VMAT
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.
Intended for radiation oncologists, medical physicists, dosimetrists and nurses interested in VMAT and IGRT training, this one and a half day course is December 5-6 at Swedish Cancer Institute in Seattle, Washington.
The program includes topics such as defining target volumes; clinical implementation; billing issues; quality assurance; various tumor application: thoracic, head and neck, prostate, abdominal, and breast; hypofractionated stereotactic radiotherapy protocols; and patient education.
In addition to the didactic sessions, the course includes a demonstration in real time of CBCT technology. Each participant will receive a manual which will provide additional information for each member of your cancer care team and a CD of PowerPoint presentations.
Upon completion, participants will be able to address:
- Target volumes for IGRT
- Billing
- Coding and reimbursement issues
- Practical aspects of setting up an image-guided radiotherapy program
- The role of IGRT in the treatment of various tumor types
- Research results
To register and view the agenda, visit: http://www.elekta.com/events_detail.php?id=1093
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.
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