Radiation after mastectomy underused, U-M study finds

ANN ARBOR, Mich. — While radiation therapy is common after breast conserving surgery, it’s much less frequent after mastectomy, even among women for whom it would have clear life-saving benefit. This is according to a new study from researchers at the University of Michigan Comprehensive Cancer Center.

The study looked at 2,260 women treated for breast cancer, assessing whether they had lumpectomy or mastectomy, and whether they would be strong candidates for radiation therapy. Women who have particularly large tumors or cancer in four or more of their nearby lymph nodes are recommended to have radiation after mastectomy.

The study found that among patients who should receive radiation therapy according to medical guidelines, 95 percent of those who had lumpectomy went on to receive radiation, but only 78 percent of those who had mastectomy received radiation. Among women for whom radiation is less clearly beneficial, 80 percent of the lumpectomy patients had radiation while only 46 percent of the mastectomy patients did.

source: University of Michigan Health Syste

Specific lymph node radiotherapy is well-tolerated after surgery in early breast cancer patient

Barcelona, Spain: In patients with early breast cancer, giving radiotherapy to the lymph nodes located behind the breast bone and above the collar bone is well-tolerated, after mastectomy or breast conserving surgery, a radiation oncologist will tell delegates at the seventh European Breast Cancer Conference (EBCC7) today (Saturday 27 March). Women at a high risk of developing breast cancer will probably benefit from additional lymph node radiotherapy, Dr Philip Poortmans, from the Dr. Bernard Verbeeten Instituut, Tilburg, The Netherlands, and a member of the EORTC* Radiation Oncology Group, will say.

Initial findings from the 4,004-patient multi-centre study carried out by the EORTC radiotherapy and breast cancer groups (46 institutions from 13 countries) show that there is no evidence of increased toxicity to the heart at three years follow-up in patients who received additional lymph node radiotherapy.

Patients will be followed-up for many years to see whether specific lymph-node radiotherapy could lead to long-term damage of the heart or the lungs, side effects that are associated with breast cancer radiotherapy.

Dr Philip Poortmans, one of the trial co-ordinators, will tell delegates that the longer-term aim of the EORTC study is to see whether giving additional radiotherapy to the lymph nodes located behind the breast bone and above the collar bone (internal mammary and medial supraclavicular [IM-MS] lymph nodes) to patients with early operable breast cancer will improve overall survival.

source: EurekAlert

Study Reveals TomoTherapy® Plays Key Role in Enabling Concurrent Chemo-Radiation Treatment

Clinical Trial from Brussels University Hospital in Belgium

MADISON, Wis – March 23, 2010 – TomoTherapy Incorporated (NASDAQ: TOMO), maker of advanced radiation therapy solutions for cancer care, today cited the first published results on the concurrent use of hypofractionated TomoTherapySM radiation treatments and chemotherapy for unresectable locally-advanced non-small cell lung cancer (NSCLC). The clinical trial was carried out by the Department of Radiation Oncology at the Universitaire Ziekenhuis (UZ) Brussel in Brussels, Belgium, and published in the journal Cancer (Volume 116, Issue 1, Pages 241-250, Jan 2010). Previous studies have shown an increase in the rate of tumor control via either escalating biologically effective radiation dose, or the addition of chemotherapy concurrent with the course of radiation. This trial tests the feasibility of dose escalation along with concurrent chemotherapy, taking advantage of the accuracy and dose conformity of helical TomoTherapy treatments in minimizing radiation damage to normal tissues.

The paper, “Toxicity Report of a Phase 1/2 Dose-Escalation Study in Patients With Inoperable, Locally Advanced Non-small Cell Lung Cancer With Helical TomoTherapy and Concurrent Chemotherapy”, concludes that a TomoTherapy schedule of 67.2 Gy in 30 fractions, concurrent with cisplatin/docetaxel, is feasible and has acceptable toxicity with a promising tumor response rate.

source: TomoTherapy

ASTRO publishes supplement on protecting cancer patients by reducing radiation doses, side effects

The Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) review has been published in the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Radiation Oncology (ASTRO) to update recommendations for the safe irradiation of 16 organs. For each organ, the relationship between dose/volume and clinical outcome is reviewed. These reviews replace initial recommendations published in 1991.

When physicians began using radiation therapy to treat cancer, there was limited technology available to image a tumor and then target radiation specifically to it while limiting the dose to nearby healthy tissues. In the 1980s and 1990s, the field of imaging was revolutionized through the use of computed tomography-based diagnosis and radiation therapy treatment planning, allowing for treatments to be targeted more directly to the tumor and minimizing exposure to surrounding tissues.

No radiation treatment can be given while avoiding all nearby healthy tissue, but unlike cancer cells, normal tissue cells can repair themselves after receiving radiation. The QUANTEC review was published to help the radiation oncology treatment team decide which areas of healthy tissue surrounding a tumor can most safely receive radiation and to provide guidance for selecting doses/volumes to be treated.

source: ASTRO

New Device Optimizes Targeting of Radiation Therapy for Prostate Cancer

PR Log (Press Release) – Mar 16, 2010 – Radiation oncologists and prostate health specialists at South Nassau Communities Hospital’s Center for Prostate Health are using a new device that helps target the radiation dose delivered to the prostate and further reduces radiation exposure to surrounding tissues.

The device, a temporary, implantable balloon prostate immobilizer, “increases the effectiveness of leading-edge, external beam radiation technologies such as Intensity Modulated Radiation Therapy (IMRT) by preventing the prostate from moving at the time radiation is delivered to the cancer,” said Edward E. Mullen, Jr., MD, director of radiation oncology.

Numerous studies demonstrate that even after the patient has been positioned and secured externally, the prostate can move internally up to ½-inch before the patient is treated. This internal prostate movement (which is factored into the treatment plan) is a key challenge to ensuring the precision of the radiation treatment.

source: PR Log

Researchers Pave Way for Tracking of Prostate Motion With a Single kV Imager During Arc Radiotherapy

PALO ALTO, Calif., March 3 /PRNewswire/ -- Researchers in the US and Denmark have made a breakthrough in image-guided targeting of prostate tumors during arc radiotherapy treatments. In research partially supported by Varian Medical Systems (NYSE: VAR), physicists at Stanford University (California, USA) and Aarhus University Hospital (Aarhus, Denmark) have devised a method for 'real-time' tracking of the prostate motion using Varian's On-Board Imager® that shows promise in paving the way for advanced clinical treatments.

Arc therapy techniques such as Varian's RapidArc® technology are fast and efficient radiotherapy treatments delivered in a continuous rotation of the treatment machine around the patient. The position of the target must be updated in real-time in order for the dynamic multi-leaf collimator (DMLC) to track tumor motion. To date, a combination of MV portal images and kV orthogonal images have been tested to achieve this.

"Acquiring mega-voltage images is not ideal during RapidArc because the DMLC can block the view of the target during the treatment," says Per Rugaard Poulsen, lead author of the research. "The kV image beam is not obscured by the treatment DMLC making the markers visible from all treatment angles, unlike with the MV beam."

source: Varian