Planning Comparison of TomoTherapy with Standard Multi-Leaf IMRT and Conventional AP/PA Fields in the Treatment of Advanced Nodular Sclerosing Hodgkin’s Lymphoma

Brian Wichman, DABR

April 16, 2010 - TomoTherapy Americas User Education Symposium

Kansas City Cancer Center (KCCC) treats patients at 11 facilities in the metropolitan area, and is the only Kansas City provider to offer TomoTherapy treatments. In this presentation, we hear how KCCC chose TomoTherapy technology for an advanced Hodgkin’s Lymphoma case after a planning comparison revealed lung dose to be unacceptable with a conventional AP/PA technique, and sub-optimal with standard 9-field IMRT. “TomoTherapy did a better job of protecting the lung and covered our PTV as well or better than other techniques,” said KCCC’s chief medical physicist, Brian Wichman, DABR. Comparison results were shared with the patient, who delighted in staying close to home for the TomoTherapy treatments.

Kansas City Cancer Center web site
Related news: Kansas City Cancer Center Adopts TomoTherapy Platform to Advance Patient Care

APBI for TomoTherapy

Mark Guerts

April 16, 2010 - TomoTherapy Americas User Education Symposium

Puerto Rico's Caribbean Radiation Oncology Center has introduced TomoTherapy-based accelerated partial breast irradiation (APBI) based on the 2009 ASTRO Consensus Statement and constraints outlined in RTOG 04-13. The center has found the technique easy to implement and has experienced satisfactory results with acceptable toxicities. In this presentation from chief physicist Mark Geurts, we learn how the short fractionation schedule - one week instead of seven - is well appreciated by patients, who typically travel an hour or more for treatment. In addition, we hear that the center has seen an increase in its referral base after successfully sharing its TomoTherapy-based APBI plans with breast surgeons on the island.

Early Experience with TomoDirect

David Lockman, DSc and James Herman, MD

April 16, 2010 - TomoTherapy Americas User Education Symposium

Sparrow Regional Cancer Center of Lansing, Michigan, chose TomoDirect^™ technology for a case that would have been difficult to treat in any other way. With TomoDirect delivery, Sparrow applied two pairs of medial-lateral tangents, with body pairs irradiating the upper portion of the target and one pair used for the lower portion. The plan resulted in a highly homogenous dose distribution with superb posterior muscle compartment sparing. The efficient transition between beam angles contributed to a treatment time of less than 10 minutes.

Hippocampal Avoidance during Whole-Brain Radiotherapy: Preserving Neurocognition

Vinai Gondi, MD

April 16, 2010 - TomoTherapy Americas User Education Symposium

RTOG 0933 is a phase II clinical trial that aims to explore the hypothesis that sparing the hippocampus during whole-brain radiotherapy (WBRT) for brain metastases may mitigate radiation-induced neurocognitive toxicity. Emerging clinical and preclinical evidence suggests that a neural stem cell compartment in the hippocampus is central to the pathogenesis of neurocognitive deficits observed after cranial irradiation. Notably, these neural progenitor cells seem to be anatomically clustered within the dentate gyrus of the hippocampus, availing the opportunity to conformally avoid them during cranial irradiation using modern IMRT technologies. Applying TomoTherapy technology to this setting, significant sparing of hippocampus (mean dose to the hippocampus reduced by 87%) has been achieved without compromising target coverage or homogeneity¹. RTOG 0933 has been approved by the National Cancer Institute and is scheduled to open soon. TomoTherapy users are encouraged to participate.

¹ Gondi V, Tolakanahalli R, Mehta MP, et al. Hippocampal-sparing whole-brain radiotherapy: A "how-to" technique, utilizing helical tomotherapy and LINAC-based intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 2010; In Press.

Advances in Craniospinal Radiotherapy with Helical TomoTherapy

William Parker

April 16, 2010 - TomoTherapy Americas User Education Symposium

McGill University Health Centre of Montreal shifted its entire craniospinal irradiation (CSI) service to the TomoTherapy treatment system in 2007. With its large pediatric practice, McGill saw that the TomoTherapy system's daily MVCT imaging could guide highly conformal treatment plans with margins as small as 3mm, thereby protecting the heart, kidneys, and liver of patients. In addition, staff came to understand additional benefits that might contribute to both practical and clinical success. This includes a single point set-up, obviating the need for junctioning - and enabling homogenous dose.

Hypofractionated TomoTherapy Treatment (HTT) in Prostate Cancer Lymph Nodal Relapse Detected By 11c-Choline PET/CT

Genoveffa Berardi

May 7, 2010 - TomoTherapy EMEA User Education Symposium

Scientific Institute San Raffaele of Milan, Italy, has studied the use of TomoTherapy technology for many forms of prostate cancer treatment. In this presentation, Dr. Genoveffa Berardi reports on the feasibility (efficacy and acute/late toxicity) of Hypofractionated TomoTherapy Treatment (HTT) in lymph node relapse of patients previously treated for prostate cancer. PET/CT positive lymph nodes were treated with high dose using a simultaneous integrated boost technique. The doses ranged from 42 Gy to 74,2 Gy (6-28 fractions). During HTT, the course of systemic therapy underway at the time of PET/CT was maintained. The center reports that HTT was well tolerated in all patients. The median follow-up was 16 months (3-54). 37/40 patients documented a significant reduction of PSA value (< 0.2) after HTT. Preliminary data show that PET/CT-guided HTT is a safe and effective treatment in the event of lymph node relapse.

Phase I-II Study Of Hypofractionated Simultaneous Integrated Boost With TomoTherapy for Prostate Cancer (Acute And Late Toxicity)

Nadia Di Muzio

May 7, 2010 - TomoTherapy EMEA User Education Symposium

In this presentation, Dr. Nadia Di Muzio reports on planning and acute and late toxicity data of the first 100 patients treated within a Phase I-II study with moderate hypofractionation by image-guided helical TomoTherapy. This study shows excellent results with regard to acute and late uGI and rectal toxicity. Further research is necessary to assess tumor control outcome.