COMMUNITY CLINIC USES IMAGING-EQUIPPED ELEKTA TREATMENT SYSTEM TO ZERO IN ON CANCER

URO clinicians have been using Elekta Synergy® – an IGRT system equipped with integrated imaging and treatment beam shaping technology in about 20 patient cases a day since November 2005. “We use the Elekta Synergy system for patients in whom soft tissue localization is key ,” says Oscar Mendiondo, M.D, radiation oncologist at URO, a division of Lexington-based specialty clinic, United Surgical Associates. “These include patients who have prostate, head and neck, brain or lung tumors. The precise location and position of these lesions inside the patient on a day-to-day basis are hard to determine without being able to actually see the tumors. Elekta Synergy has imaging technology integrated on the treatment system, meaning that we can make fine adjustments to the patient’s treatment while he is positioned in the treatment system and immediately before the patient receives its radiation treatment for the day.”The version of Elekta Synergy (See “About Elekta Synergy” below) system that URO uses includes a special beam shaping device called Beam Modulator™, which enables clinicians to create radiation beam shapes that closely conform to the outlines of the tumor. Combined with Elekta Synergy system’s imaging capabilities, the conformal beam shapes that Beam Modulator creates, help physicians focus treatment beams more accurately – enabling them to treat the tumor, while avoiding healthy normal tissues near the tumor. Elekta Synergy® in practiceDr. Mendiondo reports that between 17 and 23 patients are treated on the Elekta Synergy system at URO each day. Eighty-five percent of these treatments will include use of the treatment system’s imaging technology, which uses a method called VolumeView™ to afford volumetric imaging capability. “We use VolumeView to localize the tumor on a daily basis to maximize accuracy,” Dr. Mendiondo says. “As a result, we are able to escalate doses giving our patients the best probability of local control while minimizing side effects.”Nowhere is this more important than in prostate radiation therapy, in which the target (the prostate) can move around significantly due to variable filling and emptying of the bowel and bladder, which can push the prostate out of its normal zone. Patients with prostate cancer comprise half of URO’s case volume.“Because we can acquire an image of the prostate just before treatment, we can make the treatment margins around the prostate very tight – a posterior margin of just three millimeters and an anterior margin of between four and five millimeters,” he notes. “Without the benefit of integrated imaging, the smallest margin I dared use in the past was at least one centimeter, which would, by necessity, include a good portion of rectum and bladder. With Elekta Synergy however, we are able to treat these patients with very tight fields – and it’s wonderful to see patients go through an entire treatment course and not even blink – so to speak -- because the rectal side effects are absolutely minimal” says Dr. Mendiondo.Lung nodules also are among the tumor targets that benefit from Elekta Synergy system’s ability to visualize soft tissues. VolumeView imaging helps Dr. Mendiondo accurately localize small tumors that hide behind the heart or in the paraspinal gutters, or are otherwise difficult to identify using a conventional portal imaging device. “I believe we are reproducing the treatment parameters with one millimeter accuracy on a day-to-day basis and I’m also able to use just five millimeter margins around the target,” he says. Dr. Mendiondo sees Elekta Synergy as representing a paradigm shift in radiation therapy. “We’re extremely happy with what Elekta Synergy enables us to do here at URO – this system truly change the way we think and the way we do things,” he concludes.About Elekta Synergy®The creation of Elekta Synergy, introduced in 2002, was driven by the need to visualize internal structures, including soft tissues, in three dimensions within the reference frame of the treatment system and at the time of treatment. This will allow the clinician to minimize geometric uncertainties resulting from both organ motion/deformation and slight differences in patient set-up. Elekta Synergy has therefore been designed to inspire clinical confidence via IGRT to practice advanced radiation therapy techniques. This combination of high resolution imaging, taken in 3D and at the time (the 4th dimension) of treatment – combined with workflow solutions developed to be applicable on a routine basis – is described as ‘4D Adaptive™ IGRT’ and is the Elekta IGRT solution.******