The Beam: PBS for ocular cancers; prostate cancer support group; meet Brooke Wolford

Proton Therapy launches ‘pencil beam scanning’ for ocular melanoma patients

In early February, Fred Hutch began treating patients with ocular melanoma who've been recommended for proton therapy with a sophisticated new technique known as “pencil beam scanning” or PBS. 

Medical physicists, dosimetrists and radiation therapists conducted extensive research on this advanced form of proton therapy, developing and testing the system and training staff on therapy delivery.

As a result, the first pencil beam treatment went seamlessly, free of any complications.

“PBS is the most advanced form of proton therapy, allowing us to manipulate proton dose distributions through advanced algorithms,” said Jatinder Saini, PhD, MBA, clinical professor and lead medical physicist who managed the process for testing and implementing PBS for ocular melanoma at Fred Hutch. “One of the key advantages of using PBS for ocular treatments is the remarkable reduction in treatment time. While uniform scanning treatment delivery may require seven to 10 minutes per patient, PBS treatments can be completed in 30 to 60 seconds. This efficiency is crucial for enhancing patient comfort, as it minimizes the need for the patient to gaze at a specific point for long periods.”

In addition, PBS has other significant benefits, including sharper dose fall-off, which enables physicians to minimize radiation exposure to healthy critical organs around the eye.

Using the Monte Carlo algorithm for treatment planning, the care team can calculate highly accurate doses. Though treatment set-up remains the same, with patients sitting in a special chair and wearing a mask, most changes to treatment happen behind the scenes.

“Due to their small size, ocular tumors require extremely narrow proton beams for effective treatment,” Saini said. “In uniform scanning, we begin with a large beam and then narrow it down using apertures to target the small lesions, which is inefficient. With PBS, we can generate small fields from the outset, eliminating the need for beam cropping, except to sharpen the beam edges."

According to Saini, this method is more efficient and leads directly to shorter treatment times. PBS also allows spot-by-spot delivery, he said, ensuring conformity to the treated area and minimizing radiation exposure to healthy tissues.

The Ocular PBS Program at Fred Hutch has integrated numerous state-of-the-art technologies, including Monte Carlo dose calculations, beam-shaping apertures and inverse planning. While some clinics may have adopted individual components of these technologies, Fred Hutch is the first in the U.S. to incorporate all of them to overcome the additional challenges of treating small targets for ocular treatments.

All patients receiving proton therapy for ocular melanoma will be treated with PBS from now on.

Questions? Please email info.proton@fredhutch.org for more information.

The Proton Prostate Cancer Support Group: Why it might be right for you!

The Fred Hutch proton therapy facility offers a virtual monthly prostate cancer support group. The meetings are held the fourth Wednesday of the month from 5:30 – 7:00 p.m. and are professionally facilitated and led by Cancer Lifeline, a community-based non-profit that offers educational, emotional and financial services to individuals and families experiencing cancer.

Senior Program Manager Basha Brownstein, a Cancer Lifeline staff member for 26 years, is the current support group facilitator and planner.

Meetings usually feature a one-hour presentation, followed by an open-ended discussion where participants can exchange experiences, concerns and thoughts. The goal is to meet the needs of patients, survivors, caregivers and family members during the ongoing upheaval of diagnosis, treatment and recovery.

“This is a very welcoming and easy-going group,” said Brownstein. “Everyone is invited, but no one is pressured to speak about their experiences. We usually have a good mix of long-timers and folks new to the group. I see a real dedication to support each other amongst the men. The value of community support in dealing with cancer is huge.”

“During a time of great stress and uncertainty, our group often provides a more personal and approachable face to the sometimes-technical information offered by the medical professionals, and in this way helps to reduce some of the anxiety associated with treatment and follow-up,” said Ron, a group participant.

Presentations cover a variety of topics, including how to incorporate healthy eating habits into your diet, the importance of exercise during and after treatment and how to mitigate the side effects of ADT, or androgen deprivation therapy, commonly used in prostate cancer. 

Brownstein frequently collaborates with advanced practice provider Jen Flannery, who leads the Prostate Cancer Survivorship Program at the proton therapy facility, to find experts to present topic to the group.

Brownstein said all are welcome to attend both the presentation and discussion or choose whatever segment is of interest to them. Meetings are designed for current proton patients, patients who have finished their therapy regimen, and those who are considering proton therapy to treat their prostate cancer. Caregivers are also welcome.

According to Brownstein, the group is non-judgmental and it offers a great sense of camaraderie. Participants can find a sense of community and inclusion that can help them regain a sense of control that cancer often erodes.

The support group was established years ago and prior to COVID-19, met in person. Although the meetings are now virtual, participants continue to feel supported.

“This group, led by Basha, has been very valuable to me throughout my treatment and tracking due to the topics she has coordinated,” said Ben, another participant. “It’s great to have an opportunity to relate to other men on a similar cancer journey. My wife and I realize that we are not alone.”

Brownstein said switching to a virtual platform has actually increased access.

“While we all miss in-person meetings, there is a benefit to virtual meetings,” she said. “Patients can attend from afar or when they are not feeling well enough to travel, or don’t have someone to drive them. It’s reducing barriers to participation, and we hope even more folks will join.”

Questions about the proton therapy support group? Please email Brownstein at bbrownstein@cancerlifeline.org. For other free support groups, educational programs and services, check out Cancer Lifeline’s website or go to Fred Hutch's Cancer Support Group page.

Proton therapy patients can also join a meditation group which meets on the third Friday of each month. The group offers different meditation strategies as well as a dedicated time to decompress. To join the prostate cancer support group or the meditation list, please email us. 

Meet Brooke Wolford, child life specialist

Brooke Wolford joined the proton therapy facility at Fred Hutch recently as our new child life specialist. In this role, Wolford is trained in how to help children and their families navigate difficult medical situations such as a cancer diagnosis. 

“I provide psychosocial support to the kids that come for treatment,” explained Wolford. “This involves things like prepping them for a procedure like a port access, proton therapy treatment and CT simulation, which all can be scary for kids. I engage our pediatric patients with developmentally appropriate activities that support their positive development, such as medical play to familiarize them with their environment and equipment here. Finally, I also support the entire family and advocate for the patient’s best interest.” 

The youngest of five siblings, Wolford grew up in the San Francisco Bay area. She attended Azusa Pacific University and graduated with a Master of Science degree in Child Life. After graduation, she interned at the Pediatric Burn Center in San Diego and worked in the ER and trauma center at a Tucson, Arizona, hospital.

“My mom is my inspiration for this career,” said Wolford. “She went to nursing school as a single mother and worked very hard to get to where she is today. I like to think that my interest in medicine sparked as a child when she brought me with her to her college courses. Her professors would give me anatomy coloring pages to keep me busy during class.”

Wolford loves that she can be a source of support and comfort to the families that bring their children to the proton therapy facility, and that she gets to share such a vulnerable space with each patient, hopefully making it easier.

In her spare time, she’s a personal trainer at two wellness studios. Wolford also enjoys reading psychological thrillers, doing arts and crafts and going on walks with friends.

“Being with people makes me happiest,” she said. “I love spending time with family and friends, being immersed in different communities around Seattle and meeting new people.” 

Subscribe to our monthly proton therapy newsletter

Get once-a-month updates about proton therapy, including science and medicine news, survivor stories, staff profiles and more.