Posts Tagged ‘liver cancer’
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.”
*Approval of indications may vary between different countries. Additional regulatory clearances may be required in some markets.
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
Elekta offers the world’s most complete portfolio of stereotactic treatment solutions for the treatment of cancer and diseases of the brain, spine and body. The resulting systems’ design and performance reflect decades of leadership and innovation.
Our radiation oncology and neurosurgery customers face the constant cost-benefit challenge of wanting to adopt the most advanced treatment protocols within the constraints of the resources available. Elekta Axesse™ has been specifically developed to help meet this challenge, to bring the highest treatment quality to the maximum number of patients.
Resource management benefits
Caseload versatility • Workflow efficiency • Patient throughput
Treatment quality benefits
Patient safety • Targeting accuracy • Dose escalation • Hypofractionation
A wide range of stereotactic and intensity modulated treatments
Lung • Liver • Prostate • Head-and-neck • Spinal metastases • Large brain metastases
Cancer is a group of more than 100 different diseases. They affect the body’s basic unit, the cell. Cancer occurs when cells become abnormal and divide without control or order. Like all other organs of the body, the colon and rectum are made up of many types of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy.
If cells keep dividing when new cells are not needed, a mass of tissue forms. This mass of extra tissue, called a growth or tumor, can be benign or malignant.
Benign tumors are not cancer. They can usually be removed and, in most cases, they do not come back. Most important, cells from benign tumors do not spread to other parts of the body. Benign tumors are rarely a threat to life.
Malignant tumors are cancer. Cancer cells can invade and damage tissues and organs near the tumor. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. This is how cancer spreads from the original (primary) tumor to form new tumors in other parts of the body. The spread of cancer is called metastasis.
When cancer spreads to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if colon cancer spreads to the liver, the cancer cells in the liver are colon cancer cells. The disease is metastatic colon cancer (it is not liver cancer).
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