Targeted, pinpointed treatments may mean better control and fewer side effects
Radiation therapy is a standard treatment for many types of cancer, as it can successfully destroy cancer cells. But it can also come with downsides: skin damage, fatigue, nausea, long-term side effects and long treatment schedules. Fortunately, advancements in targeted and pinpointed radiation therapy can offer patients less radiation time, less toxicity, more comfort and improved outcomes.
A standard six-week course of radiation would have been particularly tough for 70-year-old Marie Bartolo, who was diagnosed with stage 1 ductal carcinoma breast cancer in 2015. The daily trips would have interfered with her caring for her 44-year-old son Mathew, who has autism, and her elderly mother.
Fortunately, Bartolo’s radiation oncologist, William Small Jr., MD, chair of Loyola Medicine’s Department of Radiation Oncology and director of Loyola’s Cardinal Bernardin Cancer Center, had a suggestion: a new treatment that would reduce six weeks of radiation to a one-time dose.
“One of the reasons I wanted it is because I care for my mother; I have a grown son with autism; and, at the time, I had a part-time job,” Bartolo says. “Six weeks of radiation would have just been really difficult.”
Intraoperative Radiation Therapy
Small’s suggestion was Intraoperative Radiation Therapy (IORT), a new treatment that delivers a one-time radiation dose during surgery and tumor removal. The radiation precisely hits the cavity where the tumor had been. It’s administered in highly focused, highly concentrated doses and stays away from healthy tissue.
“IORT can replace having to come in for more radiation and can do as well as or better than standard radiation,” Small says. “It is less toxic and more convenient. It is a reasonable option with early stage breast cancer, and, for certain tumor sites, can increase the chance of tumor control and survival.”
Small says IORT can be used on almost all cancers depending on the clinical situation, including colorectal, brain, gynecological, rectal, head, neck and early stage breast cancers.
Loyola is involved in a clinical trial using IORT for patients with glioblastoma, a deadly brain cancer with a survival rate of just 11 to 15 months. An early phase of the trial showed outcomesthat looked dramatically better than what’s come to be expected. “If true,” Small says, “it would be a remarkable breakthrough.”
MRIdian Linac System
Small has another new favorite treatment tool — the MRIdian Linac System, a state-of-the-art, MRI-guided technology.
Previously, radiation was applied beyond the diseased tissue to be sure all the cancer was treated. “Now, we can precisely target areas to millimeter accuracy in delivering radiation,” Small says.
The MRIdian System pinpoints the tumor site precisely and treats it with an ultra-sharp beam of radiation while accounting for natural breathing movement. It is used on some patients who have tumors in the chest and abdomen, as well as some breast and pancreatic cancers, where breathing causes the tumor to move during treatment. It can be a dramatic game changer, Small says.
“The machine will only turn on when the tumor is in target,” Small says. “When you treat a smaller field, you protect healthy tissue and have less toxicity and a reduction in radiation time.”
C-RAD Optical Surface Monitoring System
“Advancements in radiation oncology the last two years have been incredibly rapid,” says radiation oncologist Stephen Nigh, MD, medical director of Cancer Services at Northwest Community Hospital in Arlington Heights.
One of those advancements is the C-RAD Optical Surface Monitoring System, which can pinpoint radiation treatment to tumor sites while protecting healthy organs and tissue.
“The [C-RAD] product shines a light over the patient’s treatment surface and uses color mapping so the color lights up the screen when the patient is in the exact accurate position to be treated,” Nigh says.
“Those who benefit most are breast cancer patients, especially patients with left-sided tumors, because that’s where the heart lies,” Nigh says. The technology helps make sure the heart is out of the radiation field.
“We can confidently tell our patients that we have treated their cancer accurately, and we can also tell them that we can avoid the heart and therefore better avoid long-term complications,” he says. “Patients have less anxiety and it is just a more accurate treatment delivery.”
The Halcyon Linear Accelerator
Nigh is also enthusiastic when talking about the new Halcyon Linear Accelerator. Linear accelerators are used to aim high-energy rays from outside the body into tumors.
“Every radiation department has a linear accelerator, but the Halcyon is a real game-changer and a whole new platform,” says Nigh, who uses it for patients with brain, breast, prostate, pancreas, head, neck and lung cancers.
“The uniqueness of it is that it’s 100% image-guided with a built-in cone-beam CT and a built-in X-ray machine. It is designed for a patient’s comfort and treatment accuracy,” Nigh says. The Halcyon is a fast, quiet scanner with an open design, so patients don’t feel claustrophobic.
The definition of the word halcyon is tranquil, calm and peaceful. But, “when you get cancer, you are anything but tranquil, calm and peaceful,” Nigh says. “The big benefit to this machine is it’s a calming experience for patients and not as intimidating as in previous years. It is also super accurate.”
Specialists are on the cusp of exciting advances in pinpointedradiation treatments. For Bartolo, the new approach allowed herto achieve remission and to take care of both herself and her family.And the development of new radiation technology may offer new options to millions of other patients with a cancer diagnosis.