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.
