A 65-year-old man with inoperable lung cancer has become the first lung cancer patient in India to receive stereotactic radiosurgery, a promising new approach for treating this disease. Doctors at Yashoda Hospital in Hyderabad were able to deliver the treatment using RapidArc technology from Varian Medical Systems (NYSE: VAR).

Several recent studies* have shown that lung cancer responds favorably to radiosurgery, which involves delivering the full dose in as little as one to five treatments. With the Varian RapidArc technology each radiosurgery session could be performed in just ten minutes, including patient setup and imaging, with the actual 'beam-on' time being as little as three minutes.

"Shorter treatment times mean the patient has to spend less time on the treatment machine and is better able to maintain a regular breathing pattern, which is important in lung treatments," said Dr. G.S. Rao, executive director at Yashoda Hospital. "Shorter treatment times and fewer treatment sessions compare favorably with the previous approach for non-operable lung patients, which would have required conventional radiotherapy techniques delivered over 25 to 30 sessions at more than 30 minutes per session. Now, instead of five to six weeks the patient's treatment can be completed in just nine days."

The 65-year-old patient was diagnosed with non small cell lung cancer, with a 2.5 cm tumor in the right middle lobe, which meant the tumor moved extensively during breathing. With the gated 4D-PET/CT planning and shorter treatment times made possible by RapidArc, the patient was able to cope better with active breathing control during treatment. Since this first treatment, Yashoda has used RapidArc radiosurgery with a second lung cancer patient and two pancreatic cancer patients.

RapidArc quickly delivers a complete volumetric treatment in a single or multiple arcs of the treatment machine around the patient and makes it possible to deliver advanced image-guided, intensity-modulated radiation therapy (IMRT) two to eight times faster than is possible with conventional IMRT or helical tomotherapy. Better imaging, greater precision and faster delivery also allow clinicians to deliver the required dose in fewer treatments.

"Our next challenge is to combine RapidArc with respiratory gating, where the beam is triggered by the exact position of the tumor," said Dr. Rao. "This will come in the future and will mean that patient will no longer need to hold their breath during treatment." Varian recently added advanced motion management capabilities including gated RapidArc to its Trilogy linear accelerator platform to support this capability.

400th Treatment at Hyderabad

Doctors at Yashoda in Hyderabad have now treated 400 patients with RapidArc on a single machine. "We are proud to become the first hospital in Asia to reach this milestone and we will continue to be at the forefront of advanced radiotherapy delivery in the future," said Dr. Rao. "With RapidArc we are able to give many more patients access to advanced cancer care."

RapidArc at Secunderabad

Yashoda Hospital also recently upgraded the Varian Clinac® medical linear accelerator at its Secunderabad facility with RapidArc capability to meet a growing demand for treatment. In the six years since the Secunderabad facility opened, more than 6,200 patients have been treated with this Varian linear accelerator. "By adding image-guidance and RapidArc capability to this Varian machine, we will be better able to keep pace with the huge demand for treatments," says Dr. Rao.

According to the Cancer Foundation of India, it is estimated that at any given point of time there are 2.0 to 2.5 million cancer cases requiring cancer treatment in India and this number is increasing by 10,000 new cancer cases each year.

*Examples of published research on this subject:

Stereotactic body radiation therapy for inoperable early stage lung cancer. Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J, Fakiris A, Bezjak A, Videtic G, Johnstone D, Fowler J, Gore E, Choy H. Department of Radiation Oncology, University of Texas Southwestern Medical Center

McDonald, F., et al. "Clinical Implementation of Volumetric Modulated Arc Therapy (Vmat) Image-Guided Stereotactic Radiotherapy Using Active Breathing Control (Abc) for Small Volume Lung Tumours." Lung Cancer 67 Supplement 1 (2010): S29-S29

McGrath, Samuel D., et al. "Volumetric Modulated Arc Therapy for Delivery of Hypofractionated Stereotactic Lung Radiotherapy: A Dosimetric and Treatment Efficiency Analysis." Radiotherapy and Oncology 95 2 (2010): 153-157.

Verbakel, Wilko F. A. R., et al. "Rapid Delivery of Stereotactic Radiotherapy for Peripheral Lung Tumors Using Volumetric Intensity-Modulated Arcs." Radiotherapy and Oncology 93 1 (2009): 122-1224.

Source:
Varian Medical Systems