July 14, 2025 • 30 mins
Community DC Host Dennis Glasgow speaks with Dr. Reed McDonagh, a radiation oncology physician, Dr. McDonagh treats various cancers. His primary focus is on treating gynecological cancers (cancer that begins in a woman’s reproductive organs). He also treats breast and blood cancers.The discussion includes a wide variety of topics including; what is Proton Therapy, what MPTC does and offers, types of treatable cancers with Proton Therapy and much more over the 30 mins...
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Episode Transcript
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Speaker 1 (00:08):
Good morning, and welcome to another edition of Community d C.
I'm your host Dennis Glascow. This morning, we get an
opportunity to talk about cancer and proton therapy with doctor
Reed McDonough, a radiation oncology physician of the Maryland Proton
Treatment Center in Baltimore.
Speaker 2 (00:23):
Now.
Speaker 1 (00:23):
Doctor macdonna treats various cancers. His primary focus is on
treating gynological cancers, cancers that begin in women's reproductive organs,
and he also treats breast and blood cancers. The MPTC
specializes in proton therapy, a precise form of radiation therapy
used to treat various localized cancers. It's designed to deliver
(00:43):
a high dose of radiation to the tumor while minimizing
damage to surrounding healthy tissue. MPTC is the only proton
therapy center in Maryland, answers patients from Baltimore, Washington region
and beyond. We go over a ton of enlightening information
over the next thirty minutes that I think you'll find
detailed and it so here's my conversation with doctor Madonna.
I hope you enjoy it as much as I did.
(01:04):
Good morning, doctor McDonough.
Speaker 2 (01:06):
Good morning, Dennis. How are you doing this morning?
Speaker 1 (01:08):
I'm well, thank you so much, and I've had a
chance to talk to some of your peers from MPT
MPTC before and I'm really thrilled that you have time
to talk to us today for the next thirty minutes.
And I would like to do this, doctor mcdona, if
we could, because I know that while some of our
listeners have heard about the Maryland Proton Treatment Center before,
I'd like to talk about everything that you do with
(01:30):
the other doctors there and the nurses and the staff.
But when it comes to proton therapy, I know it's
not necessarily relatively new, but it might be new from
our listeners hearing about it. Can you exactly tell us
what it is?
Speaker 2 (01:42):
Sure? So, proton therapy is a type of radiation therapy.
So when we talk about radiation therapy, there are two
main modalities of how we deliver it. So there's external
beam radiation treatment, so patients are laying on a table
and the radiation machine kind of rotates around them, and
focus is the radiation at the site of the tumor.
(02:03):
There's also something called break e therapy where we use
a seed to localize our radiation right inside of the tumor.
And this proton therapy is a type of external beam
radiation treatment. So Occasians may have heard of photon or
X ray treatment. This is a different type of particle
and it delivers the radiation in a very precise manner
(02:25):
and it's able to deliver that dose two where the
tumor is located and avoid getting dose to the organs
that are surrounding the tumor.
Speaker 1 (02:33):
How long has proton therapy been around to the point
where doctors said listen and researchers to this is effective.
Speaker 2 (02:40):
It's been around for decades. So the research that's been
going on with with proton therapy has been done for decades.
And you know, while the proton therapy centers are relatively
new thing, protons have been known to be very effective
for cancer treatment for many decades.
Speaker 1 (02:57):
I know you're coming up on a year anniversary there
at MPTC. But your background and I know you have
some specialities that I'd love to talk about and that'll
lead into what you do specifically, especially when it comes
to cancer and women. But how far does it go
back about when you got interested in this and your
background of getting into the field.
Speaker 2 (03:14):
You know, in college, I started off as a physics major.
You know, the radiation therapy is based in physics as
its basis. During college, I decided that I wanted to
go into a medical specialty where I could apply physics,
So I did a specially called Physics in Medicine at
(03:35):
the University of Notre Dame. After graduating college, I continued
my medical training at Virginia Commonwealth University. I did their
MD PhD program. So spent a full eight years of
training at VCU for my medical school and PhD training,
and then continued there for my residency in the Radiation
(03:57):
Oncology residency program.
Speaker 1 (04:00):
So when it comes to proton therapy and the different
traditional radiation that you kind of alluded to, and when
it comes to treating cancers affecting women, you know, can
you tell a little bit more about that and specifically
with women, because I know there's so many different cancers
out there, and you can talk about your specialities as well,
but can you kind of expand that just a little
bit for us, for the traditional to what it is
(04:20):
now in proton therapy.
Speaker 2 (04:21):
As you mentioned, my specialties are in women's cancer, so
I treat gynecologic and breast cancers, as well as lymphoma
cancers as well. Proton therapy has a specific benefit for
breast cancer due to the organs that are right close
by to the breast, the lung, and the heart. Proton
therapy allows us to direct the radiation basically directly at
(04:44):
the breast, and the special property of this proton therapy
allows it the radiation to stop at a certain point,
preventing that radiation does from getting past the breast into
the heart and the lungs. This is especially important for
all patients in general to reduce those to those lungs,
but especially for our patients with comorbidities like COPD, asthma,
(05:07):
heart disease, history of heart attacks, or heart surgeries. So
especially for those patients, it's important to reduce the dose
of radiation that gets to the lung and the heart
to reduce the risk of side effects from radiation treatment.
Speaker 1 (05:22):
I promise I won't hold you to any specific numbers,
but as we look either in the DMV or nationally
even worldwide, when it comes to some of the cancers
that you deal with, what kind of numbers are we
looking at and are they going up? Are they stable
or are they going down right now?
Speaker 2 (05:35):
Yeah, Unfortunately, the cancer rates among women are increasing for
specific types of cancer. You know, cancer remains the second
leading cause of death in the United States and the
leading cause of death for those under eighty five. While
the cancer rate in men has remained relatively stable for
those who are under fifty years old, women under fifty
(05:55):
have seen an increase in cancer rate, to the point
that women fifty are actually twice as likely to develop
cancer as men. Lung cancer is now more common in
women than men for those under sixty five. So even
though the cancer rate in women has been increasing, we
do know that the mortality rate for cancer those fruit
(06:16):
who die from their disease continue to decline due to
treatment advancements. However, this is not the case for two
types of gynecologic cancer, endometrial cancer and cervical cancer, so
those are cancers that I specifically treat. The incidence of
(06:37):
cervical cancer has actually declined due to increased prevention due
to HPV vaccinations and increased screening, but the survival rate
has actually decreased due to more women being diagnosed with
a more aggressive type of cancer called adinocarcinoma. That's more
(06:58):
difficult to detect on screening. Endometrial cancer or uterine cancer
has not seen progress progress in treatment, and survival outcomes
have been worse with that type of cancer in the
last few years. This is at least in part due
to decrease research funding. The research for endometrial cancer. The
(07:21):
funds are only one sixth the amount of that for
cervical cancer, and even though it kills more than three
times as many women as cervical cancer does. Endometrial cancer
is also associated with obesity, so the incidence has increased
as the proportion of obese patients in the US has increased.
Speaker 1 (07:42):
And I guess I'll state the obvious, but you can
expound on it. But I imagine that research and the
funding for that is absolutely paramount to helping you and
your patients try and have a better survivalry. Would I
be correct?
Speaker 2 (07:54):
Yes? Absolutely, Yeah. The more research that is funded, the
more treatment technique we can determine as beneficial for patients.
Clinical trials are crucial for increasing the benefits of our
treatment and improving the outcomes for these cancer patients.
Speaker 1 (08:14):
So something I'd like you to talk about it. And I
understand that every patient is its own individual case and
diagnosis and how you treat that. But for layman like myself,
and for the women listening out there, or the partners
and the spouses, and the brothers and sisters and everybody
that has women that have gone through some kind of cancer,
I've heard about, of course radiation treatment and chemotherapy and
(08:36):
proton when it comes to that, and we're just talking,
of course, doctor in general terms, what's the criteria to
any one of those and then when you shift them
towards proton therapy, can you just kind of talk about
that in general terms?
Speaker 2 (08:49):
Absolutely? So, treating cancer is a multimodal approach. In general,
we have three treatment approaches. So surgery removal of the
tumor that's done by a surgical oncologist. We have systemic
therapy such as chemotherapy, immunotherapy and other directed therapies that
is done by a medical oncologist. And then radiation treatment
(09:12):
with proton therapy included in that is done by a
radiation oncologist like myself. When it comes to deciding which
of these treatment modalities is the most appropriate for our
cancer patients, it takes a group approach. Often patients are
seen by either a surgical oncologist or a medical oncologist
first and then they get referred to their radiation oncologist.
(09:36):
I always tell patients that if they are getting treatment
for their cancer and they don't have a good understanding
of what their treatment options are, as second opinion is
always a great thing. We often see patients here at
the Maryland Proton Center MPTC for second opinions. Patients see
radiation oncologists who specialize in photon or X ray therapy
(09:58):
and patients wonder if pro toon therapy could be beneficial
for them. So, you know, the often we see these
patients in consultation as referrals from as I mentioned, the
surgical or medical oncology teams, and usually radiation treatment is
what we call an adjuvant therapy, meaning it's done after surgery,
(10:21):
or after chemotherapy, or even in combination with chemotherapy. So
the treatment that we do is in combination with all
these different types of modalities. Proton therapy can be done
along with surgery, along with chemotherapy. The patients who have
(10:41):
the most benefit from from proton proton therapy are as
I mentioned those who have tumors that are in areas
that are at high risk for side effects, So we
want to see patients who have left sided breast cancer,
the heart being more located on the left side of
the boy. If we're trying to treat a breast cancer
(11:03):
with photons or X rays, it becomes a lot more
difficult to prevent radiation from getting to the heart and
the lungs, especially the heart for our left sided patients.
For our gynecologic cancer, cervical and indometrial cancer, the bladder
and the bowels are right close by, so proton can
certainly have a benefit in reducing the dose that gets
(11:24):
to the bowel and the bladder, reducing the risk of
side effects to those organs as well.
Speaker 1 (11:30):
And speaking of side effects, and once again I disliked
you talk in general terms because I know we could
go really into the weeds between the chemo and the
radiation the proton a little bit about side effects and
what the process is exactly like for everybody out there
that gets done.
Speaker 2 (11:43):
So, yeah, the usually patients who undergo a surgery, you know,
we want them to recover for a little while after
their procedure, let the wounds heal up. The chemotherapy can
take several weeks to months for their treatment. If we're
doing radiation treatment after either of these, we usually see
them in consultation during or right at the end of
(12:06):
their treatment. For radiation treatment, the very first thing that
we do is something called a CT simulation. It's a
CT scan that we do for our patients that we
get them in the treatment position. We have them lying
on the CTE table, just like they'll be lying on
the table for their radiation treatment. The CT scan allows
(12:28):
us to outline exactly where we want the radiation to go,
and we also outline the areas where we don't want
it to go. So for the breast, we're covering the
areas of the breast and potentially the lymph nodes or
surrounding the breast, and then we're outlining the lung and
the heart, the spinal cord, the esophagus to make sure
all of those areas get as little dose of radiation
(12:50):
as possible. For our gynecologic cancers, we are outlining the
area where the tumor is or used to be if
patients had a surgery, and then we're outlining the bladder
and the bowels and the rectum to make sure that
those areas are getting as little dose of radiation as possible,
so we do the CT scan for these patients. We
(13:12):
do our planning. The planning involves that outlining. It goes
to our docimetrists. Our docimetrists are the ones who figure
out the beam arrangements with the proton therapy to how
the radiation is going to be directed at the tumor.
It goes to our physics team. We have a fantastic
medical physics team here that does our quality assurance. They
(13:35):
are the backbone of making sure that these plans are
deliverable and safe for our patients. So everything goes through
quality assurance. We test to make sure that these radiation
treatment plans can be delivered safely. And then when the
patient comes in for their actual treatment, they will get
in that same position that they were in for their
CT scan. They'll be laying flat on the table. The
(13:59):
radiation machine is a big head of a machine that
will be initially above the patient. It can rotate all
around the patient and direct that proton radiation wherever we
want it to go. While the radiation beam is on,
the patient won't feel anything, they won't see anything. They
should leave the department feeling the exact same way they
did when they came in, and we do know that
(14:23):
side effects do add up over time. Usually we are
doing what's called fractionation, meaning where the radiation treatment is
a prolonged treatment over the course of several weeks, where
we're doing small doses of radiation at each treatment. We
check in with the patient every week to make sure
they're tolerating things, go over side effects, make sure they're
(14:45):
being addressed, and then at the very end of treatment,
we have a nice big bell for patients to celebrate
that they have completed their radiation treatment. So it's very
nice that we can get together with the nurses and
the radiation oncologists and the staff here to all celebrate
when patients have completed their radiation treatment course.
Speaker 1 (15:07):
Well, I appreciate you sharing all of that, doctor Madonna,
and I did want to talk to you a little
bit more about women and cancer. I've got two women
in my family, my wife of twenty five years and
my daughter who's in early twenties, and you were talking
about data a little bit earlier, and it was a
little shocking when I read the latest from the American
Cancer Society. One in three women will develop cancer at
(15:27):
some point in their lifetime, which is staggering. And I
wanted you to share a little bit about the different
cancers affecting women and when it comes to maybe screenings
for cancers such as breast cancer, some mothers, you know,
what should women do? How often should they be seeing
their doctors? And I'm hoping you could expound on that
just a little bit for us.
Speaker 2 (15:44):
Yeah, absolutely so. As you mentioned, the most common breast
cancers are sorry, the most common cancers in women include
breast cancer, cervical cancer, and matrial cancer. As we mentioned,
those incidences are increasing, so screening is very important. I
do want to mention firstly, everyone should be aware that
(16:05):
there is a vaccine for HPV that is recommended by
the CDC which can help prevent cervical cancer. It can
be started as early as age nine, but should be
routinely done by age eleven or twelve. This vaccine is
also recommended for everyone up to age twenty six who
have not received it previously. Those who are older than
(16:26):
twenty six can still discuss it with their physician based
on their risk factors, and it can be given up
to age forty five. As I mentioned, this vaccine can
help prevent the development of cervical cancer. It won't prevent
it won't treat existing HPV infections, but it prevents new
HPV infections. It's been associated with a decreased risk of
(16:49):
cervical cancer of over eighty five percent. So, as you
also mentioned, screening is going to be very important for
catching disease early. So for cervical cancer, women over twenty
one should get their PAP smear tests every three years,
and HPV testing can be started along with this at
age thirty. Breast cancer screening is also very important for
(17:10):
catching breast cancers early. Women over forty five are recommended
to get yearly mammograms. Similarly, anyone over the age of
forty five is now recommended to have regular screening for
colon and rectal cancer with colonoscope or stool testing. You
may have heard different ages over the years you know
they are screening for these types of cancer. Seem the
(17:30):
age for recommendation he continues to seem to go down
and down as we're able to catch these cancers earlier
and earlier, and as incidents is increasing. So for all people,
cancer screening recommendations are going to vary by age and
individual risk factors. So I recommend please consulting a healthcare
(17:52):
provider for personalized advice based on your individual circumstances.
Speaker 1 (17:57):
You know you had mentioned a little bit earlier about
the pro therapy has been around for a long time.
I imagine that technology is at its utmost height now.
I don't know if AI is involved. I'd love to
you to talk a little bit about that, because technology
for me, just as a layman, it doesn't matter if
it's your phone or what you do. It's moving very quickly,
which I imagine you have to constantly keep up on
the education not only about how things work, why they work,
(18:21):
and what they do and the side effects from that.
But where are we today in technology when it comes
to proton therapy and all the equipment that you use.
Speaker 2 (18:27):
Sure sure, yes, the technology continues to increase, improves the
ways that we are able to deliver this proton therapy.
As you mentioned, AI has made its way to us
in radiation oncology. We have used it often for helping
with our contours. As I mentioned, we have to outline
the areas where the tumors are outline are organs that
(18:48):
are at risk for radiation exposure. AI has helped us
with that. The AI software has also helped us with
the beam arrangements, figuring out exactly how the radiation angles
and how long it's on to make sure that these
plans are as optimized as possible. We are continuing to
(19:09):
research that here at the Maryland Proton Treatment Center, so
we are very open to exploring AI opportunities and advancing
our technology so we can get patients the best treatment available.
Speaker 1 (19:21):
You know, I know you do this every day, and
I know it's a job, but I'm sure there's an
emotional connection. But as you work with the technology and
you work with the people, I imagine that you know
why there are some real tough days, there are also
some amazing days too out there, And I'm just it's
for me as a layman as I talk to you,
I can't imagine what you go through every day with
(19:42):
the patients and what they're going through. What's a day
in the life for you, and also for your colleagues
and the nurses and the staff as you bring people
through there. What's it like for you there?
Speaker 2 (19:53):
Yeah, every day we're seeing lots of patients. You know.
That was why I wanted to get into this field.
I love working patients and guiding them through through this
radiation treatment. My days are filled with follow up, seeing
patients who have completed their radiation treatment, seeing patients who
(20:13):
are during their radiation treatment, checking in with them, making
sure they're tolerating things well. Side effects are being addressed,
and seeing consultations, seeing patients for the first time and
explaining proton therapy to them and explaining why it may
be their best treatment option. As you mentioned, a lot
of this can get emotional. Cancer is a diagnosis that
(20:36):
can be very scary.
Speaker 3 (20:38):
You know.
Speaker 2 (20:38):
I want to mention them. My dad actually went through
proton treatment right here at the Maryland Proton Treatment Center
during my residency training, so it is I do have
a very strong connection to the center here, and you know,
guiding him through through that process, knowing what he would
be going through, I think hopefully made it a little
(20:58):
easier on him. He's doing great now, he's cancer free,
so another testament to how well this treatment works. You
mentioned that this can get very very emotional for our patients,
and you know what I try to tell all my
patients is put your worries on us. We know how
(21:18):
to treat this cancer as best as we possibly can.
We're going to do everything we can to keep this
cancer from coming back. We want our patients to be
living their lives, so we're doing this treatment. We're doing
it as safe as possible with as limited side effects
as we possibly can, but knowing that the goal is
to get them to be cancer free and trying to
(21:40):
make sure that we're doing everything that we need to
do so that they can get back to living their lives,
you know, to that point.
Speaker 1 (21:47):
And I promise at the end of our interview here
with doctor MacDonald, we're going to give the web address
and the phone number so you can check more about it.
But as I was going over the website, it's super educational.
It's very informative. There really is a lot on there
about the conditions that you treat and you know, why
would you do MPTC, But also for patients. I mean,
there's really how to at a concierge service and the
(22:09):
cost of insurance, planning your visit, news and events and
you guys, everybody's really thorough about that. So we're going
to encourage people to go on the website. But I
imagine then when it comes to something like this, a
great unknown for people that have cancer and come seeing you.
It's that great unknown where can get scary. So I imagine
for you, you tell the patient's education is power. Folks
(22:30):
read about it, learn about it, you get your second opinions.
But I imagine to put them at ease. Getting the
more information about what's going on probably puts people a
little bit at ease, would I be correct?
Speaker 2 (22:40):
Absolutely? Yes. I try to keep my patients as informed
as possible. You know, the paternal approach of medicine saying
you're going to do this and that's that's what my
recommendation is, and I think that is very old fashioned.
So I want my patients to be participating in there,
know exactly what they're getting into, know their options, making
(23:03):
sure that whatever decision they are making is the right
one for.
Speaker 1 (23:06):
Them, without getting too deep in it. Because you shared
about your dad being there, I guess it must have
been at least a peace of mind that you were
there during the treatment, knowing how the technology works and
being there for him and just seeing how things were going.
To imagine it was emotional, but still it must have
been nice that you were actually there during the whole thing.
Speaker 2 (23:22):
Yeah, it was. It was very special to have that
opportunity to you know, guide him through the treatment, knowing
exactly what to expect, what he was going to go through.
My colleagues here, you know, did the actual treatment planning
for him, knowing that their expertise and that he was
getting the best treatment available and that he would have
(23:44):
as limited side effects as possible. That because of the
use of the proton therapy was very reassuring.
Speaker 1 (23:50):
I want to talk just a little bit more about
technology in the future, and I know that when it
comes to the researchers and the doctors and the staff
and all the smart people that have put this technology
together and talked about the research and it's funding about
where it's going. I know there's a lot of research,
like the proton therapy itself that's been around for decades.
But when it comes to the equipment and AI and
everything moving fast, what can we look forward to or
(24:12):
what are you getting excited about Maybe over the next two, five,
ten years, it might be coming up that makes it
even better for everybody, yourself and the patients.
Speaker 2 (24:19):
That's a great question. Yeah, We've got a lot of
opportunities for research here. You know, we do a lot
of research into what's called reradiation patients who have had
radiation treatment in the past, and how proton can be
beneficial for treating an area that otherwise we would not
have considered for further radiation treatment. So doing the research
(24:43):
into that and showing how protons can avoid excess radiation
dose for areas that have already been treated. We also
have a robust hyperthermia center here, so hyperthermia is treating
with heat therapy. We do that a lot for our
patients who have had prior radiation. So if a tumor
(25:05):
unfortunately grows back after initial radiation treatment, the thermal therapy,
the heating therapy can work along with the radiation make
it more effective. We're one of the only centers in
the country who have this available, and so if for
patients who have had prior radiation and it doesn't seem
(25:25):
like they would have been able to be treated previously,
proton therapy along with this hyperthermia therapy can be very
beneficial for them. Something that probably would not have been
considered decades ago. Now is a possibility for us.
Speaker 1 (25:42):
You know, I know you do this every day, but
when it comes to stuff like you're talking about, do
you ever get any wow moments yourself about I can't
believe this is happening right now.
Speaker 2 (25:50):
Yeah, certainly it is exciting to see when patients come
in and even during their treatment we see the tumors shrinking.
During follow up we get our imaging done and the
tumors have disappeared. It is always a great moment to
share with patients when we've had success with their treatment,
(26:13):
and it really is. It does make you go wow
sometimes that this radiation treatment is done, the patient gets
through with minimal side effects, and we're able to eradicate
their cancers.
Speaker 1 (26:25):
Standing well, listen, we only have about two NAP minutes
left and I would like to get some final thoughts
from you, and we're going to give all the information
for the Maryland Proton Treatment Center. I understand that people
have to be referred, but maybe just you know if
they are referred, about the experience, what they'll get, and
what you've been a part of so far and moving
into the future. Let's just get some final thoughts from you,
(26:47):
doctor macdonnaugh. The floor is yours.
Speaker 2 (26:48):
You know, for anyone who's been diagnosed with cancer, the
most important thing is to know what your treatment options are.
As I mentioned there is a multimodal approach to treating
cancer surgery, systemic therapy with chemotherapy, immune therapy, other directed therapies,
and radiation therapy. Proton therapy being a specific form of
(27:10):
radiation treatment, allows us to deliver radiation doses very precisely
reduce the radiation dose that gets to the organs that
are close by to the areas that we are treating.
It can be of significant benefit to reduce side effects
for a lot of our patients. Proton therapy is not
for everybody, but there is a significant proportion of patients
(27:33):
who can significantly benefit from it. At the Maryland Proton
Treatment Center MPTC, we treat a wide variety of cancers.
The treatment that I do is for gynecologic and breast
cancers as well as lymphomas, but we treat all different
sites of cancer with all of our different providers here.
If you want to see a proton therapy is right
(27:54):
for you, you can schedule a consult at the Maryland
Proton Treatment Center by calling four to one zero six
five two zero zero or visit us at askfoprotons dot com.
Speaker 1 (28:05):
Well, doctor Madonna, I'm sure you've heard this from a
lot of people like me. I'm in awe of what
you and the nurses and the staff and the researchers do.
It's uh, it's got to be tough work, but it
also has to be rewarding, and you've talked about that,
and we just are very appreciative of your valuable time
and all you do. I want to wish you and
your patients and everybody else that works there at the
center continue success. And we really appreciate you joining us
(28:26):
on Community DC today. Thank you so much, Thank you
happy to be here.
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Good morning, and welcome to another edition of Community d C.
I'm your host Dennis Glascow. This morning, we get an
opportunity to talk about cancer and proton therapy with doctor
Reed McDonough, a radiation oncology physician of the Maryland Proton
Treatment Center in Baltimore.
Speaker 2 (00:23):
Now.
Speaker 1 (00:23):
Doctor macdonna treats various cancers. His primary focus is on
treating gynological cancers, cancers that begin in women's reproductive organs,
and he also treats breast and blood cancers. The MPTC
specializes in proton therapy, a precise form of radiation therapy
used to treat various localized cancers. It's designed to deliver
(00:43):
a high dose of radiation to the tumor while minimizing
damage to surrounding healthy tissue. MPTC is the only proton
therapy center in Maryland, answers patients from Baltimore, Washington region
and beyond. We go over a ton of enlightening information
over the next thirty minutes that I think you'll find
detailed and it so here's my conversation with doctor Madonna.
I hope you enjoy it as much as I did.
(01:04):
Good morning, doctor McDonough.
Speaker 2 (01:06):
Good morning, Dennis. How are you doing this morning?
Speaker 1 (01:08):
I'm well, thank you so much, and I've had a
chance to talk to some of your peers from MPT
MPTC before and I'm really thrilled that you have time
to talk to us today for the next thirty minutes.
And I would like to do this, doctor mcdona, if
we could, because I know that while some of our
listeners have heard about the Maryland Proton Treatment Center before,
I'd like to talk about everything that you do with
(01:30):
the other doctors there and the nurses and the staff.
But when it comes to proton therapy, I know it's
not necessarily relatively new, but it might be new from
our listeners hearing about it. Can you exactly tell us
what it is?
Speaker 2 (01:42):
Sure? So, proton therapy is a type of radiation therapy.
So when we talk about radiation therapy, there are two
main modalities of how we deliver it. So there's external
beam radiation treatment, so patients are laying on a table
and the radiation machine kind of rotates around them, and
focus is the radiation at the site of the tumor.
(02:03):
There's also something called break e therapy where we use
a seed to localize our radiation right inside of the tumor.
And this proton therapy is a type of external beam
radiation treatment. So Occasians may have heard of photon or
X ray treatment. This is a different type of particle
and it delivers the radiation in a very precise manner
(02:25):
and it's able to deliver that dose two where the
tumor is located and avoid getting dose to the organs
that are surrounding the tumor.
Speaker 1 (02:33):
How long has proton therapy been around to the point
where doctors said listen and researchers to this is effective.
Speaker 2 (02:40):
It's been around for decades. So the research that's been
going on with with proton therapy has been done for decades.
And you know, while the proton therapy centers are relatively
new thing, protons have been known to be very effective
for cancer treatment for many decades.
Speaker 1 (02:57):
I know you're coming up on a year anniversary there
at MPTC. But your background and I know you have
some specialities that I'd love to talk about and that'll
lead into what you do specifically, especially when it comes
to cancer and women. But how far does it go
back about when you got interested in this and your
background of getting into the field.
Speaker 2 (03:14):
You know, in college, I started off as a physics major.
You know, the radiation therapy is based in physics as
its basis. During college, I decided that I wanted to
go into a medical specialty where I could apply physics,
So I did a specially called Physics in Medicine at
(03:35):
the University of Notre Dame. After graduating college, I continued
my medical training at Virginia Commonwealth University. I did their
MD PhD program. So spent a full eight years of
training at VCU for my medical school and PhD training,
and then continued there for my residency in the Radiation
(03:57):
Oncology residency program.
Speaker 1 (04:00):
So when it comes to proton therapy and the different
traditional radiation that you kind of alluded to, and when
it comes to treating cancers affecting women, you know, can
you tell a little bit more about that and specifically
with women, because I know there's so many different cancers
out there, and you can talk about your specialities as well,
but can you kind of expand that just a little
bit for us, for the traditional to what it is
(04:20):
now in proton therapy.
Speaker 2 (04:21):
As you mentioned, my specialties are in women's cancer, so
I treat gynecologic and breast cancers, as well as lymphoma
cancers as well. Proton therapy has a specific benefit for
breast cancer due to the organs that are right close
by to the breast, the lung, and the heart. Proton
therapy allows us to direct the radiation basically directly at
(04:44):
the breast, and the special property of this proton therapy
allows it the radiation to stop at a certain point,
preventing that radiation does from getting past the breast into
the heart and the lungs. This is especially important for
all patients in general to reduce those to those lungs,
but especially for our patients with comorbidities like COPD, asthma,
(05:07):
heart disease, history of heart attacks, or heart surgeries. So
especially for those patients, it's important to reduce the dose
of radiation that gets to the lung and the heart
to reduce the risk of side effects from radiation treatment.
Speaker 1 (05:22):
I promise I won't hold you to any specific numbers,
but as we look either in the DMV or nationally
even worldwide, when it comes to some of the cancers
that you deal with, what kind of numbers are we
looking at and are they going up? Are they stable
or are they going down right now?
Speaker 2 (05:35):
Yeah, Unfortunately, the cancer rates among women are increasing for
specific types of cancer. You know, cancer remains the second
leading cause of death in the United States and the
leading cause of death for those under eighty five. While
the cancer rate in men has remained relatively stable for
those who are under fifty years old, women under fifty
(05:55):
have seen an increase in cancer rate, to the point
that women fifty are actually twice as likely to develop
cancer as men. Lung cancer is now more common in
women than men for those under sixty five. So even
though the cancer rate in women has been increasing, we
do know that the mortality rate for cancer those fruit
(06:16):
who die from their disease continue to decline due to
treatment advancements. However, this is not the case for two
types of gynecologic cancer, endometrial cancer and cervical cancer, so
those are cancers that I specifically treat. The incidence of
(06:37):
cervical cancer has actually declined due to increased prevention due
to HPV vaccinations and increased screening, but the survival rate
has actually decreased due to more women being diagnosed with
a more aggressive type of cancer called adinocarcinoma. That's more
(06:58):
difficult to detect on screening. Endometrial cancer or uterine cancer
has not seen progress progress in treatment, and survival outcomes
have been worse with that type of cancer in the
last few years. This is at least in part due
to decrease research funding. The research for endometrial cancer. The
(07:21):
funds are only one sixth the amount of that for
cervical cancer, and even though it kills more than three
times as many women as cervical cancer does. Endometrial cancer
is also associated with obesity, so the incidence has increased
as the proportion of obese patients in the US has increased.
Speaker 1 (07:42):
And I guess I'll state the obvious, but you can
expound on it. But I imagine that research and the
funding for that is absolutely paramount to helping you and
your patients try and have a better survivalry. Would I
be correct?
Speaker 2 (07:54):
Yes? Absolutely, Yeah. The more research that is funded, the
more treatment technique we can determine as beneficial for patients.
Clinical trials are crucial for increasing the benefits of our
treatment and improving the outcomes for these cancer patients.
Speaker 1 (08:14):
So something I'd like you to talk about it. And I
understand that every patient is its own individual case and
diagnosis and how you treat that. But for layman like myself,
and for the women listening out there, or the partners
and the spouses, and the brothers and sisters and everybody
that has women that have gone through some kind of cancer,
I've heard about, of course radiation treatment and chemotherapy and
(08:36):
proton when it comes to that, and we're just talking,
of course, doctor in general terms, what's the criteria to
any one of those and then when you shift them
towards proton therapy, can you just kind of talk about
that in general terms?
Speaker 2 (08:49):
Absolutely? So, treating cancer is a multimodal approach. In general,
we have three treatment approaches. So surgery removal of the
tumor that's done by a surgical oncologist. We have systemic
therapy such as chemotherapy, immunotherapy and other directed therapies that
is done by a medical oncologist. And then radiation treatment
(09:12):
with proton therapy included in that is done by a
radiation oncologist like myself. When it comes to deciding which
of these treatment modalities is the most appropriate for our
cancer patients, it takes a group approach. Often patients are
seen by either a surgical oncologist or a medical oncologist
first and then they get referred to their radiation oncologist.
(09:36):
I always tell patients that if they are getting treatment
for their cancer and they don't have a good understanding
of what their treatment options are, as second opinion is
always a great thing. We often see patients here at
the Maryland Proton Center MPTC for second opinions. Patients see
radiation oncologists who specialize in photon or X ray therapy
(09:58):
and patients wonder if pro toon therapy could be beneficial
for them. So, you know, the often we see these
patients in consultation as referrals from as I mentioned, the
surgical or medical oncology teams, and usually radiation treatment is
what we call an adjuvant therapy, meaning it's done after surgery,
(10:21):
or after chemotherapy, or even in combination with chemotherapy. So
the treatment that we do is in combination with all
these different types of modalities. Proton therapy can be done
along with surgery, along with chemotherapy. The patients who have
(10:41):
the most benefit from from proton proton therapy are as
I mentioned those who have tumors that are in areas
that are at high risk for side effects, So we
want to see patients who have left sided breast cancer,
the heart being more located on the left side of
the boy. If we're trying to treat a breast cancer
(11:03):
with photons or X rays, it becomes a lot more
difficult to prevent radiation from getting to the heart and
the lungs, especially the heart for our left sided patients.
For our gynecologic cancer, cervical and indometrial cancer, the bladder
and the bowels are right close by, so proton can
certainly have a benefit in reducing the dose that gets
(11:24):
to the bowel and the bladder, reducing the risk of
side effects to those organs as well.
Speaker 1 (11:30):
And speaking of side effects, and once again I disliked
you talk in general terms because I know we could
go really into the weeds between the chemo and the
radiation the proton a little bit about side effects and
what the process is exactly like for everybody out there
that gets done.
Speaker 2 (11:43):
So, yeah, the usually patients who undergo a surgery, you know,
we want them to recover for a little while after
their procedure, let the wounds heal up. The chemotherapy can
take several weeks to months for their treatment. If we're
doing radiation treatment after either of these, we usually see
them in consultation during or right at the end of
(12:06):
their treatment. For radiation treatment, the very first thing that
we do is something called a CT simulation. It's a
CT scan that we do for our patients that we
get them in the treatment position. We have them lying
on the CTE table, just like they'll be lying on
the table for their radiation treatment. The CT scan allows
(12:28):
us to outline exactly where we want the radiation to go,
and we also outline the areas where we don't want
it to go. So for the breast, we're covering the
areas of the breast and potentially the lymph nodes or
surrounding the breast, and then we're outlining the lung and
the heart, the spinal cord, the esophagus to make sure
all of those areas get as little dose of radiation
(12:50):
as possible. For our gynecologic cancers, we are outlining the
area where the tumor is or used to be if
patients had a surgery, and then we're outlining the bladder
and the bowels and the rectum to make sure that
those areas are getting as little dose of radiation as possible,
so we do the CT scan for these patients. We
(13:12):
do our planning. The planning involves that outlining. It goes
to our docimetrists. Our docimetrists are the ones who figure
out the beam arrangements with the proton therapy to how
the radiation is going to be directed at the tumor.
It goes to our physics team. We have a fantastic
medical physics team here that does our quality assurance. They
(13:35):
are the backbone of making sure that these plans are
deliverable and safe for our patients. So everything goes through
quality assurance. We test to make sure that these radiation
treatment plans can be delivered safely. And then when the
patient comes in for their actual treatment, they will get
in that same position that they were in for their
CT scan. They'll be laying flat on the table. The
(13:59):
radiation machine is a big head of a machine that
will be initially above the patient. It can rotate all
around the patient and direct that proton radiation wherever we
want it to go. While the radiation beam is on,
the patient won't feel anything, they won't see anything. They
should leave the department feeling the exact same way they
did when they came in, and we do know that
(14:23):
side effects do add up over time. Usually we are
doing what's called fractionation, meaning where the radiation treatment is
a prolonged treatment over the course of several weeks, where
we're doing small doses of radiation at each treatment. We
check in with the patient every week to make sure
they're tolerating things, go over side effects, make sure they're
(14:45):
being addressed, and then at the very end of treatment,
we have a nice big bell for patients to celebrate
that they have completed their radiation treatment. So it's very
nice that we can get together with the nurses and
the radiation oncologists and the staff here to all celebrate
when patients have completed their radiation treatment course.
Speaker 1 (15:07):
Well, I appreciate you sharing all of that, doctor Madonna,
and I did want to talk to you a little
bit more about women and cancer. I've got two women
in my family, my wife of twenty five years and
my daughter who's in early twenties, and you were talking
about data a little bit earlier, and it was a
little shocking when I read the latest from the American
Cancer Society. One in three women will develop cancer at
(15:27):
some point in their lifetime, which is staggering. And I
wanted you to share a little bit about the different
cancers affecting women and when it comes to maybe screenings
for cancers such as breast cancer, some mothers, you know,
what should women do? How often should they be seeing
their doctors? And I'm hoping you could expound on that
just a little bit for us.
Speaker 2 (15:44):
Yeah, absolutely so. As you mentioned, the most common breast
cancers are sorry, the most common cancers in women include
breast cancer, cervical cancer, and matrial cancer. As we mentioned,
those incidences are increasing, so screening is very important. I
do want to mention firstly, everyone should be aware that
(16:05):
there is a vaccine for HPV that is recommended by
the CDC which can help prevent cervical cancer. It can
be started as early as age nine, but should be
routinely done by age eleven or twelve. This vaccine is
also recommended for everyone up to age twenty six who
have not received it previously. Those who are older than
(16:26):
twenty six can still discuss it with their physician based
on their risk factors, and it can be given up
to age forty five. As I mentioned, this vaccine can
help prevent the development of cervical cancer. It won't prevent
it won't treat existing HPV infections, but it prevents new
HPV infections. It's been associated with a decreased risk of
(16:49):
cervical cancer of over eighty five percent. So, as you
also mentioned, screening is going to be very important for
catching disease early. So for cervical cancer, women over twenty
one should get their PAP smear tests every three years,
and HPV testing can be started along with this at
age thirty. Breast cancer screening is also very important for
(17:10):
catching breast cancers early. Women over forty five are recommended
to get yearly mammograms. Similarly, anyone over the age of
forty five is now recommended to have regular screening for
colon and rectal cancer with colonoscope or stool testing. You
may have heard different ages over the years you know
they are screening for these types of cancer. Seem the
(17:30):
age for recommendation he continues to seem to go down
and down as we're able to catch these cancers earlier
and earlier, and as incidents is increasing. So for all people,
cancer screening recommendations are going to vary by age and
individual risk factors. So I recommend please consulting a healthcare
(17:52):
provider for personalized advice based on your individual circumstances.
Speaker 1 (17:57):
You know you had mentioned a little bit earlier about
the pro therapy has been around for a long time.
I imagine that technology is at its utmost height now.
I don't know if AI is involved. I'd love to
you to talk a little bit about that, because technology
for me, just as a layman, it doesn't matter if
it's your phone or what you do. It's moving very quickly,
which I imagine you have to constantly keep up on
the education not only about how things work, why they work,
(18:21):
and what they do and the side effects from that.
But where are we today in technology when it comes
to proton therapy and all the equipment that you use.
Speaker 2 (18:27):
Sure sure, yes, the technology continues to increase, improves the
ways that we are able to deliver this proton therapy.
As you mentioned, AI has made its way to us
in radiation oncology. We have used it often for helping
with our contours. As I mentioned, we have to outline
the areas where the tumors are outline are organs that
(18:48):
are at risk for radiation exposure. AI has helped us
with that. The AI software has also helped us with
the beam arrangements, figuring out exactly how the radiation angles
and how long it's on to make sure that these
plans are as optimized as possible. We are continuing to
(19:09):
research that here at the Maryland Proton Treatment Center, so
we are very open to exploring AI opportunities and advancing
our technology so we can get patients the best treatment available.
Speaker 1 (19:21):
You know, I know you do this every day, and
I know it's a job, but I'm sure there's an
emotional connection. But as you work with the technology and
you work with the people, I imagine that you know
why there are some real tough days, there are also
some amazing days too out there, And I'm just it's
for me as a layman as I talk to you,
I can't imagine what you go through every day with
(19:42):
the patients and what they're going through. What's a day
in the life for you, and also for your colleagues
and the nurses and the staff as you bring people
through there. What's it like for you there?
Speaker 2 (19:53):
Yeah, every day we're seeing lots of patients. You know.
That was why I wanted to get into this field.
I love working patients and guiding them through through this
radiation treatment. My days are filled with follow up, seeing
patients who have completed their radiation treatment, seeing patients who
(20:13):
are during their radiation treatment, checking in with them, making
sure they're tolerating things well. Side effects are being addressed,
and seeing consultations, seeing patients for the first time and
explaining proton therapy to them and explaining why it may
be their best treatment option. As you mentioned, a lot
of this can get emotional. Cancer is a diagnosis that
(20:36):
can be very scary.
Speaker 3 (20:38):
You know.
Speaker 2 (20:38):
I want to mention them. My dad actually went through
proton treatment right here at the Maryland Proton Treatment Center
during my residency training, so it is I do have
a very strong connection to the center here, and you know,
guiding him through through that process, knowing what he would
be going through, I think hopefully made it a little
(20:58):
easier on him. He's doing great now, he's cancer free,
so another testament to how well this treatment works. You
mentioned that this can get very very emotional for our patients,
and you know what I try to tell all my
patients is put your worries on us. We know how
(21:18):
to treat this cancer as best as we possibly can.
We're going to do everything we can to keep this
cancer from coming back. We want our patients to be
living their lives, so we're doing this treatment. We're doing
it as safe as possible with as limited side effects
as we possibly can, but knowing that the goal is
to get them to be cancer free and trying to
(21:40):
make sure that we're doing everything that we need to
do so that they can get back to living their lives,
you know, to that point.
Speaker 1 (21:47):
And I promise at the end of our interview here
with doctor MacDonald, we're going to give the web address
and the phone number so you can check more about it.
But as I was going over the website, it's super educational.
It's very informative. There really is a lot on there
about the conditions that you treat and you know, why
would you do MPTC, But also for patients. I mean,
there's really how to at a concierge service and the
(22:09):
cost of insurance, planning your visit, news and events and
you guys, everybody's really thorough about that. So we're going
to encourage people to go on the website. But I
imagine then when it comes to something like this, a
great unknown for people that have cancer and come seeing you.
It's that great unknown where can get scary. So I imagine
for you, you tell the patient's education is power. Folks
(22:30):
read about it, learn about it, you get your second opinions.
But I imagine to put them at ease. Getting the
more information about what's going on probably puts people a
little bit at ease, would I be correct?
Speaker 2 (22:40):
Absolutely? Yes. I try to keep my patients as informed
as possible. You know, the paternal approach of medicine saying
you're going to do this and that's that's what my
recommendation is, and I think that is very old fashioned.
So I want my patients to be participating in there,
know exactly what they're getting into, know their options, making
(23:03):
sure that whatever decision they are making is the right
one for.
Speaker 1 (23:06):
Them, without getting too deep in it. Because you shared
about your dad being there, I guess it must have
been at least a peace of mind that you were
there during the treatment, knowing how the technology works and
being there for him and just seeing how things were going.
To imagine it was emotional, but still it must have
been nice that you were actually there during the whole thing.
Speaker 2 (23:22):
Yeah, it was. It was very special to have that
opportunity to you know, guide him through the treatment, knowing
exactly what to expect, what he was going to go through.
My colleagues here, you know, did the actual treatment planning
for him, knowing that their expertise and that he was
getting the best treatment available and that he would have
(23:44):
as limited side effects as possible. That because of the
use of the proton therapy was very reassuring.
Speaker 1 (23:50):
I want to talk just a little bit more about
technology in the future, and I know that when it
comes to the researchers and the doctors and the staff
and all the smart people that have put this technology
together and talked about the research and it's funding about
where it's going. I know there's a lot of research,
like the proton therapy itself that's been around for decades.
But when it comes to the equipment and AI and
everything moving fast, what can we look forward to or
(24:12):
what are you getting excited about Maybe over the next two, five,
ten years, it might be coming up that makes it
even better for everybody, yourself and the patients.
Speaker 2 (24:19):
That's a great question. Yeah, We've got a lot of
opportunities for research here. You know, we do a lot
of research into what's called reradiation patients who have had
radiation treatment in the past, and how proton can be
beneficial for treating an area that otherwise we would not
have considered for further radiation treatment. So doing the research
(24:43):
into that and showing how protons can avoid excess radiation
dose for areas that have already been treated. We also
have a robust hyperthermia center here, so hyperthermia is treating
with heat therapy. We do that a lot for our
patients who have had prior radiation. So if a tumor
(25:05):
unfortunately grows back after initial radiation treatment, the thermal therapy,
the heating therapy can work along with the radiation make
it more effective. We're one of the only centers in
the country who have this available, and so if for
patients who have had prior radiation and it doesn't seem
(25:25):
like they would have been able to be treated previously,
proton therapy along with this hyperthermia therapy can be very
beneficial for them. Something that probably would not have been
considered decades ago. Now is a possibility for us.
Speaker 1 (25:42):
You know, I know you do this every day, but
when it comes to stuff like you're talking about, do
you ever get any wow moments yourself about I can't
believe this is happening right now.
Speaker 2 (25:50):
Yeah, certainly it is exciting to see when patients come
in and even during their treatment we see the tumors shrinking.
During follow up we get our imaging done and the
tumors have disappeared. It is always a great moment to
share with patients when we've had success with their treatment,
(26:13):
and it really is. It does make you go wow
sometimes that this radiation treatment is done, the patient gets
through with minimal side effects, and we're able to eradicate
their cancers.
Speaker 1 (26:25):
Standing well, listen, we only have about two NAP minutes
left and I would like to get some final thoughts
from you, and we're going to give all the information
for the Maryland Proton Treatment Center. I understand that people
have to be referred, but maybe just you know if
they are referred, about the experience, what they'll get, and
what you've been a part of so far and moving
into the future. Let's just get some final thoughts from you,
(26:47):
doctor macdonnaugh. The floor is yours.
Speaker 2 (26:48):
You know, for anyone who's been diagnosed with cancer, the
most important thing is to know what your treatment options are.
As I mentioned there is a multimodal approach to treating
cancer surgery, systemic therapy with chemotherapy, immune therapy, other directed therapies,
and radiation therapy. Proton therapy being a specific form of
(27:10):
radiation treatment, allows us to deliver radiation doses very precisely
reduce the radiation dose that gets to the organs that
are close by to the areas that we are treating.
It can be of significant benefit to reduce side effects
for a lot of our patients. Proton therapy is not
for everybody, but there is a significant proportion of patients
(27:33):
who can significantly benefit from it. At the Maryland Proton
Treatment Center MPTC, we treat a wide variety of cancers.
The treatment that I do is for gynecologic and breast
cancers as well as lymphomas, but we treat all different
sites of cancer with all of our different providers here.
If you want to see a proton therapy is right
(27:54):
for you, you can schedule a consult at the Maryland
Proton Treatment Center by calling four to one zero six
five two zero zero or visit us at askfoprotons dot com.
Speaker 1 (28:05):
Well, doctor Madonna, I'm sure you've heard this from a
lot of people like me. I'm in awe of what
you and the nurses and the staff and the researchers do.
It's uh, it's got to be tough work, but it
also has to be rewarding, and you've talked about that,
and we just are very appreciative of your valuable time
and all you do. I want to wish you and
your patients and everybody else that works there at the
center continue success. And we really appreciate you joining us
(28:26):
on Community DC today. Thank you so much, Thank you
happy to be here.
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