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A little over three years ago a small group of staff gathered on the treatment level of Winship Cancer Institute’s Emory Proton Therapy Center to press a button and summon an invisible beam of protons to treat their very first patients. “And now,” says Mark McDonald, MD, the center’s medical director, “to mark this calendar year, we have completed treatment for 2022 patients. We’ve pressed that button more than fifty thousand times!”
Wisconsin native and Dahlonega, Ga., resident Megan Smith became—most unexpectedly—the Emory Proton Therapy Center’s 2022nd patient.
Twenty-seven-year-old Smith was the picture of good health. She loved hiking, hanging with her rescue dog, running marathons and exploring the great outdoors. In August 2020, Smith and her boyfriend, now fiancé, Joe, left their friends and family in Wisconsin for Georgia, so Joe could take a new job as a paramedic.
They had no idea what awaited.
In February 2022, Wisconsin native and Dahlonega, Ga., resident Megan Smith became Winship Cancer Institute's 2022nd patient at the Emory Proton Therapy Center.
In February 2022, Wisconsin native and Dahlonega, Ga., resident Megan Smith became Winship Cancer Institute's 2022nd patient at the Emory Proton Therapy Center.
WHEN A HEADACHE ISN'T JUST A HEADACHE
In November 2021, Smith began to experience painful, persistent headaches. She didn’t chalk it up to anything serious right away. Until November 7, that is, when Smith experienced a headache she couldn’t ignore.
Joe’s paramedic instincts took over, and Smith was rushed to the hospital emergency room. “The doctors assumed I had a stress headache, but my fiancé insisted that they do a CT scan to ensure it wasn’t a tumor,” says Smith. “Afterward, the doctor came into the room and told us they found a lemon-sized tumor that needed to be removed immediately.”
She was released from the hospital, headache-free, three days after undergoing an awake craniotomy with speech mapping. The procedure begins with the patient deeply asleep under general anesthesia, on a breathing machine. Once the brain is exposed, sedation is lightened, the breathing tube removed, and the patient is able to talk and interact with the neuropsychologist. Patients feel little if any discomfort while awake. Speech mapping reduces the risk of damaging the brain’s speech areas. The tumor is removed once the speech mapping is complete.
Smith’s tumor was considered an Astrocytoma IDH-mutation WHO 4 brain tumor. With these tumors, there is no identifiable distinction between the tumor and normal brain tissue. They are typically treated with surgery and radiation or chemotherapy.
WHEN PROTON THERAPY MAKES SENSE
Treatment decisions are made on a case-by-case basis by a multidisciplinary team at Winship Cancer Institute of Emory University. For some patients, other radiation approaches—external beam radiation, stereotactic radiotherapy, gamma knife radiosurgery, and brachytherapy (in which radiation sources, like seeds, are placed in the body)—are still the best option.
“In Megan’s case,” says her Winship radiation oncologist Hui-Kuo Shu, MD, PhD, “we felt that the proton therapy could potentially reduce the dose—compared with X-ray therapy—to regions of the brain important for memory, which could lead to better neurocognitive function after treatment.”
Shu explains that proton therapy is particularly useful in sensitive areas of the body, such as the brain, because it is highly focused, irradiating less normal brain tissue and thereby reducing the risks of long-term effects such as developing another radiation-induced cancer. Guided by a plan that is personalized for each patient, the “pencil beam scanning” delivers small “spots” of radiation that match the target’s shape and adjust to the tumor’s depths and contours. Like X-ray radiation therapy, proton therapy is invisible and painless.
Radiation therapists prepare Smith for her proton treatment.
Radiation therapists prepare Smith for her proton treatment.
Smith received proton therapy for her brain tumor.
Smith received proton therapy for her brain tumor.
Did Smith’s proton therapy accomplish what it was meant to do? “We were able to successfully target the regions with residual, infiltrating tumor in the brain with the proton therapy,” says Shu. “We will only be able to tell that the therapy was effective by continued MRIs and follow-ups that show that the tumor remains under control.”
MARKING MILESTONES AND MOVING FORWARD
Megan Smith’s chemo and proton therapy treatments ran from December 20, 2021, through February 3, 2022.
After completing her treatment, Smith says, “I am looking forward to going hiking, playing disc golf, going for motorcycle rides with my fiancé and just enjoying life in general.”
Marking the milestone in February 2022 of Emory Proton Therapy Center’s 2022nd patient, McDonald said, “Every day our patients are having milestone moments in what is often a difficult journey. And every day we have the opportunity to do something amazing not just with this technology, but with our hearts, to show the compassion and care that I hope will continue to distinguish and define us in the years to come.”
Writer, John-Manuel Andriote; photographer, Stephen Nowland; designer, Stanis Kodman
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Winship Cancer Institute • Emory Proton Therapy Center • Winship Magazine • Emory News Center • Emory University
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