A dosimetric comparison of proton versus photon irradiation for pediatric glomus tumor – Vidal et al.
👉 Most notable are the lower doses to ipsilateral (left) cochlea, right-sided structures, and expanded cord with the proton plan. The mean oral cavity dose was also significantly lower. Dosimetric superiority of protons in the skull base region is largely due to the absence of dose deposition distal to the target, or “exit dose”. This phenomenon is explained by the distinctive Bragg Peak that protons have which allows for a rapid fall-off of the irradiation dose beyond the target. Contralateral structures were significantly spared with the proton plan. As previously established, proton beam therapy remains the therapy of choice for pediatric patients given their long term survival and concerns for secondary malignancy, as well as lower doses to most if not all normal structures of interest.
Long-Term Update of Proton Beam Re-Irradiation for Recurrent Head and Neck Cancer – Lee et al.
👉 Proton Therapy re-irradiation of the head and neck provides effective tumor control with acceptable acute and late toxicity profiles, likely secondary to the decreased dose to surrounding normal, albeit previously irradiated tissue.
Proton Therapy for Non-Skull Base Head and Neck Adenoid Cystic Carcinoma – Lee et al.
👉 Proton Therapy is a feasible option for ACC for the non-skull based head and neck in the definitive and postoperative setting, offering low rates of acute and late toxicities. Patients with metastatic disease also had acceptable outcomes and local treatment was well tolerated.
Improved Outcomes by proton beam radiation for nasal cavity and paranasal sinus malignances – Fan et al.
👉 Proton Therapy offers durable local control and survival in patients with nasal cavity and paranasal sinus malignancy. Even patients with recurrent tumor or with prior radiation history could achieve encouraging outcomes.
Chemosensory Outcomes in Nasopharyngeal Cancer Patients Treated with Proton Beam Therapy: A Prospective Longitudinal Study – Slater et al.
👉 with Proton Therapy the long-term chemosensory outcomes are preserved.
Proton Therapy for Nasopharyngeal Cancer: A Matched Case-control Study of Intensity-Modulated Proton Therapy and Intensity-Modulated Photon Therapy – Li et al.
👉 IMPT showed dosimetry advantages over IMRT and lower rates of acute toxicities while both had comparable treatment outcomes.
Outcomes following Proton Therapy for Squamous Cell Carcinoma of the Larynx – Ausat et al.
👉 Proton Therapy for SCC of the larynx demonstrates a high rate of overall survival, local-regional control, and disease-free survival with low toxicity profile.
Outcomes of Major Salivary Gland Tumors Treated with Proton Beam Radiation Therapy – Zakeri et al.
👉 rates of locoregional control were high and treatment was well tolerated.
Intensity Modulated Proton Therapy (IMPT) to the Parotid Gland: A Seven-Year Experience – Hanania et al.
👉 IMPT for treatment 724 of the parotid gland manifests in low rates of acute and chronic toxicity 725 while maintaining dosimetric coverage and high rates of biological control. 726 Skin V30 may predict for radiation dermatitis.
Redefine End-of-range RBE of Protons Based on Long-term Clinical Outcome – Zhan et al.
👉 RBE in brain is 1.18
Abstracts published in International Journal of Radiation Oncology • Biology • Physics, Volume 106, Issue 5, April 1, 2020
The beginning of the year has been pretty busy for the SAH Team, advocating around the world so all patients can get the right treatment at the right time.
In Muscat, the SAH team has been honored to meet with Dr Ahmed Mohammed Obaid Al Saidi , the Minister of Health of the Sultanate of Oman, with H.R.H. Princess Dina Mired of Jordan, President of the Union for International Cancer Control (UICC), and with Dr Wahid Al Kharusi, President of the Oman Cancer Association, (OCA) to prepare the 2020 World Cancer Congress.
The UICC is the largest cancer federation in the world, internationally recognized for its excellence.
UICC is the largest global organization solely dedicated to reducing the global cancer burden, promoting greater equity, and integrating cancer control into the world health and development agenda.
It is the only global cancer organisation in the world representing all cancer types and entire cancer spectrum, uniting a common voice for cancer in the international space through its formal relations with the World Health Organisation – WHO
UICC connects the most influential decision leaders in cancer control through its platforms, and addresses unmet needs and building the capacity of its 1000+ members in 170 countries.
UICC is holding its first-ever global Cancer Congress in the Middle East Region in Muscat Oman on October 20-22, 2020.
“The World Cancer Congress is an award-winning global conference organized by UICC, which encourages effective knowledge transfer, and best practices exchange amongst over 3,500 cancer control and public health experts from 130 countries.
It aims to strengthen the participants’ actions and impact on national, regional, and international scales through a multidisciplinary program that features the latest successful interventions in cancer prevention, diagnosis, treatment, and care.
It will be the first time that the Congress is held in our region. Under the theme ‘The way forward’, it aims to highlight the need for the region and other parts of the world to work towards reducing the burden of cancer.
The 2020 edition of the Congress is hosted by the Oman Cancer Association (OCA) and the National Oncology Centre, Royal Hospital Muscat. It will take place in the Oman Convention and Exhibition Center.
Stakeholders from the entire cancer control spectrum, health ministers, mayors, finance ministers, oncologists, representatives from NGOs, patient groups, universities, and the private sector will engage in debates and conversations about public health and cancer issues.”
HRH PRINCESS DINA MIRED
Very warm thanks to Dr Wahid Al Kharusi and his wife who organized a cordial barbecue to close the meetings session.
SAH, UICC and OCA share the same goal :
Together delivering better patient treatment and care for cancer
In 2020, SAH will keep advocating, explaining the benefits of Proton Therapy, and fighting to make sure that the patients who need the most that treatment can get it on time.
Last week, SAH has conducted patient follow-up clinics in Bahrain for patients previously treated in the US, and held a guest lecture about Proton Therapy at King Hamad University Hospital.
In 2011, SAH has signed an agreement with the Ministry of Health of the Kingdom of Bahrain to take patient who qualify for Proton Therapy to partner centers in the US for Cancer Treatment. For each patient, once the treatment plan has been discussed and validated by the local oncologists, by the Overseas Treatment Committee, and by the SAH Care Team, SAH Care organizes the travel and treatment at one partnering facilities. Twice a year, the SAH physicians come in the Middle-East & Africa region to see the patients they have treated with Proton Therapy in the US.
Dr Atman Pai has conducted last week those patient follow-up clinics in Bahrain.
Bahraini pediatric patients previously treated by SAH Care in the US have been seen at Salmaniya Medical Complex. Dr khulood and her team have outstandingly coordinated the consultations with our young patients.
Adult patients have been seen at King Hamad University Hospital with the remarkable Dr Hanadi Malik, Radiation Oncologist at KHUH.
SAH also held a lecture about Proton Therapy at King Hamad University Hospital presenting a practical approach to Proton Therapy.
Proton therapy has gained acceptance throughout the world, but it remains difficult to define which patients benefit the most of Proton Therapy.
Utilizing proton therapy is quickly becoming the best practice for pediatric radiation oncology services. Proton Therapy is a form a radiation therapy which aggressively treats the tumor while substantially reducing side effects that could impact the child’s development and quality of life. This advanced cancer therapy has been proven to protect vital organs, important tissues, nerves, and glands during treatment, while also decreasing the estimated risk of secondary malignancies.
Proton Therapy is also very beneficial for adult patients with cancer that occurs near vital organs. It can be precisely and narrowly targeted specifically on cancerous tumors and tissues, applying intense amounts of radiation only to the affected area. This advanced therapy is most commonly used for localized cancer and tumors that have not spread, or metastasized, to other distant parts of the body.
Proton Therapy is ideally suited as well to minimize toxicity to previously irradiated organs. It offers dosimetric advantages for normal tissue sparing and it provides effective tumor control with acceptable acute and late toxicity profiles because of the decreased dose to the surrounding normal, albeit previously irradiated, tissue. Proton beam therapy can be a safe and effective curative reirradiation strategy, with acceptable rates of toxicity and durable disease control.
In 2020, we’ll keep advocating, explaining the benefits of Proton Therapy, and fighting to make sure that the patients who need the most this treatment can get it on time.
We could tell you the story of Zahra, a 6-year old girl from Bahrain diagnosed with a medulloblastoma.
We could detail her pathology and the treatment plan agreed with her local medical team.
We could report the heartbreaking words from her family.
We could depict the efforts by the Ministry of Health and US Embassy Teams to have her traveling as soon as possible.
We could relate her journey to Hampton.
We could talk about the exams and procedures she underwent.
We could narrate how we’ve struggled to get her chemotherapy in short-supply.
We could elaborate on the benefits of Proton Therapy over other treatment modalities in her case.
But we can’t describe the love we share with our patients.
Zahra has elected Walter, our Anesthesia Nurse, as her new best friend. They’re walking together along the corridor to fetch Zahra’s anesthesia stretcher. They come from different countries, 50 years separate them, they don’t speak a common language, and yet they truly love each other.
SAH Global and neutron Therapeutics Inc (NTI) have entered into agreement to develop Boron Neutron Capture Therapy (BNCT).
BNCT is a powerful alternative to traditional radiotherapy and proton therapy, with the ability to deliver targeted radiation to cancer cells while sparing surrounding healthy tissue.
In BNCT treatment, a boron carrier compound injected into the blood stream is selectively absorbed by tumor cells. The tumor is irradiated with a therapeutic neutron beam. The neutron beam reacts with the boron, while safely passing through surrounding tissue. The boron reaction produces highly excited alpha particles of very short path lengths (5–9 µm) that destroy tumor cells from the inside with minimal effect on immediately surrounding tissue. BNCT has successfully been used to treat cancer patients in cases where other treatment options have been exhausted. Typical BNCT therapies utilize two patient treatments vs. dozens for traditional radiotherapy, reducing stress on patients while enhancing treatment center efficiency and patient throughput.
NTI’s unique and patented neutron source replaces the nuclear reactor in traditional BNCT research platforms. Engineered from the ground up for high reliability and ease of maintenance, NTI’s platform can enable the widespread adoption of BNCT.
SAH is committed to the development and introduction of state-of-the-art cancer treatment technology in the Middle-East, Africa, Latin America, and Asia.
Through this agreement, SAH and NTI will collaborate to secure FDA and CE marks, and to introduce BNCT as a treatment for cancer patients worldwide.
About SAH Global
Strategic Alliance Holdings Global, LLC (“SAH Global”), is a holding company founded in 2005 to establish highly specialized projects in areas such as healthcare. SAH Global has actively pioneered the effort to bring vital cancer treatment solutions to the Middle East. SAH Global believes in building a strong sustainable society, and as such, will leverage the success of its global ventures to make long-term contributions to the community, promote the growth of their employees, and help create a greener environment.
About SAH Care
SAH Care was established to ensure that patients from across the world can have access to the best treatments available. We work tirelessly with local physicians and a global network of leading healthcare providers to bring excellent quality cancer care to our patients. Our team, partners, and supporters share a commitment to improve the delivery of high-quality, patient-centric cancer care. Through travel medicine, we have found a way to provide access to advanced cancer care for those who live in areas where proton therapy centers are yet to be built. We believe that patients deserve to receive the most advanced cancer treatment in the world today despite geographic boundaries and limitations. The SAH Care team provides this compassionate, comprehensive care to patients wherever they live.
About NTI
Neutron Therapeutics is a Boston-area medical equipment company founded in 2015 by New Zealander, Bill Buckley. The mission of NTI is to provide innovative technology solutions that will enable BNCT to realize its maximum potential in the treatment of difficult cancers.
The Neutron Therapeutics neutron source is not approved for commercial or clinical use by the FDA or EMA or other regulatory body.
The dosimetric advantages of proton therapy—compared with photon therapy—have been clearly defined in many comparison studies involving various tumor sites. There are now accumulating clinical data demonstrating that this dosimetric advantage can lead to better outcomes such as reduced RT toxicity and improved treatment outcomes.
Pediatric Tumors
RT has an important role in treating pediatric tumors including central nervous system (CNS) tumors, extra-cranial sarcomas, neuroblastoma, and hematopoietic tumors. Long-term toxicities, including secondary malignancies, neurocognitive dysfunctions, growth and musculoskeletal problems, and cardiac problems, are major concerns in pediatric patients who undergo RT. There have been many efforts to reduce the RT dose and volume to avoid these RT-related toxicities.
Proton therapy is one of the best options to reduce unnecessary irradiation dose and volume in pediatric patients.
More than 30 pediatric tumor types were treated, mainly with curative intent: 48% were CNS, 25% extra-cranial sarcomas, 7% neuroblastoma, and 5% hematopoietic tumors
Head and Neck Tumors
Retrospective data have demonstrated better local control (LC) and overall survival (OS) with proton therapy than with photon therapy including IMRT and stereotactic body radiation therapy (SBRT).
Proton therapy has also demonstrated better survival rates in nasal cavity and paranasal sinus tumors.
In oropharyngeal cancers, proton therapy can reduce toxicity to normal tissues.
Proton therapy can also reduce toxicities in unilateral irradiation, such as in cases involving major salivary gland tumor and oral cavity cancers, because the exit dose of the proton beam is essentially negligible
CNS tumors
Cognitive impairment has been one of major concerns following RT for CNS tumors. Proton therapy has a potential benefit to reduce the irradiated dose to normal brain tissue to prevent cognitive dysfunction. In addition, a dose escalation could be possible in radioresistant brain tumors such as high-grade gliomas.
Gastrointestinal tumors
Proton therapy can spare the surrounding normal tissues when it is used to treat gastrointestinal tumors. In the management of hepatocellular carcinoma (HCC), it is very important to spare liver function. Because the liver is an organ with parallel functional subunit in the model of radiation response of normal tissues, liver toxicity is more sensitive to irradiated volume. Proton therapy has a major advantage in reducing the irradiated volume of remnant liver when irradiating the tumor. In many retrospective trials, proton therapy resulted in favorable outcomes.
Re-irradiation
Proton therapy has the advantage of irradiating the target while reducing the dose to the surrounding normal tissues; thus, it has a potential benefit in re-irradiation. Many retrospective studies investigating re-irradiation in various tumor sites have been reported.
Non-Small Cell Lung Cancer
Low-dose shower is a major risk for radiation pneumonitis (RP) when treating non-small cell lung cancer (NSCLC) with photon therapy. If the lateral beam placement is avoided to reduce the lung dose, the irradiated dose to heart is consequently increased and results in increased cardiac death in long-term follow-up. In many dosimetric studies, proton therapy demonstrated advantages in lung and heart dose compared with photon therapy. Several clinical studies have reported treatment outcomes and toxicities of proton therapy in early-stage disease, locally advanced disease, re-irradiation, and in postoperative settings
Indications for Proton Therapy
American Society for Radiation Oncology (ASTRO) has updated the recommendations for insurance coverage. The ASTRO recommendation is based on four selection criteria:
a decrease in dose inhomogeneity in a large treatment volume is required to avoid an excessive dose “hotspot” within the treated volume to lessen the risk for excessive early or late normal tissue toxicity;
the target volume is in close proximity to ≥1 critical structure(s), and a steep dose gradient outside the target must be achieved to avoid exceeding the tolerance dose to the critical structure(s);
a photon-based technique would increase the probability of clinically meaningful normal tissue toxicity by exceeding an integral dose-based metric associated with toxicity;
and, finally, the same or an immediately adjacent area has been previously irradiated, and the dose distribution in the patient must be carefully modelled to avoid exceeding the cumulative tolerance dose to nearby normal tissues.
Based on the above medical necessity requirements and published clinical data, group 1, which is recommended coverage is listed as follows:
ocular tumors, including intraocular melanomas;
skull base tumors, primary or metastatic tumors of the spine, where spinal cord tolerance may be exceeded with conventional treatment or where the spinal cord has previously been irradiated;
hepatocellular cancer;
pediatric tumors;
patients with genetic syndromes making total volume of radiation minimization crucial;
malignant and benign primary CNS tumors;
advanced and/or unresectable H&N cancers;
the paranasal sinuses and other accessory sinuses cancers;
a Areas in which the VMAT / IMRT plans will deliver more dose to organs at risk or the body compartment. b Areas in which the proton plan delivers more dose to organs at risk or the body compartment compared to the VMAT / IMRT plant
“Proton therapy for mediastinal lymphoma reduces significantly the dose to organs at risk and the integral body dose. It might lead to reduced late toxicities and secondary malignancies. This is especially important for children and young adults. It should be considered for both sexes, as both male and female patients benefit from the unique features of particle irradiation. Whenever proton for mediastinal lymphoma is not available or technical not feasible the alternative photon concepts have to be chosen carefully. Depending on the used technique certain organs at risk, i.e. the breasts in young females, can be spared with higher priority. However, with all photon techniques that comes at the cost of higher doses to the other organs at risk. If available, proton therapy should be the standard pattern of care for mediastinal lymphoma for young adults below 30 years of age, no matter if male or female.”
S. Lautenschlaeger, G. Iancu, V. Flatten, K. Baumann, M. Thiemer, C. Dumke, K. Zink, H. Hauswald, D. Vordermark, C. Mauz-Körholz, R. Engenhart-Cabillic & F. Eberle Radiation Oncology volume 14, Article number: 157 (2019)
Noah SMICK, COO of Neutron Therapeutics Inc., and Feroz AGAD, Chairman of SAH Global
August 9th, 2019 – Atlanta, Georgia U.S.A.
Feroz AGAD, Founder, Chairman and Chief Executive of SAH Global and SAH Care has been appointed to Neutron Therapeutics Inc. Board of Advisors.
Neutron Therapeutics Inc. (NTI) is a Medical Equipment Company founded in 2005 to bring Boron Neutron Capture Therapy (BNCT) out of the realm of medical research and transform it into a widely available first-line cancer therapy.
NTI has developed an accelerator-based, in-hospital neutron source composed of a 2.6 MeV electrostatic proton accelerator and a rotating, solid lithium target for generating neutrons. NTI will provide this neutron source as part of a comprehensive therapeutic treatment suite, that will combine all of the necessary components for BNCT treatment into a user-friendly package.
BNCT is a unique type of radiation therapy that enables targeting of cancer at the cellular level and treating cancer with a non-invasive two-step process. First, patients are injected with a tumor-seeking drug containing a non-radioactive isotope (boron-10) with a high neutron capture cross-section. In the second step, the patient is exposed to a beam of low energy neutrons, many of which are absorbed by the boron-10. The absorption initiates a reaction that emits short-range, high-energy charged particles. Which systematically destroy the tumor cells while imparting relatively little damage to adjacent areas of healthy tissue.
Feroz AGAD is an accomplished executive, investor and entrepreneur with over 15 years experience of managing multimillion-dollar corporations in industries including healthcare, real estate, communications, tourism and information technology. By capitalizing on his business acumen, technical expertise, interpersonal skills and strategic mindset, Mr. Agad has been instrumental in penetrating new markets and achieving significant sales growth for the companies he has previously founded and managed. Mr. Agad presently sits on the board of directors at four companies and sits on three advisory boards, a committee for a non-profit humanitarian organization and a committee on education.
He established SAH in 2004 with the vision of using the company as a catalyst to bring cutting edge Healthcare technology to the developing world. SAH Global is currently focused on establishing a global network of Proton Therapy Cancer Centers, while SAH Care is the medical treatment abroad division which currently brings cancer patients from around the world to SAH’s network of Cancer Centers for treatment in the USA.
In his overall reach in the fight against cancer, Feroz AGAD has particularly impacted the Industry of Proton Therapy and has demonstrated an exceptional spirit of Innovation to ensure patients from across the world have access to best treatment available. Feroz AGAD defines the future readiness of the Oncology organizations to not only meet the market demand, but to provide compassionate and comprehensive care to patients wherever they live.
With this appointment, NTI will use the experience of Feroz AGAD and of the SAH teams to develop its business, to get the regulatory approvals such as FDA and CE marks, and to conduct the necessary clinical studies to make BNCT available to more of the patients who could benefit from this exciting technique.
About SAH Global
Strategic Alliance Holdings Global, LLC (“SAH Global”), is a holding company founded in 2005 to establish highly specialized projects in areas such as healthcare. SAH Global has actively pioneered the effort to bring vital cancer treatment solutions to the Middle East. SAH Global believes in building a strong sustainable society, and as such, will leverage the success of its global ventures to make long-term contributions to the community, promote the growth of their employees, and help create a greener environment.
SAH Care was established to ensure that patients from across the world can have access to the best treatments available. We work tirelessly with local physicians and a global network of leading healthcare providers to bring excellent quality cancer care to our patients. Our team, partners, and supporters share a commitment to improve the delivery of high-quality, patient-centric cancer care. Through travel medicine, we have found a way to provide access to advanced cancer care for those who live in areas where proton therapy centers are yet to be built. We believe that patients deserve to receive the most advanced cancer treatment in the world today despite geographic boundaries and limitations. The SAH Care team provides this compassionate, comprehensive care to patients wherever they live.
Neutron Therapeutics is a Boston-area medical equipment company founded in 2015 by New Zealander, Bill Buckley. The mission of NTI is to provide innovative technology solutions that will enable BNCT to realize its maximum potential in the treatment of difficult cancers.
The Neutron Therapeutics neutron source is not approved for commercial or clinical use by the FDA or EMA or other regulatory body.
Our Patients Coordinators are our heroes. And when we thank them for the tremendous work they perform every day for our patients, they simply answer “You’re welcome !”.
They answer any single request about Proton Therapy and take care of our patients and their families.
They collect the full set of medical records which we need to analyse the situation correctly and advise rightly.
They coordinate the best treatment plan with our medical teams worldwide.
They manage the day to day operations for all patients traveling abroad for treatment, including coordination of proton therapy and other ancillary treatments.
Upon request, they can provide assistance with transportation, accommodation, translation, or any other tiny service that helps our patients feel comfortable so they can concentrate on getting better.
Once the treatment abroad is completed, they make sure our patients travel safely back home, and they ensure the follow-up plan defined by the medical staff is provided by local physicians with the high level of quality care all patients deserve.
We sincerely thank all our Patients Coordinators for treating each patient like family, and for placing them in our hands to get them safely to timely treatment.
“Once the decision is made for proton therapy, we usually send the patient to the overseas committee which will collaborate with SAH in the United States. The process is very, very simple, quick and easy. The patient, within one to two weeks of the decision making, will be sent abroad to the United States for the treatment. He or she will stay there and receive great care from the SAH team. Every patient who returns from treatment praises the team at SAH Care. From their departure from Bahrain to their arrival in the States and throughout the course of their treatment, patients praise the team. They talk about the good company they had, the good treatment they received, the perfect communication with the staff, the doctors, and the therapists – with everything. When we see patients who have fully recovered, cured from the cancer, we are more than excited. It’s a present for us. We don’t need anything else. The patient is happy.”
Dr Hanadi Malik, M.D., MSc.Radiation Oncologist, SMC, The Kingdom of Bahrain
You can read more patients stories and physicians’ testimonials on SAHcare.com
