A new radiotherapy option, developed by UAB in collaboration with Varian Medical Systems, is delivering high-quality treatments to patients with brain cancer.
UAB was the first in the nation to use HyperArc™ High-Definition Radiotherapy on brain cancer last fall, but the team that helped develop the technology hopes they will not be the only location offering the treatment for long.
With HyperArc™, clinicians can deliver more compact radiation doses that closely conform to the size, shape and location of brain cancer tumors, while sparing more surrounding healthy tissues.
John Fiveash, MD
"The most common indication for radiosurgery is metastatic cancer," said John Fiveash, MD, professor and vice chair for Academic Programs in the UAB Department of Radiation Oncology. "Radiosurgery has the advantage over other kinds of radiation in that it is focal to each individual spot and doesn't treat the normal tissue as much. You can give a higher dose to the tumor and lower dose to the normal tissue, compared to whole-brain radiation therapy, which is problematic because of potential cognitive or memory problems for the patients."
Also, with HyperArc™, multiple tumors can be irradiated at the same time without repositioning the patient. As a result, more metastatic brain cancer patients are now eligible for treatment than before.
"When we used a Gamma Knife™, we had to do a radiation plan for each tumor," Fiveash said. "So if you had five tumors, you had five times the amount of work and time for the patient, and it could easily become not feasible either to generate the plan or to deliver the plan, because the patient had to stay there a long time. HyperArc™ takes a few minutes of treatment, regardless of the number of tumors."
In addition, HyperArc™ doesn't use a stereotactic frame, another improvement over the Gamma Knife™. The stereotactic frame, a metal halo that enables physicians to locate tumors exactly, has to be screwed into bone. "Now we can take pictures and do the same thing," Fiveash said.
The patient comes in for a prep day and consult, then returns a few days later for the actual treatment, which lasts only a few minutes.
"This program was originally designed to complement the Gamma Knife™, to treat larger tumors and patients with a larger number of tumors," Fiveash said. "Now the quality has improved and the ease of planning and delivery is superior to the Gamma Knife™, so our patients and our doctors prefer it. It's a better experience for the patient."
Richard Popple, PhD
"The efficiency of HyperArc™ makes for an improved use of resources," said Richard Popple, PhD, professor and assistant vice chair for physics in the Department of Radiation Oncology. "Patients have the convenience of being in and out of the room more quickly, which also means we can better accommodate the treatment team. It's a more efficient utilization of resources, which in turn means we can provide care to more patients."
UAB collaborated with four other institutions to make the treatment more accessible. "Varian wanted to make our expertise available to the community," Popple said. "We also had that interest and had published our 'recipe.' We teach a course several times a year, and a component of that course was how to perform this treatment with our recipe, but we still found that people struggled. It took a certain level of expertise."
Varian began to develop a product to package the UAB team's knowledge. "The goal was to make safe, quality treatment available to centers that didn't have the same level of expertise as academic centers," Popple said. "We wanted to make it more available.
"We test drove a lot of the initial products. We benchmarked what their system produced against what we would have done with our expertise until we arrived at the same place. The software is wizard driven and asks a series of questions along the way. The computer prompts the user every step of the way. We're still feeding back what we learn and helping to drive the development of the product."
It is now the default treatment at UAB, and Popple hopes other treatment centers that couldn't previously afford dedicated resources will avail themselves of the new technology, which is relatively easy to learn and makes this treatment more accessible to patients with metastatic brain cancer.
