Mercy Medical Center Expands Prostate Cancer Treatment Options With Advanced TrueBeam Technology

Mercy Medical Center is expanding advanced treatment options for men with prostate cancer through the enhanced capabilities of its Varian TrueBeam radiotherapy system, providing appropriately selected patients with access to highly precise stereotactic body radiation therapy (SBRT) that can be completed in as few as five treatment sessions.

The advanced technology, available through Radiation Oncology at Mercy, combines image guidance with highly focused radiation delivery designed to target the prostate while minimizing radiation exposure to surrounding healthy tissue. Mercy's TrueBeam system is configured to deliver image-guided radiation therapy (IGRT), stereotactic body radiation therapy (SBRT), volumetric-modulated arc therapy (VMAT) and other advanced treatment techniques.

According to Kelly Orwat, M.D., Director of Radiation Oncology at Mercy, the system can target tumors with accuracy in increments of less than a millimeter and can deliver high-dose treatments in short treatment sessions.

"The evolution of radiation technology has given us an extraordinary ability to be precise," Dr. Orwat said. "With prostate SBRT, we're delivering a very high dose to a very specific target, so our ability to see the treatment area, account for positioning and carefully shape the radiation dose is extremely important."

Dr. Orwat brings a particularly broad perspective to the use of advanced radiation technology. She is skilled in advanced radiation therapy techniques including the CyberKnife system and state-of-the-art linear accelerators. That experience with both technologies gives Dr. Orwat a firsthand understanding of the different ways sophisticated radiation platforms can be used to treat cancer.

"I've worked with advanced radiation technologies, including CyberKnife and linear-accelerator-based treatments, so I understand what each platform brings to the table," Dr. Orwat said. "What is exciting about TrueBeam is the way it brings together highly sophisticated imaging, radiation delivery and treatment planning in one platform. For appropriately selected prostate cancer patients, that gives us a very powerful tool for delivering SBRT with a high degree of precision and efficiency."

Prostate SBRT presents a particular technical challenge because the prostate is located close to the bladder and rectum and can move during treatment as those organs change. TrueBeam incorporates onboard imaging that allows the treatment team to localize the treatment site and make precise adjustments. The system uses three-dimensional imaging during treatment to help physicians target tumors accurately while reducing unnecessary radiation to surrounding tissue.

"The prostate is not a completely stationary target," Dr. Orwat said. "That is why image guidance and motion management are so important. We want to know where the prostate is when we're treating it - not simply where it was when we planned the treatment."

"Dr. Orwat has brought fiducial marker tracking for prostate SBRT (a highly precise form of radiation therapy) to Mercy Medical Center," said Kai Dou, Senior Medical Physicist at Mercy. "Tiny gold markers are placed in the prostate and can be clearly seen during treatment. This helps the radiation team pinpoint the prostate's exact location and deliver the radiation more accurately. That's especially important because standard X-ray and CT imaging don't always provide a clear view of the prostate and the surrounding soft tissue."

Research has specifically evaluated TrueBeam's ability to monitor prostate motion during SBRT. Studies of Varian's intrafraction motion-review technology have found that it can detect prostate displacement during treatment and help assess the effect of motion on target coverage.

TrueBeam also offers a highly efficient method of delivering SBRT through VMAT, in which the linear accelerator rotates around the patient while modulating the radiation beam. This allows radiation to be delivered from multiple angles and shaped around the treatment target.

For appropriately selected patients, one of the most significant practical advantages of prostate SBRT is the ability to complete radiation treatment in five sessions over approximately two weeks, rather than requiring daily treatments over many weeks.

"For patients who are candidates for SBRT, five treatments can make a tremendous difference in terms of convenience," Dr. Orwat said. "But the number of treatments is only one part of the equation. Our priority is selecting the right patients and delivering the right treatment with the precision that prostate cancer requires."

The expansion of TrueBeam-based prostate SBRT is part of Mercy's multidisciplinary approach to prostate cancer care. Radiation Oncology works in collaboration with Urology Specialists of Maryland at Mercy, allowing urologists and radiation oncologists to work together when evaluating a patient's diagnosis and treatment options.

"Our role is to work with our urology colleagues, understand the specifics of his cancer and help him understand the available treatment options. When radiation is appropriate, we can then determine which radiation technology and treatment approach best fit that individual patient," Dr. Orwat said.

"Every prostate cancer patient is different," said Mercy urologist Dr. Damon Davis. "The cancer characteristics, the patient's overall health, anatomy, preferences and many other factors have to be considered. We work closely with our radiation oncology colleagues so that patients can have an informed discussion about their treatment choices and what may be most appropriate for them."

Mercy's Radiation Oncology department provides advanced radiation treatment for prostate cancer and other cancers and is accredited through the American College of Radiology Radiation Oncology Practice Accreditation Program, which evaluates clinical personnel, equipment, treatment planning, patient records, safety policies and quality-assurance practices.