When it comes to cancer radiation therapy, the goals are the safe destruction of cancer cells and tumors with minimal side effects, the shortest possible treatment time and negligible damage to healthy surrounding tissue — no more, no less.
The newest advances in radiation technology are making the “less is more” ethos possible and remarkable.
This month, Greater Baltimore Medical Center (GBMC) will debut its acquisition of the latest in radiation technology — the Versa HD™ linear accelerator, made by the Swedish oncology firm Elekta. Like GBMC’s existing linear accelerators (LINACs), the Versa HD delivers high-dose radiation, targeting cancer tumors with pinpoint accuracy. However, this system provides new superior conformance to tumor size, shape and volume, further reducing treatment time while also increasing efficacy, comfort, precision and safety.
“There are not many treatments in healthcare that are as technology-driven and technology-dependent as radiation oncology,” explains Michael Stein, GBMC’s executive director of oncology services. “It’s also one of the few areas in healthcare where we use such advanced technology to actually treat, not just diagnose.”
When Stein arrived at GBMC in 2014, the hospital used three LINAC machines. One of his early efforts was to make the quality- and safety-driven case for the Versa HD, which replaced the oldest of the three.
“As with everything in technology, (radiation) is now faster, lighter, quicker, smaller,” says Stein. The Versa HD enables GBMC to continuously improve patient care, while delivering better outcomes and maximizing healthcare resources.
And while less is more when it comes to reducing treatment time and improving outcomes, with the new Versa HD there are a few ways in which “more is more.”
The maximum dose rate for the Versa HD is three times higher than previous versions of Elekta LINAC machines. Increased power translates into decreased time in treatment.
“It has the capability to be the fastest treatment out there,” explains Geoffrey Neuner, M.D., a radiation oncologist who joined GBMC’s Sandra & Malcolm Berman Cancer Institute in 2011. He will be one of the first to use the Versa HD when it comes online.
The power isn’t just limited to the hardware, either. The software that powers the Versa HD is just as robust.
“The hardware and the software have to match,” explains Stein. “Nowadays, we understand the biology and complexity of tumors better than even five years ago.” That understanding — as well as data from advancements in diagnostics, pathology and biopsy — transforms into a precise treatment plan using the Versa HD’s software.
The Versa HD comes with a 6-degrees of freedom couch (6-DOF), which allows radiation oncologists to more accurately reposition patients for treatment, right down to the millimeter.
“With the 6-degrees couch, we can align patients in all degrees of motion,” explains Dr. Neuner. An older generation LINAC couch typically moves up and down and left to right — which means the radiation oncologist might have to repeatedly position the patient by hand to get the right angle for treatment.
Repositioning can be time-consuming, especially in complex cases. With the Versa HD, much of the repositioning is automated.
It’s a boon for therapists tasked with making sure a patient is comfortable and positioned properly during treatment, explains Stein. “We want our staff focused on the patient instead of the machine.”
The goal for radiation therapy is safe, effective treatment of the cancer tumor, with minimal side effects and damage to healthy tissue. “Twenty-five or 30 years ago, the machines shot radiation roughly in the area of the tumor,” explains Stein. “Back then, that was as good as it was going to get.”
With that type of shotgun treatment, side effects like burn marks on nearby tissue or organ damage were not uncommon.
This is less true with each advancement in radiation therapy.
“A big part of radiation is sparing healthy tissue,” explains Stein. “It can be the difference between someone being able to play with a grandchild — or not.”
And that’s because certain side effects can persist even after tumors have shrunk or been removed and cancer has gone into remission. For example, for a patient facing prostate cancer, more precise radiation treatment can translate into retaining proper sexual function for the remainder of his life. For patients with lung cancer, it can mean the ability to truly breathe easier.
Better outcomes, increased comfort and more accurate and effective treatments easily translate into increased patient satisfaction — which is the goal of all healthcare providers.
In many ways, advanced technology like the Versa HD benefits the healthcare providers as well. The machine helps radiation oncology teams better coordinate their care, reduces the risk of human error, increases safety by automating aspects of the treatment and decreases treatment time by delivering more power with more accuracy.
Dr. Neuner, for one, is looking forward to using the Versa HD. “I’ll be more at ease knowing that my patients are getting accurate care and a better experience,” he says. “If they’re satisfied, then I’m satisfied.”
—Laura Lambert for Greater Baltimore Medical Center