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:
There is quite a balancing act that goes on within healthcare facilities when it comes to whether or not medical equipment should be repaired or replaced. Unfortunately there is not one answer to address the issue. Decisions for repairing or replacing medical equipment such as linear accelerators and CT scanners needs to be done on a case by case basis. The most important factors being how the decision affects patient care and patient outcomes.
Many professionals involved in the decision to replace or repair medical equipment find weighing the costs and patient interests to be a difficult task. Facility decision makers need to determine the risks vs the rewards in how long to keep large scaled medical equipment in action. Preventative and corrective maintenance must be evaluated on a per machine basis to ensure the best decisions are made.
It is impractical to repair medical equipment when:
Replacement Parts Are Scarce: Replacement parts for LINACS or CT scanners aren’t common off the shelf items that you can find at any medical supply store. In fact, with manufacturers in a race to keep up with the latest and greatest technologies in equipment they are constantly phasing out older equipment which makes finding parts to repair medical equipment harder and harder to find. This alone makes it scary to rely on older equipment for critical patient care.
The Cost of Service: If medical equipment is not maintained or repaired by in house technicians’ facilities must look at the expense of service plans. Another factor is that as equipment ages, replacement parts are harder to find if not obsolete.
Patient Care Will Be Disrupted: When large scaled equipment starts to break down on a regular basis and interrupts patient care this wreaks havoc with patient care. If this is on-going, it can greatly affect your service and dissatisfied patients will seek care elsewhere.
On-Going Equipment Failure: Sometimes the equipment that you have is a giant lemon. If it is found that your device is failing time and time again it may make sense to replace it. Sometimes there is more liability in keeping a piece of equipment around that continues to fail than starting over.
There is a lot that goes into replacing a large scaled piece of medical equipment like a LINAC system, so it is crucial to have a plan in place for when the need arises. Not only does new equipment need to be purchased, the old equipment needs to be moved out to make room for the new. It is important to evaluate and reevaluate equipment frequently in order to avoid costly surprises. This is especially true in smaller facilities with stricter budgets.
Radparts is the world’s largest independent distributor of OEM replacement parts for Linear Accelerators and Radiation Oncology equipment. Radparts provides high quality, user friendly, low cost parts support for linear accelerators and radiation equipment. More information can be found at https://www.radparts.com/.
The prototype radiotherapy system combines a fixed
vertical radiation beam with horizontal patient rotation. (Courtesy:
Paul Liu)
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.
Many medical facilities and healthcare clinics find themselves mauling over questions regarding repairing or replacing medical equipment. Questions may include ones such as the following:
What is the typical lifespan of the equipment?
Are we near the end or at the beginning of the
equipment’s lifecycle?
Is it going to be cheaper to replace the piece
now or to repair it?
Are repairs feasible and if so, are they cost
effective?
When repaired will the equipment still be able
to provide the high patient care standards we desire?
What is the cost of removing the old equipment?
Do we see maintenance costs of the older
equipment increasing?
Often the choice to purchase a new piece of equipment verse repairing an older piece of equipment has to do with the cost of maintaining the older unit. Medical facilities and clinics figure if they are spending a couple of thousand dollars to maintain it then it is most likely better to replace it with a new piece. When it gets too expensive to maintain it is time to purchase a new piece of equipment.
For larger pieces of equipment like linear accelerators, CT scanners, and other radiation therapy equipment partsmay start to become obsolete. When this occurs, parts for older equipment LINAC become quite scarce. It is important for facilities to ensure there are enough replacement parts available to maintain their equipment because the parts won’t be available any longer. It doesn’t mean that facilities need to plan for new equipment in the next year but that they should start planning for alternative part sources and planning for new equipment.
Make sure you are totaling up the annual costs of medical equipment repairs. Costs for parts and repairs can change as parts become scarce. Obviously, manufacturers of large scaled equipment want you to buy new sooner rather than later while the finance people within your facility want you to maintain the equipment as long as possible, especially when technology has not changed a great deal. Obviously, the goal is to make sure you are not spending valuable resources unnecessarily.
Medical facilities should find various resources in which to seek opinions on equipment and whether it should be replaced or not. Finding a solid medical repair and maintenance partner, such as Acceletronics and Radparts when determining whether to replace or repair an item, as well as what to do with older pieces when purchasing new ones.
Radparts is the world’s largest independent distributor of
OEM replacement parts for Linear Accelerators and Radiation Oncology
equipment. Radparts provides high
quality, user friendly, low cost parts support for linear accelerators and
radiation equipment. More information can be found at https://www.radparts.com/.
A linear accelerator is a large scaled piece of medical equipment that is used to treat cancerous tumors. It does this through a process of high energy x-rays that conform to the shape of a tumor and emits a radiation beam that destroys cancer cells while trying to spare the surrounding healthy tissue. Linear accelerators have a number of features that are built in which works to ensure the patients safety. These measures prevent dosages higher than what the patient has been prescribed to be given.
When you are schedule to receive radiation therapy using a linear accelerator, your oncologist will deliver the treatment that was planned between them, the dosimetrist and your physicist. The oncologist will double-check your treatment plan each and every time before they begin treatment. This ensures quality control and ensures that your treatment is delivered exactly as it should be.
Linear accelerators delivers external radiation therapy for patients with cancer. The LINAC is used to delivery treatment on a variety of areas throughout the body. High energy x-rays are delivered directly to the tumor using a radiation beam that is delivered from the linear accelerator. The treatment is designed to shrink and destroy the cancerous tumor without harming the healthy tissue that surrounds the tumor. LINAC is used to treat cancerous areas throughout the body using all of the conventional radiation techniques including: IMRT, IGRT, VMAR, SRS, and SBRT.
Linear accelerators work using technology similar to a
radar. In the “wave guide” a part of the
accelerator, electrons collide with a metal target to produce high-energy
x-rays. The high-energy x-rays exit the
machine in the shape of a patient’s tumor.
These beams are shaped by a multileaf collimator that is within the head
of the linear accelerator.
Patients are put onto a moveable treatment couch that is
positioned properly and are asked to lie still.
It is important to note that the treatment couch can move up, down,
right, left, in, and out. The radiation
beam comes out of the gantry, part of the accelerator, that can be rotated
around the patient. These two systems,
working together, can deliver radiation in a variety of angles.
Linear accelerators are operated by a radiation therapist. There are a team of experts who work together to create a treatment plan. A radiation oncologist, a medical physicist, and a dosimetrist work in conjunction of one another to come up with a treatment plan. The radiation oncologists prescribes the correct treatment volume and dose. A medical physicist and dosimetrist determine how your prescribed dose is delivered and calculated.
Patient safety is insured in a number of ways. Before treatment is given the plan is developed and approved in collaboration with your team. This plan is continually reviewed for quality assurance. Safety measurements are built directly into the accelerator that does not allow a higher dose of radiation to be delivered to patients. Before a patient is treated the radiation, therapist will perform unilateral checks across the LINAC. More thorough linear accelerator checks are done monthly and annually. Specialized companies are available for hire that maintain, service, and repair linear accelerators. It is important to have access to LINAC service providers and LINAC parts for repair. The less downtime a facility incurs the higher the quality of patient care they can provide.
Patients are supervised throughout treatment using monitors
and microphones that in the room. This
allows the patient and radiation therapist to communicate. The position of the radiation beam are
continually checked to ensure the positioning has not moved from the original
treatment plan.
The safety of the staff and patient are crucial when using linear accelerators in treating cancerous tumors. The LINAC is installed in a room all by itself. The walls of the room are made from lead and concrete to eliminate the high energy x-rays from escaping and exposing people outside of the room. Radiation therapists do not tun on the LINAC until they are safely outside of the treatment area. Linear accelerators will only emit radiation when the machine is in use.
Radparts is the world’s largest independent distributor of
OEM replacement parts for Linear Accelerators and Radiation Oncology
equipment. Radparts provides high
quality, user friendly, low cost parts support for linear accelerators and
radiation equipment. More information can be found at https://www.radparts.com/.
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/
Anyone that is starting a new medical treatment has a right to be a little nervous. This article is being written to help ease the anxiety of cancer patients that are scheduled for radiation therapy. Fear comes because of the unknown and common misunderstandings patients have about radiation.
Radiation therapy is delivered using a large piece of medical equipment known as a linear accelerator. With maintenance, repairs, and part replacement linear acceleratorscan deliver radiation to an average number of patients for between five and ten years. Below we will answer the most commonly asked questions about radiation therapy using a linear accelerator, LINAC.
Is Radiation Therapy Painful?
Thankfully radiation therapy is not painful. Patients often report that they do not experience any sensation when the radiation is delivered from the LINAC. A few patients have reported that they feel a slight warm tingle in the area where the LINAC is delivering radiation. The skin in the area where linear accelerators deliver treatment can become dry and itchy over time. This can cause some discomfort but definitely not enough to stop treatment. Skin reactions due to radiation can be treated with over the counter ointment.
Does Radiation Therapy Cause Me to Be Radioactive?
Radiation therapy only makes patients radioactive when internal radiation is given. Patients are radioactive while the radioactive materials are in them. These patients are secluded in a private hospital room. Patients that are treated using a LINAC through external radiation, will not be radioactive at all. External radiation delivers a precise dose of radiation to the cancerous tissues instantaneously. With external radiation the radiation does not linger. Once the LINAC is turned off the radiation isn’t an issue. In external radiation, patients can continue on their normal routines without worry.
Will I Lose My Hair During Radiation Therapy?
Radiation is considered a localized treatment which means that it focuses directly on the area being treated. This being said you can expect hair loss in the area of treatment however unless treatment is done on your head you shouldn’t experience hair loss. Confusion occurs because people associate radiation and chemotherapy as one in the same therapies. The difference is that chemotherapy is a systemic treatment which means it affects the entire body. During chemotherapy there is a likelihood that patients will lose their hair.
Should I Expect to Experience Nausea and Vomiting?
Radiation therapy doesn’t usually cause patients to feel sick. If treatment is given in areas such as the liver, brain, or gastrointestinal tract patients have more of a risk to experience nausea. Also, patients that are going through chemotherapy and radiation at the same time there is more of a risk for feeling ill.
Radparts is the world’s largest
independent distributor of OEM replacement parts for Linear Accelerators and
Radiation Oncology equipment. Radparts
provides high quality, user friendly, low cost parts support for linear accelerators
and radiation equipment. More information can be found at https://www.radparts.com/.
This is a frequently asked questions when healthcare centers
are starting the process to budget for the purchase of a new or refurbished
Linear Accelerator. It is important to
not be surprised when it comes to financial obligations within a medical organization. The answer is Yes, there is a cost to have
old LINAC systems removed from your
facility. There is a cost to have new
equipment installed as well but that is often combined with the price you pay
for the equipment itself.
Although linear accelerators are a machine that offers a priceless treatment in the fight against cancer with lifesaving radiation beams treating thousands of patients for countless number of years, they do become worthless. Like most machines, over time the labor and linear accelerator parts cost more to repair the LINAC machine than it is worth. When this occurs, the machine is worth nothing and needs not only to be removed but also properly disposed of.
Another element to
add to the mix is the introduction of new technology. This is a reoccurring issue that is seen in
medical equipment. Older machines cannot
be updated to run properly with the latest and greatest treatments and
therefore simple become worthless. Yep,
even some LINAC machines with life left in them become obsolete to healthcare
providers promoting the latest and greatest treatments. Although these machines are worthless to
these facilities they can often be moved and utilized by other facilities such
as veterinarians, possible dermatologists, and of course in poverty-stricken
locations that would otherwise go without.
When a linear accelerator has been deemed to have little to know value, meaning no one is willing to pay you for it, your facility will face the cost of removal. This cost includes professional and safe dismantling, removal, and disposal of the LINAC. This process often requires the system to be loaded onto a crane as they weigh several thousand pounds. This should be done by professionals to prevent catastrophe. After the machine has been removed from the facility it will be tested for radioactivity and disposed of once they are cleared.
At the end of the day, when all is said and done the cost to
have a large scaled piece of medical equipment such as a linear accelerator
removed, dismantled, and disposed of ranges between $5,000 and $25,000.
Radparts is the world’s largest independent distributor of
OEM replacement parts for Linear Accelerators and Radiation Oncology
equipment. Radparts provides high
quality, user friendly, low cost parts support for linear accelerators and
radiation equipment. More information can be found at https://www.radparts.com/.
DOTmed.com – Elekta Unity MR-linac gains FDA 510(k) clearance The Elekta Unity magnetic resonance radiation therapy (MR/RT) system has gotten its FDA 510(k) premarket notification and is now ready for sale and clinical use in the U.S.
“Since receiving CE mark in June 2018, Elekta Unity has been transforming the care of cancer patients in Europe, and we are excited that this cutting-edge technology is now commercially available to U.S. patients,” Elekta president and CEO Richard Hausmann said in a statement, adding that the Unity will make possible the development of personalized, precision radiation therapy regimens optimized for safety and efficacy.
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The Unity will “make radiation therapy a viable treatment option for more patients,” he added, thanking all involved in the MR-linac consortium and MR technology partner, Royal Philips.
The Unity is designed to simultaneously deliver radiation dose and visualization of tumors and adjacent healthy tissue in the form of high-quality MR images, employing integrated tools for possible treatment adjustments to match current anatomical information in a treatment session.
“Unity is a tremendous leap forward in our ability to tailor radiation therapy to each patient’s tumor and anatomy, and to adapt treatment in real time as the tumor changes shape and position relative to organs at risk,” said Dr. Christopher Schultz, chair of the Elekta MR-linac Consortium.
He called the new technology “fundamentally” transformational in terms of the development and implementation of therapy regimens that will permit clinicians “to achieve optimal outcomes for our patients.”
Back in September, Elekta forecast a net sales compound annual growth rate of 8-10 percent through its 2022/2023 financial year.
“We have improved our margin and cash flow and have returned to high growth. We are now in a good position to realize our vision,” said Hausmann in a statement, noting that “the future of our industry is in precision radiation medicine, including diagnostic quality imaging at the point of treatment, real-time adaptive treatment planning, data-driven personalization and intelligent automation.”
Its predictions follow the company’s recent decision to sell its magnetoencephalography (MEG) business to Croton Healthcare subsidiary York Instruments as part of an initiative to restructure and strategically prioritize its treatment solutions and oncology informatics portfolio, agreements set up between the radiotherapy manufacturer and other parties over the past year.
A trial has shown that radiotherapy is more effective when levels of ropidoxuridine in a patients’ body reach a certain level…
A
new drug designed to make radiotherapy more effective in treating
cancer has been given to patients while they are receiving radiation and
shown to be safe.
The drug, called
5-iodo-2-pyrimidinone-2′-deoxribose (IPdR), or ropidoxuridine, has the
advantage that patients can take it in capsule form, as opposed to
intravenously. When the drug enters the body, researchers believe it
changes into an active form that can make cancer cells more susceptible
to the effects of radiotherapy.
Results of US NCI trial #9882, presented by Dr Timothy Kinsella from the Department of Radiation Oncology at the Warren Alpert Medical School of Brown University and Rhode Island Hospital in the USA, show that the drug has minimal side effects when given to patients with a variety of gastrointestinal cancers during the course of their radiotherapy.
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Dr Kinsella explained: “The aim of my research is to find better ways to treat patients with cancer, and specifically to develop ways to make radiation treatment safer and more effective.
“Previous
research found a promising compound called iododeoxyuridine, or IUdR,
that worked very well to improve the effectiveness of radiotherapy, but
IUdR could only be given intravenously and proved to have many side
effects for patients.
“As a result, this new drug, IPdR, was
developed. It’s a prodrug that can be taken as a capsule and, once
inside the body, it’s converted into the active drug, IUdR.
“This
trial is the first to test it out in patients while they are receiving
radiation therapy, and the results suggest that it’s safe with minimal
side effects.”
Dr Kinsella and his colleagues tested the new drug
in a group of 18 patients with advanced cancers including oesophageal,
pancreatic, liver, bile duct, rectal and anal cancers. All had been
referred for palliative radiotherapy.
Alongside their
radiotherapy, patients were given a daily dose of the IPdR prodrug over
28 days. They were given blood tests to check on the levels of both the
IPdR prodrug and the active IUdR drug at various points during their
treatment. The dose of the prodrug was gradually increased, and patients
were monitored for side effects.
Results of the trial suggest
that IPdR can be safely given to patients up to a dose of 1200mg per day
for 28 days without causing serious side effects. The results also
suggest that this dose creates levels of the active IUdR drug in
patients’ blood that are high enough to have a radiosensitising effect.
Of
the 18 patients on the trial, 14 could be assessed for any effect on
their tumours with a CT or MRI scan 54 days after beginning the
treatment. Among these patients, one had a complete response
(disappearance of tumour), three showed a partial response (at least 30
percent reduction in the tumour targeted by radiotherapy), nine had
stable diseases (no growth in the tumour) and one patient stopped
treatment because of an infection and had progressive disease (at least
20 percent growth in the tumour).
Dr Kinsella added: “This
clinical trial showed that when patients take IPdR at home before coming
for radiation treatment, the level of IUdR in their bloodstream is high
enough to make radiation more effective at killing cancer cells. It
also showed that the dose of IPdR needed to achieve therapeutic levels
of IUdR in the blood causes minimal side effects.
“However, this
trial was with patients who had recurrent cancer and had already
received a number of other cancer treatments. In newly diagnosed
patients, it could be that we can safely use a higher dose and have a
bigger effect on tumours.”
Dr Kinsella and his colleagues are
already studying the effects of IPdR in patients receiving whole brain
radiotherapy for cancer that has spread to the brain. Following this
trial, plans are in progress to study the drug in patients who have been
newly diagnosed with glioblastoma, an aggressive form of brain cancer.
Dr Eric Deutsch, Professor of Radiation Oncology and head of the radiation oncology department and research unit at the Institut Gustave Roussy, Villejuif, France, is a member of the EORTC-NCI-AACR Symposium scientific committee and was not involved with the research. He commented: “Radiotherapy is a vital element in treating many forms of cancer. This research is investigating whether the IPdR drug could make radiotherapy even more effective for more patients.
“In treating cancer
patients, we must always consider the risks and benefits of any therapy.
In this study, the risks of the IPdR drug were minimal, and the benefit
was that it can be taken by patients at home. We don’t have enough
evidence yet on whether IPdR can improve patient outcome, but we hope
that this will become clearer as the research continues.”
The research was presented at the 30th EORTC-NCI-AACR Symposium on Molecular Targets and Cancer Therapeutics in Dublin, Ireland.
