Dr. Jonathan Yang offers hope through proton therapy for leptomeningeal disease
In this blog post hear from Dr. Jonathan Yang regarding proton therapy treatment for leptomeningeal disease, ease into the New Year with suggested resolutions from our social workers, and get to know Radiation Therapist, Kulani Chopra.
Dr. Jonathan Yang joined the Fred Hutchinson Cancer Center – Proton Therapy team in September 2022 after training and practicing at Memorial Sloan Kettering Cancer Center in New York City for 11 years. He will join Dr. Lia Halasz, Dr. Yolanda Tseng and Dr. Simon Lo as an expert in central nervous system tumors. In particular, Dr. Yang will start offering proton therapy for leptomeningeal disease (LMD), which is a form of cancer metastasis where tumor cells float freely in the cerebrospinal fluid that bathes the brain and spinal cord. In his November 2022 paper, Dr. Yang reported that LMD is clinically detected in five to 10 percent of patients with solid tumors but lung cancer and breast cancer are most associated with it. LMD is frequently underdiagnosed, and the incidence is rising, likely because of improved imaging techniques and systemic disease control.
“Options are limited for patients with LMD, and I found that I couldn’t do enough for these patients with conventional involved-field radiotherapy,” says Dr. Yang. “There had to be a better way.” Therefore Dr. Yang conducted two clinical trials that looked at proton therapy as a treatment option for LMD. The first was a Phase I trial that evaluated the safety of proton craniospinal irradiation for LMD. The second was a randomized, Phase II trial which compared treating the entire craniospinal axis with proton therapy versus treating only localized, symptomatic areas with photons/X-rays.
“The results were found to be so positive at interim analysis that the safety monitoring board stopped the trial early,” says Dr. Yang. The trial showed that patients treated with protons had better disease control and were living longer. “We hadn’t seen this before in this diagnosis. It was a huge step for our patients.”
Now, Dr. Yang is offering proton therapy to patients referred to the facility. His aim is to treat immediately upon diagnosis, rather than waiting until they develop symptoms. This will require some work on his part to inform the community of oncologists about the benefits of early treatment. “The sooner we start, the better,” explains Dr. Yang. “We want to prevent symptoms from setting in because once there’s a loss of function, it’s very difficult to restore.”
Besides treating LMD, brain and spinal tumors, Dr. Yang also uses protons to treat metastatic disease elsewhere in the body, such as oligometastases, which have been shown to benefit from radiation treatment. “Protons are a good option for these metastases because we can limit the amount of radiation that the body receives while delivering high dose to control the tumors,” he says.
Dr. Yang is enjoying the collaborative environment among his peers here in Seattle. And he’s happy to work with Dr. Apisarnthanarax (Dr. A) again. While Dr. Yang was a radiation therapist at UNC – Chapel Hill Radiation Oncology, Dr. A was a resident there.
He is still getting used to the differences between Seattle and New York City, the biggest one being transportation. In New York City, Dr. Yang never had to drive much. Now he commutes every day and it’s a tough hurdle, although he shares the commute with his husband, Mark, who’s a lawyer at Fred Hutchinson Cancer Center. He’s also getting used to having their two little girls, Avery (4) and Philippa (1), in preschool. “It’s been one cold after another, and I just want to get some sleep,” he confesses.
When he’s caught up on sleep, Dr. Yang, Mark and their girls like to get out into nature – which is so much easier to do here than in New York City. His extended family, who live in Taiwan, is also more willing to visit Seattle than the Big Apple, and they have plans to come next year.
Please join us in welcoming Dr. Yang to the team.
New Year’s resolutions to make your life easier
Don’t worry! We’re not going to overwhelm you with recommendations to eat healthy, exercise or quit drinking, although those are always good ideas for resolutions. Instead, for the new year, our social workers suggest you focus on ways to make things more manageable for yourself and to ease your life while you’re dealing with cancer.
Jourdan Cruz, MSc, MSW, LICSW, social work manager for Fred Hutch, recommends, “Be gentle with yourself. There are so many demands of daily life and trying to fit healing into them takes practice. Self-compassion and kindness are ways to start being less critical and to stop telling ourselves we should be able to handle it all alone. That’s why supportive care teams are available to our patients to help you learn these strategies”
Elizabeth Darlington, MSW, LICSW, our social worker for proton therapy, suggests what she calls “do it poorly.” It may sound strange, but she says, “It’s better to do something poorly than to not do it at all. In our society, we are taught to strive for perfection in everything that we do. Of course, for certain tasks, such as building bridges or performing surgery, striving for perfection is essential. However, for many everyday tasks, we remain in an ‘all or nothing’ mindset, thinking, ‘If I can’t do something perfectly, I won’t do it at all.’”
Darlington frequently sees that procrastinating on tasks that a person hopes, needs or wants to do — such as exercises, completing household tasks or emailing a friend — can lead to a decline in mood and an increase in feelings of distress.
“Go for a five-minute walk instead of 20 minutes. Do some stretching or yoga that feels good to you without worrying about how it looks or how long it takes,” says Darlington. “In social work, we often talk about behavioral activation, which is a mental health technique that has been shown to lift your mood. The idea is to strive to engage in behaviors that will ultimately make you feel better. Rather than waiting until you feel better to go for a walk, go for a walk first, and then you actually will feel better. Sometimes, once you start, you will bring more to the activity than you thought you would.” Keep in mind that we rarely regret going to the gym or going on a walk.
Our child life specialist, Erin Behen, MS, CCLS, adds, “Learn how to say no or simply ‘not right now.’” When dealing with requests and invitations from others, or whenever you feel overwhelmed, Behen recommends you “say yes only to what matters the most to you and try to not to worry about whatever you say no to.” Family and friends often do understand that you have limits.
Whatever resolutions you choose to make — or not — we wish you a year full of positive outcomes, happy times and health!
Meet Kulani Chopra, Radiation Therapist
Kulani Chopra is one of our newest radiation therapists. She joined the team in fall 2022 after getting her degree in radiation therapy and shadowing the staff at Fred Hutchinson Cancer Center – Proton Therapy for two days through her Oregon Health Sciences University program. “I just loved the way the team worked together, the environment at the facility, the patients and the location,” she says. As a radiation therapist, Chopra positions patients for treatment and delivers the prescribed proton radiation to the patient’s affected area. She greatly enjoys interacting with the patients and being part of their path to wellness.
Becoming a radiation therapist can take two to four years of school and clinical work, and our radiation therapy manager, John Bono, provides further training at the facility that is specific to proton therapy. Most programs do not offer special training in protons, so we make sure our staff is well versed in the differences between standard radiation and protons.
Before she became a radiation therapist, Chopra worked as a pharmacy technician. “I knew I wanted to be in the health field, I just didn’t know what,” says Chopra. “My twin, Dulani, knew she wanted to be a pharmacist, so I followed suit, but I decided it wasn’t for me. I needed more patient involvement and less routine. Working with patients here is a highlight for me.”
Chopra moved up from Oregon and just got married this summer to her husband, Ishaan. They recently added Leo — an Australian Doodle — to their new family. He’s only two months old and is keeping her busy. Dulani and the rest of her family live in Oregon. Because they are so close, she gets to see them at least once or twice a month.
Chopra loves to hike, travel, ride on horseback, ride ATVs and SCUBA dive (in Hawaii). She is also a big foodie and loves to try out different restaurants and types of food. So far, she has really liked Six Seven (a seafood restaurant at the Edgewater Hotel), Di Fiora (Asian Fusion), Nue (global street food), and Rasai (Indian).
Her family is from Sri Lanka, and though she hasn’t discovered any Sri Lankan restaurants in Seattle, she recommends kottu roti, a street food dish that is full of aromatic spices. Please welcome Chopra the next time you see her.
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