How did you come to practice radiation oncology?
I was introduced to radiation oncology after my first year of medical school, and the field immediately appealed to me. I loved the personal patient interactions and found the privilege of caring for cancer patients to be tremendously rewarding. Radiation Oncology, in particular, is a unique field that combines patient-focused multi-disciplinary care with state-of-the-art technology.
How did you learn about proton therapy?
I was fortunate to complete my Radiation Oncology residency at Emory University in Atlanta, which commissioned a new, multi-room proton therapy center during my training. This allowed me to gain invaluable clinical experience using proton therapy that I was able to later bring to my position here at the New York Proton Center.
Tell us more about what it’s like working at the New York Proton Center.
I started at NYPC shortly after the center opened in 2019. It’s been a special and transformative process to be a part of a center like this from the beginning. NYPC is a unique endeavor combining the latest cutting-edge proton therapy technology within a novel academic consortium of three major healthcare systems.
We care for amazing patients from the tri-state area and around the world. We see complex and challenging scenarios, often when patients have limited alternative treatment options. We work with our patients and multi-disciplinary teams to come up with the best plan of care possible. It is really rewarding to help people in what is oftentimes the most difficult circumstances they will face in their lifetime.
It is also the staff that makes NYPC so remarkable. We have a fantastic team made up of people who are positive, hardworking and experienced, and it really shows in the quality of care they provide to our patients. It’s always a pleasure to work with this team every day.
What causes head and neck cancer?
Head and neck cancers cover a wide range of diseases with varying causes. The most classic risk factors for head and neck cancers are cigarette smoking and excessive alcohol use.
There are also head and neck cancers associated with the human papillomavirus (HPV). These cancers most commonly involve the tonsil or base of tongue and generally affect younger patients and non-smokers. HPV-related cancers are increasing in incidence, whereas the rate of tumors related to smoking is declining.
The Epstein-Barr Virus (EBV) is another type of cancer-inducing virus that is related to cancers of the back part of the nasal cavity called the nasopharynx. These cancers are most common in endemic areas in South and Southeast Asia, although we still see them in North America.
What is the role of proton therapy in treating head and neck cancers?
The use of proton therapy has some major advantages when treating cancers in the head and neck region. Head and neck anatomy is complex, and the normal tissues near the tumor are sensitive to the effects of radiation. This means that traditional X-ray radiation therapy for head and neck cancers can be quite toxic for patients.
Minimizing the acute and late toxicities of treatment is an important goal that all physicians desire for their patients. With proton therapy, we’re able to eliminate the unnecessary exit dose behind the tumor compared to traditional X-ray radiation, sparing more of the normal tissues. There’s growing evidence that this can make a big difference in patient outcomes and minimize the side effects of treatment. We’re not just trying to treat the tumor; we’re trying to cure the patient and help them experience the best quality of life possible during and after treatment. Proton therapy can most effectively achieve this and is changing the way we think about these types of tumors and how we make our treatment recommendations.
How long has proton therapy been used to treat head and neck cancers?
Proton therapy has been used to treat these types of tumors for decades, ever since the FDA approved it for cancer treatment in 1988. However, proton therapy technology has evolved over time. The New York Proton Center uses the most modern pencil beam scanning proton therapy, which can shape and modulate the radiation dose with extreme precision. This allows the maximal sparing of normal healthy tissue, such as the oral cavity, salivary glands, swallowing muscles, and the jaw.
What are the differences in acute and long-term health with proton therapy versus traditional radiation treatment?
Proton therapy is different from X-ray radiation in that it can eliminate the unnecessary “exit dose” beyond the tumor. This minimizes the total dose around the head and neck region. Studies comparing the two modalities report proton therapy significantly reduces the irritation in the mouth during treatment, resulting in fewer severe mouth and swallowing toxicities, less reliance on narcotic pain medications, and less frequent placement of temporary feeding tubes. Patient-reported outcomes show improvements in metrics like overall well-being, swallowing function, and dry mouth.
In addition, a recent study from MD Anderson Cancer Center found that patients were more likely to return to work if treated with proton therapy instead of traditional radiation. This has implications not only on a patient’s quality of life, but also their financial health and ability to minimize time away from normalcy and productivity. More studies are ongoing, and it will take time for us to fully appreciate all of the long-term benefits, but we’re learning more each day, which is exciting for the future of proton therapy.
What makes the New York Proton Center special?
We have a fantastic multi-disciplinary team here that integrates three leading academic healthcare systems. We also have patient and nurse navigators, nutritionists, and social workers who are available to work with and counsel our patients throughout the entire treatment process. Head and neck radiation treatments can be uniquely challenging for patients. Every bit of support we can provide is essential to help patients be cared for and thrive.
Our staff is dedicated to reducing the side effects of treatment and the risk of chronic issues afterwards. Long-term quality of life is an integral part of our care philosophy at NYPC.
Dr. Robert (Bob) Press is a radiation oncologist at the New York Proton Center and an Assistant Professor of Radiation Oncology at Mount Sinai Hospital. He specializes in the use of proton therapy for the treatment of head and neck cancers and central nervous system tumors. Dr. Press is the author of more than 50 peer-reviewed publications and has presented his research on the benefits of proton therapy at numerous international conferences.