Breast cancer patients at Highlands Oncology are the first to be treated with technology that clinicians say could significantly impact the way clinical teams treat and manage breast cancer. Over 2 weeks, 19 breast cancer patients at the facility's North Hills Radiation Clinic in Fayetteville, AR, were treated with the ExacTrac Dynamic (ETD) and Deep Inspiration Breath Hold (DIBH) module. This technology combines "highly accurate surface-guided technology with triggered X-ray imaging...to address challenges that often necessitated large treatment margins, due to the lack of available technology and integration."
The module works through the utilization of surface monitoring technology, used in conjunction with thermal and X-ray imaging to align and monitor patients for movement during breast therapy, explained Scott M. Jones, MS, Director of Medical Physics at Highlands Oncology. The data and images obtained with the system are used to align the patient for treatment during deep inspiration breath hold, as compared to the corresponding treatment planning CT.
"This allows for the patient to be positioned and monitored for correct alignment both prior to and during treatment," Jones stated. "Any deviations in the positioning of the patient from the proper alignment cause beam termination until the planned patient position is reestablished."
While treatment is performed, the patient is asked to take in a deep breath and hold it during treatment, with a visual feedback system providing continuous visual clues to assist the patient with proper breath hold volume and duration. "The addition of these features has provided us the ability to perform these treatments in an accurate and efficient manner," Jones said.
According to American Cancer Society (ACS) statistics, breast cancer is the second-most common cancer among women in the United States, with only skin cancer more prevalent among American women. Accounting for roughly 30 percent of all new female cancers each year, more than 287,000 new cases of invasive breast cancer will be diagnosed in women in 2022, with more than 43,000 women dying from breast cancer this year, according to ACS estimates.
While noting that breast cancer survival rates have been improving and acknowledging strides that have been in numerous therapies, researchers posit that reducing late cardiac toxicity remains a challenge for clinicians treating breast cancer.
"In the ongoing pursuit of curative radiation treatment, clinicians find that they may undesirably irradiate the heart while attempting to eradicate breast cancer for left-sided cancer patients, as unmanaged breathing may bring the vital organ into the radiation targeting field," according to researchers, noting that the tracking technology actively monitors breathing with correlation to internal anatomy checks.
Patients receiving breast cancer radiation treatments "have been typically treated using large treatment margins and without the benefit of internal anatomical verification during treatment." By incorporating "on-the-fly" X-ray confirmation, ExacTrac "streamlines the process and delivers confidence that the heart is outside of the treatment beam." The technology delivers correlation between internal and external anatomy "in one shot, revealing any misalignment that may otherwise remain undetected."
"The clinical community has been waiting for a solution like this. For physicians, we often have the dilemma of shielding healthy tissue and organs at the expense of more aggressive cancer destruction," said Hershey H. Garner, JD, MD, Chief of Radiation Oncology at Highlands Oncology. "With ExacTrac Dynamic and DIBH, we can now mitigate the risk to the heart with minimal trade off. We can now track a surrogate and image internal anatomy."
Jones lauds the system's performance at Highlands Oncology to date, telling Oncology Times that using this technology "has allowed our clinic to deliver consistent daily DIBH breast treatments." The DIBH technique is significant, he noted, "in that it can lower the radiation dose delivered to the heart, thereby reducing side effects. ETD is extremely efficient, which enables treatment delivery in a typical time slot on our machine schedule. The efficiency afforded is important, because it allows for daily use on a large subset of patients with a conventional time frame."
Mark McGraw is a contributing writer.