biology and Physics 95:422-434, 2016. The reduced treatment time plus the fact that Cyber Knife  costs a fraction of what proton therapy costs, makes treatment with Cyber Knife a winner all the way around.

3. Radiation therapy added to hormonal therapy (called ADT or androgen deprivation therapy) cut in half the risk of men dying from prostate cancer.

And the results were huge! Radiation therapy added to hormonal therapy reduced the risk of death from 34% to 17% at 15 years. The study of 875 Scandinavian men with prostate cancer was recently published in the March 2016 issue of the Journal European Urology.  Importantly, the radiation therapy was only 70 Gy over 7 weeks, a lower radiation dose compared to 80 Gy over 8 weeks typically given to men with locally aggressive prostate cancer in the US.

Unfortunately, now that routine PSA testing in the US has declined, more and more men are faced with a diagnosis of locally aggressive prostate cancer requiring radiation therapy in addition to hormonal therapy.

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton1

Follow-Up Visits: Too much, Too Little, or Just Right?

Are you a More patient or a Less patient?

Are you a More patient or a Less patient?

Each and every day in my practice I listen to the same old questions about follow up care from my patients.  Questions about how often follow-up visits can be grouped into 2 major categories: 1) Patients who want more and 2) Patients who want less. The ‘Mores’ ask “How about getting more scans, like a PET scan, CT scan, or MRI scan?”; and the ‘Less’ ask “Why do I have to come back to you as well as my other doctors?”

For HPV positive oral pharyngeal cancer patients, the answer is now clear-cut.  Research specialists, led by Dr. Jessica Frakes from the H. Lee Moffitt Cancer Center in Tampa, studied 246 patients with HPV positive squamous cell carcinoma of the oropharynx who completed either radiation therapy alone or radiation plus chemotherapy from 2006 to 2014.  Those patients then had a PET/CT scan 3 months following completion of treatment.

Follow up visits with a patient history and physical examinations were conducted by members of the multidisciplinary team consisting of a radiation oncologist, medical oncologist or surgeon as follows: Year 1 patients followed up every 3 months; Year 2 patients followed up every 4 months; Years 3-5 patients followed up every 6 months.

As reported at the 2016 Multidisciplinary Head and Neck Cancer Symposium that I attended this past February, the vast majority of recurrences -98% to be exact- were found by physical examination alone.  98% of recurrences of the neck were found by feeling a lump in the neck.  So physical examinations, especially by a qualified specialist, are key.

Dr. B. Chera, an associate Professor of radiation oncology at the University of North Carolina Chapel Hill, told Oncology Times, “I conclude from this study that more frequent surveillance with imaging is not necessary for HPV positive oral pharyngeal squamous cell carcinoma patients.”  Dr. Christine Gourin from Johns Hopkins Hospital added, “I think we probably due too much post-treatment surveillance imaging.  And it’s true we pick up more recurrences clinically and radiologically.”

So there you have the answer. For patients with the most common form of head and neck cancer, frequent physical examinations after PET/CT scan is key.  More scanning is not beneficial, and may in fact be harmful.

If you have any questions about your head and neck cancer, please feel free to call me, Dr. Edward Hughes, at 855 Dayton 1.

 

 

WHO IS CARING FOR THE SURVIVORS CAREGIVER?

This blog was posted a while back, however, it rings true every day. Happy Mother’s Day to all the moms who took care of you.

"One person caring about another represents life's greatest value."- Jim Rohn

“One person caring about another represents life’s greatest value.”- Jim Rohn

A cancer diagnosis changes the lives of many. The patient is not the only person affected. Life also changes for those who care about and love the person with cancer especially for the person who will help the patient get through the cancer experience-the caregiver. Caregivers are the unsung heroes of cancer survivorship. Primary caregivers are a major part of the health care team because they are doing things like: giving medications on time, helping manage side effects, communicating with the physicians and nurses, taking the patient to appointments, and keeping other family and friends up to date on what is happening. This primary caregiver does all of this while trying to manage normal day to day activities. Becoming a caregiver is like taking on a second job. It is not an easy job. And it must be done with a positive attitude as the cancer patient often draws strength from the caregiver.

The question is “who is caring for the caregiver?” This is a role that a friend or a secondary family member can take on.

Depression and exhaustion are two major concerns with primary caregivers. The American Cancer Society has a Checklist for Caregivers that gives excellent advice. I strongly recommend that survivors, primary caregivers and family/friends utilize this resource. It offers tips and insights to keep the caregiver healthy inside and out.

The focus of course is to find excellent support for the cancer survivor, as it should be; but the caregiver will benefit from support too. They do not usually have time to join support groups in person, so the internet can be just what is needed. There are online support groups that are disease specific or simply cancer in general. Find the one that is easiest to use and has like-minded people. The chat rooms can be a great place to trade information and to learn from each other’s experiences. Sometimes it serves as a place to share your fears and frustrations with others who understand what you are going through. The right online chat room should be a safe place without judgment. I only ask that you use caution when taking advice regarding medical treatment and medication. Always seek the counsel of the patients health care professional. This includes beginning any new supplements. Some herbs and vitamins are very powerful and may interfere with some medications or treatments.

Know your Rights as a Caregiver. The Family and Medical Leave Act (FMLA) is a federal law that guarantees up to 12 weeks off from work per year to take care of a seriously ill family member. Your employer must hold your job and not penalize you. However, they are NOT required to pay you. FMLA only applies to companies that employ more than 50 employees or public agencies. Learn more here.

The caregiver is likely the point person for a number of legal issues as well. An Advanced Directive is a document that can help the patient to spell out their wishes in regards to their overall health care, with special attention to end-of-life care. The caregiver may also be asked to become the Durable Power of Attorney for health care decision. This has nothing to do with money or finances, but only to help carry out health care decisions. Ask your attorney or physician to help get these forms started. I recommend that these forms be completed early, while the patient is capable of making sound decisions. This really takes the pressure off of the caregiver and gives them the legal support that may be necessary when family members disagree.

Every cancer survivor needs a strong, compassionate caregiver. This caregiver needs special attention and care themselves.

Another Proven Benefit of Cyber Knife Treatment for Prostate Cancer

Cyber Knife allows sub-millimeter targeting to spare rectum, urethra and bladder.

Cyber Knife allows sub-millimeter targeting to spare rectum, urethra and bladder.

 

External beam radiation for men with prostate cancer appears to result in a small, but definite risk of bladder cancer and rectal cancer- so concludes Dr. Paul Nam and colleagues from the University of Toronto.

Dr. Nam and co- workers reviewed 3,056 published papers and selected 21 studies for more refined analysis. Their conclusion was that external beam radiation increased the chances for a second cancer 5 to 10 years down the road.

Dr. Nam and colleagues readily admit that most of the included studies had “moderate bias.” Nonetheless, men who had external beam radiation for their prostate cancers had an increased risk of bladder cancer ranging from 0.1% to 3.8%. Their risk of rectal cancer varied from 0.3% to 1.2%.  Their study was reported in the British Medical Journal, March 2, 2016 issue.

BUT NOT ALL RADIATION FOR PROSTATE CANCER IS EQUAL.

In the accompanying editorial to the study, Dr. Zeitman and Dr. Eyler from Harvard, pointed out the importance of radiation dose to surrounding organs, like the bladder and rectum. Collateral damage to bladder and rectum is key. In fact, men with prostate cancer who underwent radiation implants, with little or no dose to the bladder or rectum, had no such increased risk for a second cancer.  Fortunately, as Drs. Zeitman and Eyler point out in their editorial, cancer of the bladder and rectum can be caught early by screening and can be readily cured.

SO WHAT IS A MAN WITH PROSTATE CANCER TO DO?

With Cyber Knife, we can achieve the same sparing of bladder and rectum as with radiation implants. So for men with early stage and intermediate risk prostate cancer, I believe Cyber Knife may be their best choice. Cyber Knife has the same cure rates as external beam radiation and far fewer embarrassing side effects.  In fact, First Dayton Cancer Care is the only Cyber Knife center in Southwest Ohio whose planning system and treatments mimics that of temporary implants.

For our men with high risk prostate cancer- men who need IMRT and a boost by either temporary implants or Cyber Knife- I think the benefits of combined radiation treatments dwarf the small risk of a second cancer.

And now that we know the risks, it’s even more important to screen our prostate cancer survivors for bladder and rectal cancer in the future- all part of our survivorship plan.

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855- DAYTON 1.

What Is “Onco-Politics” and How It May Affect Your Cancer Cure

Let us start out with some shocking facts. 

 1. About 40% of all cancer cures are due to radiation therapy, but only 11% are due to chemotherapy – so says Professor Michael Richards, the United Kingdom’s cancer czar. american medical politics

 2. Of the 200 featured clinical trials supported by the US National Cancer Institute, only 11 involve any radiation therapy, and only 2 involve modifiers of radiosensitivity. 

3. Despite pre-clinical trials showing that stereotactic radiosurgery, like that delivered by Cyber Knife, generates an immune response against your own cancer, there are no major trials at the National Cancer Institute that address this approach. 

So what’s the hold-up?

I think part of the answer may be found in a recent memoir called “The Death of Cancer” Dr. Vincent DeVita, a chemotherapy specialist who for over 40 years held just about every major position in cancer care – from a lymphoma specialist at the National Cancer Institute to Physician-in-Chief at Memorial Sloan-Kettering Cancer Center, to the head of the Cancer Center at Yale University.  In his recent book, Dr. DeVita paints the portrait of a “Cancer Industrial Complex” desperately in need of a new direction.  Dr. DeVita’s memoir details a very human endeavor hampered by petty politics and power mongering.  In short, it’s been “Onco-Politics” since President Nixon declared the War on Cancer in the early 1970’s.

Yet in the end there is hope.

The nationally recognized radiation oncology thought leaders, Dr. J. Martin Brown and Dr. John Adler from Stanford University, wrote in a recent editorial “… Given the molecular therapeutic revolution that is about to take over the treatment of cancer and the socioeconomic power of Big Pharma, it is not inconceivable that radiation oncology could be marginalized as only a physically based specialty… Yet the prospects of a brighter future are there….  What patient would not prefer 1 or up to 5 daily fractions over the current practice of 6 weeks of daily treatments or oftentimes highly morbid conventional surgery.”  Their editorial was published in the International Journal of Radiation Oncology, Biology and Physics in late 2015.

But I am hopeful that the spectacular results with stereotactic radiosurgery, like that delivered by Cyber Knife, will win out at the end of the day.  If you have any questions about the treatment of your cancer, please call me, Dr. Ed Hughes, at 855-DAYTON1.

 

 

The CyberKnife Explained by Dr. Ed Hughes, Radiation Oncologist

As you see family and friends this holiday season, we hope that you are not faced with being told that a loved one has cancer. But if you are, you need to know about the CyberKnife Radiation Therapy treatment. First Dayton Cancer Care is the only center in Southwest Ohio with this treatment option. Learn more today. Let us know if we can help you or a loved one beat  cancer. Watch here.

 

WDTN Living Dayton’s Katie learns about the CyberKnife from Dr. Ed Hughes, Radiation Oncologist.

June Is Men’s Health Month

PSA Screening: What You Don’t Know Really Can Kill You

Real-Life Consequences of PSA Testing

Know the Facts.

Know the Key Facts about Screening your Prostate.

The first key fact that no one can dispute: from 1992 to 2011 there was a 47% decrease in prostate cancer deaths with the start of PSA screening in the USA.  Yet in 2009 and again in 2012, the Federal Government,  embodied in the US Preventative Service Task Force (USPSTF), recommended against PSA testing to detect men with prostate cancer.  There were claims by the USPSTF about over diagnosis and over treatment, yet it seems to me that the patients were penalized, not the doctors doing the over diagnosis and doing the over treatment.

In my own clinic, many patients still seemed to be surprised that prostate cancer can be deadly-second only to lung cancer in cancer deaths among Americans.  In 2015, the American Cancer Society stated that over 220,000 men will be diagnosed with prostate cancer in the United States.  And 32,000 men will die from their prostate cancer.  That’s hardly a disease to be taken lightly.

More Men Now Diagnosed with High Risk Prostate Cancer

As I reported previously in my blogs, City of Hope Medical Center’s Dr. Timothy Schultheis found that from 2011 to 2013-following the USPSTF’s recommendations- the number of men found with intermediate and high risk prostate cancers increased significantly in the USA.  And that study had big numbers-Dr. Schultheis looked at 87,562 men diagnosed with prostate cancer from 2005 to 2013.

Dr. Catalona, a urologist and recognized expert on prostate cancer from Northwestern University School of Medicine, said “There is a price to be paid for not doing PSA testing.  We have learned from cancer statistics in the US and from randomized clinical trials in Europe that PSA testing can cut the prostate cancer death rate nearly in half.  The strategy for success is to detect the prostate cancer early, when it is curable.  If doctors and patients do not work together to ensure appropriate PSA testing and treatment in an organized and routine fashion, there will be more unnecessary suffering and death from incurable prostate cancer in the near future.”

So What’s A Man to Do?

The second key fact that no one can dispute: the majority of prostate cancer deaths are in men 70 years or older.  So it may be even more important to screen our senior men.  Now that the Federal Government issued its edict that PSA testing is no longer needed, it’s really up to men to advocate for their own health.  Men need to stand up to protect themselves. Ask your doctor about PSA testing.  Bring PSA testing up at your next check-up.  There are even some laboratories, right here in Dayton, where you can pay $30 and have the test done on your own, without a doctor’s order.

I agree that as a stand-alone, one time test PSA screening is less useful than thought over 25 years ago.  But when combined with physical examination, family history, and tracking any changes in the PSA level over time, it really can be useful and even lifesaving.  In fact, a change in the PSA level of only 0.75 ng/mL over one year may be worrisome for prostate cancer, especially in men younger than 60.

What you don’t know about your prostate and PSA level really can kill you.  Once again, the USPSTF’s latest recommendation seem to be extreme. They are watching out for the dollar and not for the individual man.