The Beam: Particle therapy conference comes to Seattle, Obliteride recap and meet Candice Day-Darby

Fred Hutchinson Cancer Center clinicians are excited to host PTCOG-NA in Seattle this fall

The Particle Therapy Co-Operative Group – North America annual conference is coming to Seattle October 28 - 30. PTCOG-NA is a non-profit organization for experts and thought-leaders in protons, neutrons and other charged-particle radiation therapy. At this conference, physicians from all over North America, as well as medical physicists, dosimetrists and other clinicians, will share their latest research on particle therapy. Many of Fred Hutch providers, staff and affiliated UW Medicine faculty will present on innovative new ways to improve patient care.

Smith Apisarnthanarax, MD (commonly known as “Dr. A” who you met in last month’s news) and his research team will present their findings regarding the safety and efficacy of proton therapy in liver cancer patients who have also been treated with Yttrium-90 radioembolization, a form of internally directed radiation where tiny glass or resin beads filled with the radioactive isotope Y-90 are placed inside the blood vessels that feed a tumor. Limited data exist on the safety of using external beam radiation therapy in livers that have previously received high doses of Y-90 radiation. They report that proton therapy is feasible in high-risk patients previously treated with Y-90 with excellent local control of the disease.

John Kang, MD, PhD will present his work on challenging cases using proton as well as neutron therapy. Challenging cases include patients whose tumor is not possible to be surgically removed – one example was of a patient with an adenoid cystic carcinoma of the trachea. They were referred for definitive neutron therapy, which our physicians believe is a better way to overcome radioresistant cancer cells (which are cells difficult to treat with low LET X-rays). A proton boost is often used in conjunction with neutron therapy to increase the dose to areas of tumors next to critical structures.

Ralph Ermoian, MD, who treats childhood cancer patients, and his team will present on the how the burden of caring for pediatric cancer patients receiving radiation therapy disproportionately falls on female parents and guardians.

Jatinder Saini, PhD, MBA, and the medical physics team at the proton center will be presenting multiple projects at PTCOG-NA. One project is related to ultra-high dose rate radiotherapy (UHDR-RT) and its potential to achieve the “FLASH effect:” decreasing normal organ side effects from radiation without sacrificing cancer control rates. This could potentially cure more patients of cancer and decrease the side effects of treatment. The physics team will present their commissioning work of a proton clinical beamline for UHDR-RT preclinical experiments. In addition, the physics and dosimetry teams will present their work on the quality and workflow improvements in ocular treatment with a dedicated eye model and eye fundus images.

Intensity Modulated Neutron Therapy (IMNT)

Clinicians at UW Medicine and Fred Hutch will present on innovative new treatments using the first hospital-based fast neutron treatment facility in North America. Since October 1984, more than 3,500 patients have benefited from high linear energy transfer (LET) neutron therapy. High LET neutrons, similar to high LET carbon ion therapy, have the ability to overcome resistance to most other forms of radiation therapy.

Graphic of IMNT — Representative example of a 5-field IMNT treatment targeting a head and neck cancer.

“Fast neutron therapy is most beneficial to patients with disease that has progressed or re-occurred after prior treatment with low LET radiation, which includes electrons, X-rays and protons. There is also some evidence in the literature that high LET neutrons may be more effective at stimulating anti-tumor immune responses than low LET radiations,” says UW Professor of Radiation Oncology and Medical Physicist Robert D. Stewart, PhD. He is also the lead medical physicist of the neutron therapy program at UW Medicine.

In October of 2022, UW Medicine clinicians introduced a major advance in our ability to treat patients with high LET fast neutron therapy. This advance is called intensity modulated neutron therapy (IMNT), and it greatly reduces the dose to healthy tissue with the same or improved targeting of dose to diseased tissue.

As illustrated in the image above, neutron beams are targeted at diseased tissue from multiple directions. For each one, the radiation beam is shaped using a multi-leaf collimator (MLC) to reduce the dose to nearby healthy tissue.

“Our institution is the first and only in the world to be able to offer this unique patient care option in situations where low LET radiation therapies are less or no longer effective. The only comparable treatment is high LET carbon-ion therapy, which is not available anywhere within North America. Over the past 10 months, we have treated more than 30 patients with the expectation (based on dosimetry) of improved local tumor control and few or no unexpected (early) side-effects. Longer-term patient follow-up and clinical trials are ongoing,” says Stewart.

Several of our experts will present at PTCOG-NA on other most recent developments in neutron therapy, including a study headed by our medical director, Jing Zeng, MD on neutrons for urothelial carcinoma. Fred Hutch’s first medical director for proton therapy, George Laramore, MD PhD, FACR, FASTRO, will speak about the clinical use of high LET radiation, including fast neutron radiotherapy, boron neutron capture therapy (BNCT) and carbon ion radiotherapy. In addition, head and neck specialists, Upendra Parvathaneni, MD, FRANZCR, Neil Panjwani, MD and Jay Liao, MD, and their team will also present on early toxicity outcomes from IMNT for head and neck cancers.

Facility tours at PTCOG-NA

Attendees of the PTCOG-NA conference will have the chance to tour our proton therapy center, which will include tours of the cyclotron as well as a reception. Led by professor Marco Schwarz, PhD, the tour will highlight the facility’s research on ultra-high-dose (FLASH) proton therapy. A separate tour of the Clinical Neutron Therapy System (CNTS) at UW Medical Center - Montlake will be offered by acting cyclotron director Marissa Krantz and Professor Rob Stewart. This facility also has an active program to produce radioisotopes for targeted radiation therapy with 211At (Astatine-211) and to test the use of electronics in high earth orbit and space.

To learn more about PTCOG-NA, view here.

Staff and providers reflect on Obliteride

You may have heard of Obliteride—a summer bike ride and 5K walk/run that empowers people to help cure cancer faster by raising funds for Fred Hutch. This was its 11^th year and 100% of participant-raised dollars go to work at Fred Hutch, advancing cancer prevention, detection, treatment and cures.

Dr. Gillespie before the 50-mile bike ride.

“The science that happens at Fred Hutch is critical for our ability to come up with new cures,” says Thomas J. Lynch Jr., MD, Fred Hutch president and director and holder of the Raisbeck Endowed Chair. “Obliteride provides funding for that science, but most importantly, it provides a community of people who are dedicated to putting cancer behind us.”

“Every dollar donated, every drop of sweat, and every high-five adds up to something big: A powerful community united to obliterate cancer,” says the Obliteride website. At Fred Hutchinson Cancer Center – Proton Therapy, our team members also participated. Some ran or walked, others biked. But all wanted to be part of the cure.

“I participated in Obliteride to raise awareness about cancer,” says Jen Flannery, PA-C, who works with our proton therapy prostate cancer patients. “I did it because our communities need folks who can put their busy little hamster wheels on pause, think of the greater good, and find a way to do their bit to keep us all moving in the right direction. Also, there was a ton of great energy at this event, you have to experience it.”

Joe Riggs, vice president of radiation oncology at Fred Hutch, agrees: "I participated in the Obliteride fundraiser because I am not only supporting groundbreaking cancer research but also standing in solidarity with those affected by the disease." He continues:

"Each step I took during the Obliteride 5K reminded me of our progress towards a brighter future – where cancer is obliterated. I am honored to play a part in this quest for a healthier tomorrow."

Dr. Rengan and Joe Riggs — Riggs, right, poses with Ramesh Rengan, MD, PhD at the 5K run.

Erin Gillespie, MD, MPH, who works with breast cancer patients at the proton therapy facility, touts the community aspect of Obliteride: “This was a great opportunity to build and connect the community at Fred Hutch through collective commitment to cancer advocacy, research funding, and the health and wellbeing of our workforce in order to optimally serve our patients. I am relatively new to Fred Hutch but excited to have found this event and a team eager to share the experience.”

Dr. Gillespie and medicial physicists — Gillespie, center, rode the 50-mile bike ride with members of the medical physics team.

“It also helps to get into better shape,” quips John Kang, MD, PhD, who sees patients with thoracic cancers. “But becoming more connected with the Fred Hutch community was also one of my big reasons for participating.”

“It was great seeing my colleagues from different sites in a casual setting, including Ian and Dan from the proton therapy facility,” he adds. “And I appreciated the volunteers cheering us on from the sidelines.”

Dr. Kang and group walking — Dr. Kang did the 3K walk with some colleagues.

Meet patient care coordinator lead, Candice Day-Darby

Candice Day-Darby is our patient care coordinator lead for the Patient Access Department at the proton therapy facility. “Our team does all the scheduling, patient registration, finance and medical records, so there is always something to do at all times of the day,” says Day-Darby. “We’re the first people our patients encounter for proton therapy treatment.” As lead, she also does a lot of projects to support the staff, including creating better workflows or building resources to help the team.

“I love being able to help others,” says Day-Darby, “and to work with both patients and my team. I look for a connection in most aspects of my life, so I am grateful to have a position where I can interact with so many.”

Candice and her mom, Sharon, who also worked at the proton therapy facility.

Day-Darby comes from a Seattle-area family of 10, and she is right in the middle. Her mother, Sharon Day, worked for the proton therapy facility as a financial coordinator in the past, so you could say she even has a family connection to this place! Her family does a lot of activities together and every year they head to the Oregon sand dunes to do some camping and ATVing for a week.

“I enjoy being with people, creating memories with them, especially the people I love. It’s what makes me most happy,” says Day-Darby.

She is also a big Disney fan and tries to make it to the Enchanted Kingdom every year. She’s such a long-time fan that she even interned for Disney through the Disney College Program.

Candice as a Disney intern. — Candice shows off her intern badge at Disney World.

“That was probably the best professional growth experience I’ve had in my life because I learned an immense amount about the corporate world, but also about myself and what kind of employee I want to be,” says Day-Darby. “It opened this door into a space of wanting to enact change for the betterment of employees. Without the amazing people like the ones on my team, there would be no companies.”

Day-Darby didn’t see herself working in health care, but when she returned from Florida to Washington at the beginning of the COVID-19 pandemic, a former manager at the proton therapy facility reached out and asked her to apply for a patient navigator role. She didn’t know much about proton therapy, but was eager to learn, and when interviewing with the team she knew she wanted to be part of it.

“My supervisor, Cassidy, has given me the space to grow and learn and has fostered my need to push myself professionally, so I am very grateful to have this place as my work family,” she says.

In her free time, Day-Darby spends time with her two cats, Jasper and Bug, reads, attends concerts (like the recent Taylor Swift one!), and roller skates — something she started during COVID-19.

Please say “hi” the next time you see Day-Darby, and gush about Taylor Swift or Disney together!