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Often, when a patient is older in their years and receives the bad news that they have fallen victim to a form of cancer, they begin to come to terms with the fact that their lives will soon be over due to it. This sense of thinking does not have to be a person’s future outcome since with today’s technology no matter a person’s age, cancer treatment is a very promising option to be used. However, studies have shown patients aged 90 years or older are not even being offered any treatment at all. In this article the statistics of elderly patients and their success rates of using radiotherapy as a treatment option are shown and how even at an older age these patients have gained significant years added to their lives, which can be very worthwhile. With new techniques and technology, the treatment can be much less invasive without needing surgery and can truly be a lifesaver for many of lives young and old.

Researchers as CERN are always working to find new options for radiation therapy to be more effective and more affordable. Radiation therapy is a procedure that utilizes special equipment called a linear accelerator that emits a beam of electrons into a targeted area of a cancerous tumor on a patient. At high concentration, these x-ray beams can produce a larger enough dose of radiation to kill the cancer cells. Unfortunately, even with very precise placement, the x-ray can cause damage surrounding healthy tissue and organs, so doctors have many obstacles to overcome with effective cancer options still. New developments at CERN are showing great possibilities for the future by creating a electron accelerator called CLIC which uses high energy electrons in a smaller setting and more affordable. In this following article, it describes more in detail the process of this new found technology and how its can further change and evolve radiation treatment from where it is today.

A new promising proposal regarding radiotherapy dosing in tumors could bring exciting changes to the medical field, specifically the war on cancer in patients.

In a Medical Express article, the author talks about a study that proposes more higher energy particle beams focusing on small spots deep inside the body. The hope of doing so is to target more tumors more precisely, thus making the process of eliminating tumors more precisely. The lead of the study, Professor Dino Jaroszynski, claims that “around half of the population will suffer from cancer at some time in their lives. Of these people, half will be treated using radiotherapy or a combination of radiotherapy and chemotherapy.” The ability to focus on more accurate targeting of cancerous tumors in the body should hopefully pave the way for better results for those with cancer undergoing treatment going forward in the future.

The advancements in LINAC technology are significant.  In just the last few decades, the ability to treat cancers effectively without harming additional healthy tissues have grown considerably.  Linear accelerators have been transformed into systems that offer different techniques to target cancerous tumors.  Intensity-modulated irradiation, as well as particle therapies, have helped to ensure the maximum dose of radiation can be given to the tumor without overexposure to the surrounding healthy tissues. Image-guided radiation LINAC systems allow images to be taken while delivering radiation thus decreasing the amount of uncertainty in the location of the tumors.  One of the last hurdles modern technology is working to address is patient movement, however slight, during treatment. In this installment from Physics World, “PHASER linac will translate FLASH radiotherapy to the clinic” we are introduced to technology that looks to address this issue.

A new advancement in radiotherapytechnology has provided patients with brain cancer a new alternative for treatment that could increase the accuracy and the speed of treatment. This style of treatment will rotate the patient in sync with the radiation beam with a technique called Dynamic Couch Rotation. Current treatment has been done using Volumetric Modulated Arc Therapy (VMAT). This new technique has proven to be just as accurate but can also improve delivery times which in turn will reduce exposure to healthy/sensitive brain tissues nearby and decrease side effects overall. You can read the article “New radiotherapy system that moves patients in syncwith x-ray beam can deliver accurate treatment for brain cancer” to grasp a better understanding of this new treatment.

Hearing the word “Cancer” can be very scary when a doctor first diagnoses you or someone you love. When choosing the path of Radiotherapy, often a person is unsure what this journey will entail which makes things even scarier. A simplified treatment course will follow: consultation with radiation oncologist, CT simulation scan, treatment planning, and then finally the actual treatment. Each person’s own case is unique with intensity and amount of time a treatment will need to be administered.

To Read whole article below to understand the radiotherapy process below:

https://www.irishtimes.com/life-and-style/health-family/demystifying-radiotherapy-what-patients-receiving-treatment-can-expect-1.3806908

 

Radiation therapy plays a fundamental role in cancer treatment, but there is a global shortage of radiotherapy centres, with many low-to-middle-income countries having limited or no treatment capability. This situation exists in part due to the cost of facilities and the expense of acquiring and operating radiotherapy systems. Linear accelerators with simplified designs, such as fixed gantry systems, could reduce these costs.

Researchers at the ACRF Image X Institute at the University of Sydney are developing a 3D conformal radiotherapy system with a fixed vertical X-ray beam, horizontal patient rotation and image guidance. The full-size proof-of-concept prototype, which offers high-quality radiation therapy from a smaller, more robust and more cost-effective system, has now been successfully commissioned (Med. Phys. 10.1002/mp.13356).

From a financial perspective, there are many potential advantages of a such a fixed-beam system. Without a rotating gantry, the system has fewer moving parts, which could improve reliability and robustness, and potentially reduce maintenance costs. It would also require less bunker shielding to operate safely, thereby reducing the cost of building new bunkers or renovating bunkers housing older radiotherapy equipment such as cobalt-60 units.

The prototype system — developed by Paul Liu and colleagues working on the Nano-X project to improve global access to radiotherapy — is based on the concept of patient rotation, specifically, keeping the radiation beam stationary while still achieving the necessary beam angles to achieve a desired dose distribution. Image guidance technologies will identify the tumour and adapt the treatment in real-time to ensure that the radiation dose is precisely delivered to the target.

The prototype comprises a standard Synergy linac with the gantry fixed at 0° and a horizontal patient rotation system (PRS). The PRS is a custom-designed radiotherapy couch equipped with straps for the head, chest, hips and legs, plus three independently controlled airbags that inflate over a patient’s chest and sides. The couch can move with two degrees-of-freedom to position and rotate the patient.

After the patient is immobilized and in a specified treatment position, they can be rotated to a specific angle for either kilovoltage (kV) imaging via the on-board imager or treatment with the megavoltage beam. The software operating the PRS allows for precise motion control, setting the target position or angle along with the desired velocity, acceleration and deceleration. It can also follow a series of queued motion commands, or execute quick-stop, return-to-home and patient egress commands.

The system passed all commissioning steps, which involved verification of geometric and dosimetric accuracy following conventional radiotherapy guidelines. The team also performed thorough testing of safety and interlock systems.

Clinical potential

The authors note that three essential steps will be needed before treating patients. Cone-beam CT image reconstruction under gravitational deformation may require advanced image reconstruction algorithms. They also need to develop methods to shift the beam to account for gravitational deformation-induced target motion.

Additionally, a patient’s tolerance of, and anxiety level relating to, horizontal rotation is unknown. It could be as much of a problem as an MRI exam is to a claustrophobic or noise-averse patient. An upcoming clinical trial will investigate and quantify how patients respond to strap and airbag immobilization and horizontal rotation.

Liu discussed the challenges with Physics World. “While we initially focused on static targets, an important part of the system will be its ability to adapt to motion, both from the patient’s normal physiological functions like breathing and from gravity as the patient is rotated,” he explains. “The next stage of the project will focus on implementing and testing algorithms that we’ve developed to both identify the amount of motion and to compensate for it accordingly.”

To enable real-time image guidance, the researchers are testing kilovoltage intrafraction monitoring (KIM), a novel tumour localization system developed at the University of Sydney that accurately estimates the 3D position of a target based on the 2D position of segmented markers in kV projections. Read more

Real-time image-guided ART achieved on a standard linac

“KIM will offer real-time 3D target tracking with sub-degree and sub-millimetre accuracy,” Liu says. “We have successfully tested KIM together with real-time multileaf collimation tracking on a miniature version of this system, and are currently scaling these algorithms to our full-size prototype. We will be using KIM with a deformable phantom where the target will move as it undergoes rotation.”

The researchers are also investigating intensity-modulated radiotherapy and volumetric-modulated arc therapy, which are under various stages of implementation. Liu says that both are technically feasible, because the software and hardware control of the PRS has sufficient precision and flexibility.

Much work, followed by testing with veterinary radiation treatments, will be required before the first palliative treatments on human cancer patients can be undertaken. The system is not designed for infants, very small children or obese patients. But for all other cancer patients, this prototype radiotherapy system has potential to fill the existing and expanding gap between available treatment and need, especially for patients living in economically challenged areas of the world.

Original source: https://physicsworld.com/a/patient-rotation-enables-fixed-beam-radiotherapy-system/

Original Date: Feb 14 2019

Original Author: Cynthia E Keen

The MOMENTUM study is a transformative approach to evaluating innovative medical technology

UTRECHT, The Netherlands, Feb. 4, 2019 /PRNewswire/ —

Today, the international MR-linac Consortium announced the launch of the MOMENTUM study. The study is designed to generate data that enable safe, fast and, above all, ‘evidence-based’ introduction of magnetic resonance radiation therapy (MR/RT) into clinical practice. The MOMENTUM study represents the next step in the development of the Elekta Unity MR/RT system; the study will be focused on building a robust body of real-world clinical evidence and insights made possible by this technology. Information gained through the MOMENTUM study will guide the use of MR/RT to improve outcomes for cancer patients.

“Each treatment session on this innovative system is an opportunity to gain insight into the benefits that this technology provides and, critically, to determine which patients benefit from MR/RT therapy,” said Dr. Helena Verkooijen, Professor of Evaluation of Innovation at University Medical Center Utrecht (UMCU) and a member of MOMENTUM’s Management team.

Radiotherapy is an important component many cancer treatment regimens and approximately 50% of all cancer patients receive radiation during their treatment journey*. As with most medical therapies for cancer, radiotherapy is associated with short- and long-term side effects that can be treatment-limiting and/or reduce patients’ quality of life during and after therapy. Many of these side effects result from radiation-related damage to healthy tissue. The MR-linac system is designed to address this challenge by allowing improved targeting of radiation to the tumor and reduced exposure of nearby tissues and organs.

Dr. William Hall, Assistant Professor of the Department of Radiation Oncology at the Medical College of Wisconsin noted. “We believe that this kind of rigorous and coordinated approach has tremendous potential to improve patient outcomes and change radiotherapy.”

Cancer centers participating in MOMENTUM will ask patients if they are willing to share de-identified information about their treatment and subsequent experience, including tumor control rates and quality of life. This information will be aggregated into repositories that will allow researchers to assess outcomes, enhance the product and evaluate alternative treatment approaches.

“The MR-linac Consortium includes some of the world’s most talented and dedicated cancer researchers,” said Dr. John Christodouleas, Vice President of Medical Affairs and Clinical Research at Elekta and a member of MOMENTUM’s management team. “By collaborating on the MOMENTUM Study, we expect to accelerate clinical innovations enabled by this breakthrough technology.”

Elekta Unity makes it possible to visualize the tumor with high-resolution images during treatment through combining high-field MRI technology with a linear accelerator. This allows extremely precise delivery of the radiation dose, enabling higher dosing to the tumor bed while better sparing the surrounding healthy tissues. While this is expected to lead to better tumor control and fewer side effects it is crucial to show that the advanced technical capabilities of MR/RT translate into real benefits for the patient, such as prolonged disease-free survival and better quality of life.

The innovative MR-linac technology was developed by Elekta in collaboration with the MR-linac Consortium, which comprises experts in oncology, radiation therapy, epidemiology and medical physics from leading cancer centers around the world.

Elekta Unity has CE-mark and 510(k) clearance but is not commercially available in all markets.

About the MR-Linac Consortium

The Elekta MR-linac Consortium is a collaborative industrial-academic partnership that Elekta founded with seven centers and our technology partner, Philips in 2012 to provide an evidence-based introduction of the MR-linac to the medical community, and to support the advancement of the technology. The institutions that participated are: (Founding members) University Medical Center Utrecht, the Netherlands; The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, the Netherlands; The University of Texas MD Anderson Cancer Center, USA; the Institute of Cancer Research, working with its clinical partner The Royal Marsden NHS Foundation Trust, UK; Froedtert & the Medical College of Wisconsin Clinical Cancer Center at Froedtert Hospital, USA; The Christie NHS Foundation Trust, UK; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada. Lygature, The Netherlands, provides the public-private partnership management of the MOMENTUM study.

About Elekta

For almost five decades, Elekta has been a leader in precision radiation medicine. Our nearly 4,000 employees worldwide are committed to ensuring everyone in the world with cancer has access to – and benefits from – more precise, personalized radiotherapy treatments. Headquartered in Stockholm, Sweden, Elekta is listed on NASDAQ Stockholm Exchange. Visit elekta.com or follow @Elekta on Twitter.

Original Source: https://www.biospace.com/article/releases/elekta-new-study-to-learn-from-every-cancer-patient-treated-with-magnetic-resonance-radiation-therapy/

Original Source: https://www.biospace.com/article/releases/elekta-new-study-to-learn-from-every-cancer-patient-treated-with-magnetic-resonance-radiation-therapy/

Original Date: Feb 4 2019

Written By: Elekta