SBRT
Symmetry helps radiation oncologists at Riverside & University of Virginia Radiosurgery Center avoid excess dose to healthy tissues by isolating mobile tumors
In treatments of only the first handful of patients with lung or liver tumors, Riverside & University of Virginia Radiosurgery Center (Newport News, Va.) clinicians have demonstrated the dramatic benefit that Elekta’s Symmetry™ 4D image guidance technology can provide for patients whose tumors move with their breathing. Symmetry essentially yields a more distinct picture of the tumor, without the blurring associated with breathing motion.
By having a clearer picture of the tumor position and its motion, physicians have been able to improve their targeting of tumors, thereby avoiding having to treat a larger margin of healthy tissue around the lesion. A Symmetry scan is acquired just before treatment to ensure that the patient is correctly positioned, and to visualize tumor movement.
“Symmetry scans give us clearer information about the movement of the tumor, allowing us to increase the safety of treating our patients by decreasing the dose to healthy tissues, while hopefully providing a better clinical outcome,” according to Riverside medical physicist Kelly Spencer.
Tumor motion in sharper focus
Before they began using the Symmetry feature in Elekta’s XVI package of IGRT tools, Riverside clinicians were using sophisticated XVI 3D cone beam CT (VolumeView™ CBCT) imaging technology integrated with their Elekta Synergy® S to image tumors. These pre-treatment scans provide physicians with added confidence in the margins that they have planned. Although seeing a target with IGRT technology such as VolumeView has been a key clinical improvement, the motion still created a blur that encompassed the tumor’s range of motion.
“For our current protocol, we would create an ITV [internal target volume] to cover the blur we see on the VolumeView,” Spencer says. “We began using Symmetry on a couple of patients with lower lung lesions near the diaphragm where we would expect tumor motion to be an issue. We were actually quite mesmerized by the images Symmetry provided. We could clearly see the actual motion of the delineated tumor with respect to the patient’s breathing.”
The same Symmetry benefit applied to a recent patient with a liver tumor situated near the diaphragm. In this case, clinicians inferred tumor motion by observing the movement of the liver with the patient’s breathing.
“We wanted to use Symmetry to see how the superior border of the liver moved, and what we observed was that it did not move simply superior to inferior – there was almost a rolling pattern to the liver motion,” Spencer recalls. “We knew that the liver didn’t necessarily move symmetrically on CBCT scans, but it was harder to appreciate due to motion artifact. This movement probably varies between patients, so that is an excellent reason to use Symmetry to evaluate this motion on a case-by-case basis.”
Read more at: http://www.elekta.com/healthcare_international_press_release_20071329.php.
*Approval of indications may vary between different countries. Additional regulatory clearances may be required in some markets.
2012 Future of Radiation Medicine
Thursday, March 15, 2012
1 – 6:30 p.m. • 6:30 – 8 p.m. Dinner
Four Seasons Hotel • Baltimore, MD
The 2012 Future of Radiation Medicine Symposium brings together the world’s leading authorities in radiation medicine to discuss the latest trends in radiotherapy. Radiation safety considerations in the clinic will be addressed, followed by a Q&A with presenters. To view a complete agenda with topics and speakers, or to register, please click here.
Who should attend?
The one-day symposium is designed for the entire cancer care team where you can earn AMA PR Category 1, CAMPEP, ASRT and MDCB educational credits.
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Radiation oncologists
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Medical oncologists
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Medical physicists
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Oncology nurses
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Radiation therapists
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Neurosurgeons
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Executives and administrators
Leeds Teaching Hospitals NHS Trust Accelerates Cancer Care with Monaco Planning Software from Elekta
Clinicians cut VMAT planning times, aim to increase access to rapid radiotherapy for more patients
Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) delivery techniques have dramatically reduced treatment times for thousands of patients. An obstacle to offering this technique to more patients is the time it takes to create a VMAT plan. Physicians at St. James’s University Hospital – the first in the United Kingdom to use Monaco® VMAT clinically – have been able to significantly reduce VMAT planning times, increasing the potential to offer this advanced therapy to greater numbers of patients.
“Our referral rate for radiation therapy is expanding by over seven percent annually,” says St. James’s head of radiotherapy physics Vivian Cosgrove, Ph.D. “We see VMAT as a key way to manage that growth. If we can plan complex radiotherapy quickly and deliver treatment more efficiently with VMAT, then we can treat more patients and derive more benefit from our existing fleet of treatment machines.”
Elekta VMAT is an advanced radiation therapy technique that delivers treatment in one or more continuous high-speed arcs around the patient, enabling the radiation dose to precisely conform to a tumor by modulating the radiation beam’s intensity in multiple small volumes.
The key to rapidly developing Elekta VMAT plans lies in understanding the principles of efficiently producing traditional IMRT plans with step-and-shoot (i.e., non-dynamic) delivery. Medical physics staff at St. James’s have used Monaco since January 2011 to plan head-and-neck IMRT cases.
“Monaco has transformed our IMRT service,” Dr. Cosgrove notes. “After contouring, we can complete a complex head-and-neck plan in two to three hours. This is two to three times quicker than other planning systems we have used. Since we introduced Monaco clinically, we have been able to significantly increase the number of patients receiving intensity modulated treatment: over 260 patients in 2011 and a target to increase this further in 2012.”
That number includes many patients who have received VMAT planned with Monaco, which St. James’s clinicians began performing in August 2011 on one of its 12 Elekta digital accelerators.
VMAT delivery of head-and-neck cases takes 6.5 minutes, half the time of a seven-field step-and-shoot delivery, he says. Read more at: http://www.elekta.com/healthcare_international_press_release_20071328.php.
First use of Symmetry motion management software in Australasia makes 75-year-old’s treatment more precise
To successfully irradiate a moving lung tumor requires doctors to find a way either to stop the tumor from moving or a means to compensate for its motion. On September 8, clinicians at Prince of Wales Hospital Cancer Centre (Randwick, New South Wales) chose the second option, using Elekta’s Symmetry™ respiratory motion management software for the first time to treat a 75-year-old male patient with a tumor that moved back and forth with his breathing. Symmetry enables physicians to visualize the tumor’s complete range of motion and then ensures that the tumor is always positioned in the treatment beam regardless of its movement.
Accurate treatment of this patient’s tumor, a primary, malignant non-small cell cancer (NSCLC) in the upper lobe of the left lung, was critical due to the therapy approach used. Prince of Wales Hospital clinicians used hypofractionated Stereotactic Body Radiation Therapy (SBRT), which called for precise immobilization of the patient’s body to enable just three treatment sessions (i.e., fractions), each using a highly potent radiation dose.
“The whole concept of hypofractionated stereotactic treatment relies on accurate and precise planning datasets and treatment verification systems,” says Wenchang Wong, M.D., radiation oncologist at Prince of Wales Hospital. “Symmetry afforded us clear visualization of the tumor at the treatment couch and gave me confidence that treatment delivery would be safe and reproducible for this patient.”
Symmetry, a feature set of Elekta’s X-ray Volume Imaging (XVI) software package, enables clear visualization of moving lung tumors by providing a dynamic fourth dimension (4D) of motion to enhance image guidance with the patient in the treatment position.
“Conventional cone beam CT provides only a static, blurred image of a moving lung tumor that cannot tell us in which part of the respiratory cycle it was captured,” Dr. Wong explains. “Conversely, Symmetry provides a dynamic 4D cine/picture of the movement of the tumor mass throughout the entire respiratory cycle. This is especially important in lung cancer treatment given the natural excursion of the tumor with the breathing cycle. Symmetry enables us to see the tumor’s movement in real time.”
Read more: http://www.elekta.com/healthcare_international_press_release_20071314.php.
Institution: University of Colorado Cancer Center, Denver, Colorado, US
Patient: 72 year old male
Diagnosis: Localized small cell carcinoma of the distal thoracic esophagus
Plan: Stereotactic body radiation therapy (SBRT) using VMAT
Patient History and Diagnosis
This 72 year old male presented with a localized small cell carcinoma of the distal thoracic esophagus. He underwent a single cycle of cisplatin and esoposide followed by concurrent chemoradiation therapy, using 3D conformal radiotherapy to encompase the esophageal primary and regional lymph nodes. He received a total dose of 45 Gy in 25 fractions along with the second cycle of cisplatin and etoposide. He received 4 additional cycles of chemotherapy.
He remained well until restaging with PET-CT 8 months following completion of therapy showed a new FDG-avid hypodensity in the right lobe of the liver, segment 6. The lesion measured 2.0 x 1.7 cm and had a SUV of 6. A MRI of the brain was negative. The PET was negative in the region of the esophageal primary as were upper endoscopy and biopsy. The patient performance status was excellent and despite the usual aggressive course of extra-pulmonary small cell carcinoma, because his primary was controlled, we elected to be aggressive with this solitary liver metastasis.
Download the entire case study here: http://www.elekta.com/assets/new-proof/assets/Software/CS%20Stereotactic%20Body%20Radiation%20Therapy%20for%20Liver%20Cancer%20Using%20the%20Monaco%20Treatment%20Planning%20System%20and%20VMAT%20Delivery%20at%20University%20of%20Colorado%20Cancer%20Center%20Denver%20Colorado.pdf.
SBRT
SRS technology has evolved significantly since it was first introduced in the 1950s to treat small brain tumors. The application of SRS to treat tumors in other regions of the body, known as Stereotactic Body Radiation Therapy (SBRT), is becoming much more common as evidence grows regarding the effectiveness of SBRT in treating select lung, spine and liver tumors.
Elekta supports the application of SBRT in several ways. First, from a technology perspective, Elekta provides motion management features, imaging capabilities and workflow designed specifically for SBRT treatments. These technological advancements will be on display at the Elekta booth in San Diego during ASTRO 2010.
Another way that Elekta supports the application of SBRT is by sponsoring research consortia to help gather additional clinical evidence regarding the efficacy of SBRT treatments across a variety of pathologies.
One of these groups, the Elekta Lung Research Group (ELRG), consists of physicians and physicists worldwide who are actively collaborating to evaluate outcomes in early stage inoperable non-small cell lung cancer patients. These researchers have already gathered data for more than 400 patients treated with volumetric image-guided stereotactic lung radiotherapy using daily online VolumeView™. The clinical findings of this group are summarized in a whitepaper, titled “SBRT Lung Treatment” by Dr. Joel Goldwein.
By sponsoring groups like the ELRG, Elekta continues to stay on the cutting edge of research into SBRT in order to develop innovative technology to improve opportunities for successful treatment with SBRT.
View the White Paper – SBRT Lung Treatment PDF here
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