Radiation oncology has been around for a century, and, at first, advancements in the field came rapidly. The evolution of X-rays and CT scans to inform treatment. Intraoperative radiation therapy. Technology that allows for tailored dose distribution.
But for the past 20 years, the pace of innovations seemed to slow. We remained stymied, for instance, by organs in the abdomen that move with every breath a patient takes. We struggled to find the most precise method targeting certain tumors, most notably pancreatic tumors, without damaging nearby intestinal tissue.
After decades of slowed progress, the field is once again welcoming a game-changing development that could offer hope for patients with inoperable tumors. Known as MR-guided stereotactic ablative radiation therapy, this new method uses magnetic resonance imaging (MRI) machines to provide real-time 3D imaging of tumors, allowing for precise radiation targeting.
The MR-linac combines a MRI machine and a linear accelerator into a single device. The MRI provides high-quality, real-time images of tumors and patient anatomy. This enables adaptive planning capabilities that allow us to respond to any unexpected changes during treatment and more precisely destroy tumors with radiation beams from the linear accelerator.
The importance of this capability cannot be overstated. This will save lives that otherwise may have been lost.
The discipline of radiation oncology is very much dependent on computers to deliver precise treatment. By incorporating 3D imaging in real-time, MR-guided stereotactic ablative radiation therapy allows radiation oncologists like me to provide the types of treatment our predecessors could not have imagined.
Pancreatic cancer has the highest mortality rate of any cancer. This is partly due to the way the cancer grows without symptoms, metastasizing until it becomes impossible to surgically remove. Adding to its deadliness is the fact that treating the pancreas with radiation had been almost certain to expose delicate abdominal organs to harmful doses of radiation. Giving enough dose to kill the cancer might also kill the patient.
This new technology allows us to target tumors on the pancreas even if they’re literally touching other organs in the body. In some cases, radiation reduces the chances of a recurrence of cancer or can shrink the tumors enough to allow for a successful surgical removal.
It is exciting to be able to offer patients the exact right type of treatment their condition demands, but having the right tools is only part of the equation. Having a multidisciplinary team of people who work well together and share a patient-centric philosophy is just as important. I have been impressed with how readily Hoag, for example, has adopted proven technologies like this one – and how focused on evidence-based care the team is. Patients at hospitals that take this approach don’t just have one doctor; they have an entire team.
Radiation therapy has shown gradual improvements over the past 20 years. The advent of MR-guided stereotactic ablative radiation therapy promises a leap forward in treatment possibilities. And the energy and dedication of multidisciplinary teams embracing this innovation is going to make an incredible difference in patients’ survival and quality of life.
It’s a thrilling time to be part of this field – giving hope where there hadn’t been hope before.
Shane Lloyd is a radiation oncologist, Hoag Memorial Hospital Presbyterian, Newport Beach, CA.
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