TEANECK, NJ – October 20, 2004. A team of radiation oncologists at a New Jersey hospital have become the first to treat cancer patients using a unique combination of imaging and radiotherapy delivery techniques to track the motion of tumors within the body and deliver image-guided radiation therapy with pinpoint accuracy. Clinicians at the Holy Name Hospital in Teaneck are combining 4D imaging using PET/CT scanners, respiratory gating and IMRT (Intensity Modulated Radiation Therapy) to offer extremely precise treatments for patients who experience a high level of tumor motion. Using imaging and treatment systems from GE Healthcare and Varian Medical Systems leaders in CT and PET/CT scanning and integrated radio therapysystems respectively the team has treated 23 patients to date with some surprising and promising results.
“Using these different technologies has enabled us to discover very unexpected movement in some of the tumors,” says Jacqueline Brunetti, MD, Director of Radiology. “If the patients had been treated conventionally, the tumors would have moved out of the treatment field and we might have under-treated them.”
A 70-year-old female patient with a cardiac sarcoma is among those to benefit from the new approach.
“We were able to image the motion of the heart tumor and produce a respiratory gated, bi-fractionated IMRT treatment plan that optimised the dose to the more metabolically active parts of the tumor while minimising exposure to the left ventricle, the lungs and the spinal cord,” says Charles Vialotti, MD, Director of Radiation Oncology.
“Without this technology, this would have been impossible.”Dr Vialotti adds, “The PET/CT scan showed a portion of this patient's tumor was more metabolically active, and therefore more malignant, than the rest. By using IMRT and modulating the dose, we boosted the daily dose in the active area of the tumor by 10 percent.”
He says the patient, who was in a wheelchair when she arrived at the clinic after having endured open-heart surgery and two unsuccessful courses of chemotherapy, is now recovering well and walking a mile a day.
“This is all about converging technologies for the benefit of patients, says Allan Caggiano, MS, Chief Physicist at Holy Name Hospital. “This is one of a very few establishments in the world doing 4D PET/CT scanning, gating and IMRT together and we see this as the way to go forward for many patients.”
The PET (Positron Emission Tomography) scan captures the metabolic activity of the tumor while the CT (Computerized Tomography) scan provides high resolution images clearly depicting the tumor’s location and structure. Together, the two scans can be used to detect and evaluate tumor cell activity as well as locate the site with pinpoint accuracy. By using these scans as the basis for the treatment plan and incorporating Varian’s RPM respiratory gating system and GE’s Advantage 4D gating application to track motion within the patient’s breathing cycle, treatment accuracy can be significantly enhanced. Holy Name Hospital’s patients are treated on Varian Clinac linear accelerators, which can rapidly deliver precisely shaped IMRT treatment beams that focus higher doses on tumors while protecting surrounding healthy tissue. The RPM Respiratory Gating system is one of Varian’s tools for delivering Dynamic Targeting image-guided radiation therapy.
“This validates Varian’s approach to helping doctors manage tumor motion with image-guided radiation therapy (IGRT) tools that are fully integrated, comprehensive, and clinically practical,” says Richard Levy, PhD, Varian’s President and CEO.
“By linking our technologies, Varian and GE Healthcare are providing a single, comprehensive suite of integrated imaging, information management and treatment solutions for See and Treat Cancer Care,” said Joe Hogan, president and chief executive officer, GE Healthcare Technologies.
“As a radiologist coming into the radiotherapy field,”adds Dr.Brunetti, “I have been astounded at how a team approach to the planning process really works in making an incredible difference in patient care. The convergence of these different technologies has really brought radiotherapy to a new level and confirmed that it is a very effective treatment on the road to a cure.”
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