Proton therapy in nasopharyngeal cancer

Experts from CancerFax can assist patients to directly consult with experts in major proton centers to determine the suitability of patients for proton therapy. At the same time, they can assist patients to assess their condition and choose other treatment options such as surgery, chemotherapy, immunotherapy, and biological cell therapy.

Professor Bachtiary, the chief doctor of the German RPTC (Munich Proton Center) once emphasized in our interview that there are three types of tumors that should be given priority to proton radiotherapy. The first is nasopharyngeal carcinoma. I believe that protons can achieve curative effects.

XKmed (with Kang Changrong) has selected a number of medical cases with reference value among the large number of cases of nasopharyngeal cancer treated by protons abroad, and sorted them out for patients and medical professionals.

Basic condition:

Disease: Nasopharyngeal cancer (relapse)

Sex: Male

Age: 52 years old

Release time: May 2012

First place: right nasopharynx

Tumor spread: the right posterior wall of the nasopharyngeal cavity, invading the right long muscle, skull base, cavernous sinus

 

Medical history and treatment:

Two years after the end of treatment in 2014, Mr. H suddenly felt diplopia in his upper right eye and numbness in his right upper lip. He was reexamined at the West China Hospital of Sichuan University and performed an enhanced MRI scan of the nasopharynx and neck, showing nasopharynx The cancer recurs, involving the skull base upwards.

Because of the large amount of radiation therapy done before and the involvement of the skull base, it is difficult for domestic conventional treatment to be effective anymore. Mr. H. desperate began to look for international treatment methods.

He discovered a very  advanced method of treating cancer through the Internet-proton therapy. Therefore, Mr. H found Chang Kang Evergreen, an overseas medical institution specializing in proton therapy, and conducted a preliminary pathological diagnosis. He believed that H was very suitable for proton therapy.

Proton therapy was soon started in September 2014, and now Mr. H’s  nasopharyngeal lesions have shrunk, and follow-up examinations have shown very good treatment results.

Pathological results:

Nonkeratotic squamous cell carcinoma

Immunohistochemistry:

PCK (-), P63 (+), S-100 about 25% (+); in situ hybridization: EBER nuclei (+)

Medical history and treatment:

May 18, 2012-July 5, 2012

33 times of nasopharyngeal and neck radiotherapy: 69.96Gy / 2.12Gy / 33F

High-risk plan target area: 59.4Gy / 1.80Gy / 33F

Low-risk plan target area: 56.10Gy

Simultaneous chemotherapy: 2 courses of carboplatin 150mg, 3 courses of cetuximab. Erbitux 600 mg, 400 mg, and 400 mg were given on May 23, May 29, and June 5, respectively.

July 23, 2012-July 27, 2012

Supplementary radiotherapy for residual lymph nodes after 5 times of pharynx: 10Gy / 5F

At the beginning of July 2014, he felt discomfort in his upper right double vision, numbness of his right upper lip, no headache, and no neck mass. MRI enhanced scan, nasopharyngeal carcinoma recurred, involving the skull base upwards, and no enlarged lymph nodes were seen in the neck.

Proton Center in Munich, Germany:

September 23, 2014 PET-CT

The right nasopharyngeal carcinoma recurred, the tumor infiltrated the temporal bone and skull base, and developed toward the central temporal lobe in the brain, compressing the carotid artery and the right optic nerve, and the right mastoid effusion.

GTV: tumor volume after PET-CT chemotherapy

CTV: GTV1 + initial tumor spread

PTV: CTV1 + 3mm safety distance

October 2-October 31, 2014

Proton radiotherapy dose: PTV, 40 * 1.50Gy (RBE), twice daily, 6 hours apart, total dose: 60.00Gy.

At the same time, weekly use of platinum-cis-chemotherapy.

Tolerance during proton therapy:

Diplopia, decreased hearing on the right side, and numbness in the right upper lip worsened. 1 degree radial erythema and radiation mucositis appeared on the upper right cheek, and osteonecrosis appeared on the right side of the hard palate. Simultaneous chemotherapy was well tolerated, and only some gastrointestinal reactions occurred.

Tracking and comparison of inspection results (images) before and after treatment:

February 5, 2015: Mucositis and radiotherapy erythema completely resolved.

The first review after proton therapy:

Compared with the MRI enhanced scan on January 28, 2015 compared with August 1, 2014, the tumor volume of the right nasopharyngeal wall was reduced, and there was no significant change in the rest. There was no  lymphadenopathy between the fascias of the neck, right otitis media, and sphenoid sinusitis.

The first review after proton therapy, January 28, 2015 MRI enhanced scan showed: the size of the nasopharyngeal carcinoma tumor was slightly reduced without further development or metastasis

 Patient story:

Mr. H is a doctor in a hospital in Chengdu. As a doctoral tutor, he has a superb academic academic background, a successful career, and a happy family. It is an enviable template for a happy life. However, things are unpredictable. In May 2012, I suddenly felt unwell on the right side of the nose and enlarged lymph nodes in the upper neck. I went to the outpatient clinic of West China Hospital of Sichuan University for a nasopharyngoscopy. The results showed that the tissue of the right pharyngeal crypt was bulged, the blood vessels were dilated, and some pseudomembranes were easily touched to bleed. It was considered as nasopharyngeal carcinoma. The biopsy pathology report was confirmed to be: (right pharyngeal crypt) non-keratotic squamous cell carcinoma. Immune phenotype: PCK (-), P63 (+), S-100 about 25% (+); in situ hybridization: EBER nuclei (+). MRI and whole-body Pet-CT were diagnosed as nasopharyngeal carcinoma with metastasis to deep cervical lymph nodes (T2N1M0).

 After admission, 33 image-guided intensity-modulated radiation treatments were performed, followed by two cycles of radiotherapy and chemotherapy, and three cycles of targeted therapy. Later, due to severe reactions of the oropharyngeal mucosa and systemic discomfort, synchronous chemotherapy and targeted therapy were stopped. After the treatment, the MRI of the nasopharynx was performed again, and the lesion was reduced. However, there were residual lymph nodes in the posterior pharynx and the lymph nodes in the right neck area IIb. It was decided to give local push treatment of parapharyngeal lesions at a dose of 1000 cGy / 5f. Review regularly after discharge.

 Two years after the end of treatment, Mr. H suddenly felt double vision in his upper right eye and numbness in his right upper lip. He was reexamined at the West China Hospital of Sichuan University. He underwent an enhanced MRI scan of the nasopharynx and neck, showing the recurrence of nasopharyngeal cancer , Involving the skull base upwards.

 Mr. H’s follow-up treatment report

Because of the large amount of radiation therapy done before and the involvement of the skull base, it is difficult for domestic conventional treatment to be effective anymore. Mr. H. desperate began to look for international treatment methods.

 Mr. H is a well-known doctoral tutor, Tao Li Man Tianxia, ​​and his students also help to find treatment techniques all over the world. One of the students was in Beijing, and he discovered a very advanced cancer treatment method, proton therapy, through the Internet. Therefore, Mr. H found Chang Kang Evergreen, an overseas medical institution specializing in proton therapy, and conducted a preliminary pathological diagnosis. He believed that H was very suitable for proton therapy.

After comparison and understanding, Mr. H decided to choose the RPTC Proton Center in Munich, Germany with advanced technology and high cost performance for treatment. Before leaving, I communicate with the responsible staff every day, including the dose of radiation, the hospital’s recommendations, and the clothing, food, housing, and transportation after arriving in Germany.

 In September 2014, Mr. H arrived in Germany. Accompanied by local staff, he first familiarized himself with the surrounding environment, happily shopping, enjoying food, and conducting a preliminary medical examination. Mr. H’s despair and anxiety gradually settled down. He said: “I have a feeling of seeing light in the dark.” After three days of physical examination, one week later, the precision fixed mold was completed and Mr. H’s proton therapy journey began.

Due to the complexity of Mr. H ’s condition, a part of the tumor has eroded the optic nerve of the right eye. The German hospital has formulated a detailed irradiation plan, a total of 40 irradiations, five times a week. After receiving several proton treatments, doctors at the German Proton Center gave advice if they could be combined with chemotherapy to achieve better results. So Mr. H arranged a hospital specializing in chemotherapy at the Proton Center. With professional medical equipment and intimate treatment, Mr. H felt very comfortable.

After the treatment, Mr. H and his wife had a tour around Munich and had a happy party with German friends. Two months later, Mr. H departed from Germany and returned home. Now he lives healthy and happy.

For details on proton therapy treatment treatment and second opinion, do call us at +91 96 1588 1588 or write to cancerfax@gmail.com.

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