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under the microscope
MANHASSET — Adaptive radiotherapy (ART) can be beneficial
with only one or two applications within a six-week treatment period,
according to findings by researchers led by a senior investigator
at the Hofstra North Shore-LIJ School of Medicine and The Feinstein
Institute for Medical Research. The National Cancer Institute
sponsored the first-of-its-kind clinical trial, which focused on ART
for head and neck cancer.
Trial Examines Role
of Radiotherapy in
Head/Neck Cancer
Physicians often use radiotherapy to treat head and neck cancer.
A type of radiotherapy that is commonly used is intensity-modulated
radiotherapy, or IMRT. IMRT allows physicians to “sculpt” radiation
and have it bend around healthy tissue and target the tumor so the
radiation adapts to the anatomy of each patient. Although IMRT
is a preferred mode of cancer treatment, its Achilles heel is that
it is based entirely on computed tomography (CT) or magnetic
resonance imaging (MRI) performed before a treatment period
begins. Since typical radiation treatment periods for head and neck
cancer take six to seven weeks, standard IMRT cannot compensate
for common changes that occur in a patient’s body during treatment.
Such changes could include weight loss, tumor shrinkage or gradual
movement of normal tissues. By not compensating for these
changes, there is increased risk of
toxicity or even missing the tumor.
For the new trial, investigators
started patients on standard IMRT.
Then, they took CT scans while
patients were lying in the radiation
treatment room each day so they could
monitor changes in tumor and normal
tissues during the course of treatment
(six weeks). Through computerized
techniques, the investigators “adapted” David Schwartz, MD
32 Summer 2012
By Emily Ng
(thus the name “adaptive radiotherapy”) according to significant
tumor or body changes.
“ART keeps radiation treatment tightly fitted to a patient’s body,
almost as if it were being shrink-wrapped,” noted David Schwartz,
MD, vice chair of radiation medicine at the North Shore-LIJ
Health System and a senior investigator at the Feinstein. “It is as
individualized as our current treatment can realistically be.”
“What was most encouraging about the trial findings was that
ART appears effective with only one or two additional replans. This
means that ART does not have to be overly burdensome or expensive
to make a difference. This is something that is feasible, and could
eventually make a real-world difference in many clinics.”
The findings of this trial were recently released online in
advance of publication in the International Journal of Radiation Oncology
*Biology* Physics.
Above: Intensity-modulated radiotherapy, or IMRT, allows physicians to
“sculpt” radiation and have it bend around healthy tissues and target a tumor.