The Beam: New lung cancer research, meals while away from home, meet our new head-and-neck cancer expert

Dr. John Kang reviews new lung cancer studies from the ASTRO conference

Fred Hutch Cancer Center – Proton Therapy lung cancer specialist John Kang, MD, PhD, recently attended the American Society for Radiation Oncology (ASTRO) conference in Seattle. Scientific conferences like ASTRO help keep Kang and other Fred Hutch clinicians up to date on the latest developments in the field.

“My students presented research that examined outcomes of protons versus photons in lung cancer patients treated at our center between 2018 and 2024,” he said. “We found that both modalities had similar toxicities, but protons allowed us to treat tumors that were 25-30% larger in volume with similar outcomes.”

Scientists expect more toxicities and side effects with bulkier tumors, including pneumonitis and esophagitis as well as future cardiac events. Larger tumors are also generally considered more advanced and deadlier. Because more radiation is needed to target a larger tumor, there is greater potential for radiation to impact healthy tissue.

The nature of proton therapy, however, allows more precise targeting than X-ray radiation. As a result, it spares more of the surrounding healthy tissue as providers increase the dose to more effectively destroy cancer cells.

These findings, Kang said, are good news for patients with larger tumors, as are two other studies presented at ASTRO. One showed that by sparing at least one side of the esophagus from radiation in patients undergoing lung cancer treatment, physicians were able to significantly reduce side effects. The study looked at photon treatment, but Kang said it had positive implications for proton therapy as well.

The other study showed seven- to ten-year outcomes after radiation in healthy, early-stage lung cancer patients were similar to those of surgery-only patients.

“This study is important because there’s a misconception that radiation is inferior to surgery,” Kang said.

Radiation is frequently reserved for more advanced cases and much sicker patients. But this study showed that the seven-year survival rate for radiation patients was 81% compared to 70% for surgery in early-stage cancer.

“The margins of error of the two modalities overlap, meaning that outcomes are considered similar, not better,” he said.

Fred Hutch is the only facility in Washington and surrounding states offering proton therapy as a treatment option, which gives patients and providers more flexibility when considering treatments. 

Cooking without a kitchen: How to manage your meals when you’re far from home

By Laura Martinell, RD, CSO, CNSC, FAND

Many patients at Fred Hutch have to travel from afar — be it a two-hour drive or a flight across the country. However you’re traveling, it can impact your ability to eat on a normal schedule, eat the foods you prefer or find foods that meet your nutritional needs.

Hotels often have just a microwave and small refrigerator; many have no way to cook or prepare a meal at all.

During cancer treatments —including radiation — nutritional requirements are often higher than usual; when there’s no place to prepare or store food, it can be difficult to meet those nutritional requirements. And dining out can be complicated by cost, menu options and transportation limitations.

Here are a few tips that can help you with meals away from home:

• Stock up on non-refrigerated foods (see below for examples).
• Consider bringing pre-cooked meals from home if you are staying in temporary lodging.
• Check with your hotel about bringing a blender or slow cooker to allow for more options. 
• If staying in a hotel, bring a few utensils, a mixing bowl, a can opener, a cup or a mug.
• Take advantage of free hotel breakfasts if offered.   

What non-refrigerated items can I buy if I’m staying in a hotel without a kitchen?

• Instant oatmeal packets or breakfast cereal
• Nuts, trail mix or dried fruit
• Breads, bagels, English muffins, tortillas
• Nut butters
• Canned beans
• Canned meats (tuna, chicken, salmon)
• Canned fruits or vegetables
• Minute rice
• Instant mashed potatoes
• Shelf-stable milk or powdered milk
• Shelf-stable nutrition drinks/protein shakes

Tiny refrigerator? Try these small but mighty food options.

• Yogurt
• Cottage cheese
• String cheese
• Milk
• Eggs, pre-boiled eggs
• Pre-cooked meats (rotisserie chicken)
• Dips (guacamole, hummus)
• Fresh fruits and vegetables

What can I cook with a microwave?

Microwaves can do more than just heat up food. You can make an omelet, mac and cheese, steamed vegetables, quesadillas and even “bake” a potato. For more recipes and tips on preparing microwave meals, read this Fred Hutch Cancer Center handout.

What do I do if my long commute causes me to miss a meal?

Pack some snacks for the road. Good options include pre-made protein drinks, granola bars, trail mix or a peanut butter sandwich, but do make sure you follow any dietary guidelines your provider has established for you.

Sometimes treatment-related side effects can impact what you can or want to eat. Having no place to prepare meals compounds the problem. If you’re interested in more tips and suggestions, reach out to Fred Hutch’s schedulers or the front desk to make an appointment with a dietitian.

No-cook recipes from Fred Hutch’s Cook For Your Life:

Egg salad with basil and capers

Overnight oatmeal with fresh fruit

Yogurt parfait

Avocado chicken salad

Meet new head-and-neck cancer expert, Dr. Paul Riviere

Radiation oncologist Paul Riviere, MD, joined Fred Hutch in September. Riviere completed his residency at the University of California San Diego, treating patients both at the Moores Cancer Center and at the California Proton Center.

At Fred Hutch Cancer Center – Proton Therapy, Riviere will focus predominantly on treatment of head-and-neck cancers. Other clinical interests include palliative radiation to ease the symptoms of bone metastases and osteoarthritis, which he will treat at UW Medicine – Montlake.

There, he will also have access to the only neutron accelerator in the U.S. 

“I wanted a career that was both personally fulfilling with direct patient care and to be able to have a larger impact,” Riviere said. “I was first drawn to academic medicine. I had the vision of working at the interface between patient care and research.”

Early on in medical school, Riviere said he realized he wanted to become an oncologist. Patients have a lot of anxiety, he said, and the diagnosis carries a lot of emotional weight; Riviere wanted to be part of their care, to get to know patients and families and coach them through these difficult moments. 

He researches pain and symptom management, and spent a year studying opioids and cancer survivorship, clinical trial design and patient-centered research, ethics and epidemiology via a National Institutes of Health training grant.

“I had an inspirational mentor at UC San Diego,” Riviere said. “It’s partly why I went into radiation oncology. I saw how someone could have a fulfilling clinical practice as well as a robust research career. It really motivated me to go all-in on the many elements of being an academic medicine professional.”

Riviere’s family is originally from France, but he grew up mostly in San Diego, Calif. He said he’s looking forward to life in the Pacific Northwest, with its seasons and mild climate, as well as opportunities for sailing and skiing.

Please welcome Riviere when you see him at the proton therapy facility. 

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.