Accuray

Why Motion Matters: The Advantage of Real-time Tracking

K Carr — Tue, 30 Jul 2024 11:13:11 +0000

Each day a person takes approximately 22,000 breaths, that is about 7.5 million breaths each year. But we don’t even think about it, until of course something isn’t quite right.

One of the first signs of lung cancer can be shortness of breath, the degree to which is subjective per person. Facing cancer treatment can be a frightening time. From uncertainties in the treatment journey to the sheer lack of control, it is enough to make anyone feel completely distraught. For many patients with medically inoperable non-small cell lung cancer (NSCLC) definitive radiation therapy, preferably stereotactic body radiation therapy (SBRT) is offered as a treatment option.

The importance of delivering radiation therapy accurately

When it comes to radiation therapy it is vital that the beam is delivered to the exact planned target volume (PTV) to help minimize dose to normal lung tissue. This helps to keep side effects as low as possible so as not to compromise patients’ quality of life. But trying to deliver radiation to a moving target is by no means easy. It is also extremely difficult for patients to keep perfectly still as radiotherapy is delivered.

Strategies used to control motion

Every day in thousands of clinics around the world incredible radiotherapy treatment plans are generated by very talented dosimetrists and medical physicists. But the reality is that these elaborate plans are created on static images and then delivered to a moving target.

There are several ways to help improve the reproducibility of your plan, from using restrictive immobilization devices, or creating an internal target volume (ITV) that encompasses the entire movement of the lesion during breathing, to daily pretreatment images. However, while external devices may keep the patient still on the outside, they do little to control what is going on inside. And, larger margins may encompass the entire treatment area but they also treat a lot more normal tissue too.

Pretreatment images are also essential in any treatment, though again they are only a snapshot in time, and while you know you are starting in the right place they do little to inform you of what is happening during treatment. You could also attempt gating where you turn the beam on and off based on the rise and fall of the patients’ chest and assume the lesion has returned to the same position. But making assumptions means adding margins, to ensure you are delivering dose to the target.

But what if there was a system that could adapt and compensate for the motion of a patient with submillimeter accuracy throughout the entire course of a treatment to ensure that what is planned is what is being treated.

This is what the CyberKnife^® and Radixact^® Treatment Delivery Systems can do using Synchrony^® real-time tracking with dynamic delivery. Using Synchrony helps eliminate the need for restrictive motion management techniques and enables gating-free treatments. Margins can be reduced as motion is tracked, detected, and corrected throughout treatment using integrated kV imaging.

Real-time tracking that adjusts to the patient external and internal motion

Synchrony is a technology developed by Accuray more than two decades ago, that was initially introduced on the CyberKnife System. Following its successful use on this device, Synchrony was made available on the Radixact System. It combines a complex algorithm with an artificial intelligence (AI) patient motion model that uses multiple sources of data to build a mathematical model that allows the treatment delivery system to know where the tumor or lesion is during the treatment session. Synchrony adjusts and corrects for motion in real-time in order to treat moving lesions with submillimeter accuracy and a minimal PTV. This allows confidence to deliver high doses of radiation therapy whilst helping minimize dose to normal healthy tissue.

But how does all that work?

The patient lies down on a treatment table without any restrictive devices or coaching on how to breathe. There is no gating involved, nor lights or goggles or any other peripheral devices to tell them to hold their breath. Instead, there are three small LED markers placed on his/her chest at the level of maximum motion.

These markers send a signal to a ceiling mounted camera that immediately and automatically monitor and displays the breathing model of the patient. But just knowing the breathing model is not enough to accurately predict anything other than where the chest or stomach may happen to be at any given time.

The radiation therapist begins to take a series of X-ray images. The computer now knows where the lesion is located when the patient inhales and exhales, and it knows where it is for 15-20 images throughout the breathing cycle.

The combination of respiratory signals and X-ray images are used to build a patient specific and treatment session specific model. This is used by the treatment delivery system to calculate where the targeted lesion is at a given moment in time.

The model created uses a first in/first out principle so throughout the treatment the system continues to take X-rays on its own. The newest images are added to the front of the model, keeping the model up to date since breathing normally is not as consistent as one might think.

Not only does the model continually update itself throughout the treatment, it is also dynamic in that the signal from those little LED’s is constant so even between images if the patient were to sneeze, yawn, belch or exude any other bodily function the markers sense this motion and adjust the model accordingly.

In essence, the system learns how a patient breathes from the information provided, then through use of an algorithm and AI, the robot reacts on its own to make sure the tumor or lesion is treated throughout the entire course of treatment.

Synchrony real-time tracking isn’t just available for lung cancer patients it can be used for many treatment sites that are affected by motion.

So Instead of Managing Motion Lets Do Something About It.

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Pioneering Advanced Radiotherapy in Kenya

K Carr — Wed, 17 Jul 2024 10:09:26 +0000

Radiotherapy is an essential part of cancer treatment but what is the current status in Kenya? We took a look at how Kenyatta University Teaching, Referral & Research Hospital (KUTRRH) have taken steps to offer patients advanced radiotherapy in Kenya with the CyberKnife® System.

Cancer Burden in Kenya

Cancer is the third leading cause of death in Kenya after infectious disease and cardiovascular diseases¹. The annual incidence of new cancer cases increased from 37,000 to 47,887 between 2012 – 2018¹, and are expected to continue to rise. With a population of 54.7 million nearly 23% of sick patients do not pursue healthcare due to several barriers, including high costs, the need to travel long distances and a lack of healthcare education and awareness¹. Sadly, even to date the majority of cancer patients only seek treatment when the disease is already advanced, contributing to high mortality rates². In Kenya, 60% of patients with cancer are less than 60 years old³.

What is the Status of Radiotherapy Services in Kenya?

Between 2009-2021, six private hospitals and three public hospitals opened facilities for cancer care and treatment, including radiotherapy services. The majority of workload remains at public institutions where costs for cancer are more affordable compared to private hospitals.

Kenyans can apply for the National Health Insurance Fund (NHIF) to help cover the cost of their cancer treatments, including radiotherapy. In 2019, a commitment was made to strengthen efforts to address cancer as part of universal health coverage⁴. And, now there is a ‘National Cancer Control Strategic Plan 2023-2027’ in place with a focus on cancer prevention, strengthening primary based healthcare and community health interventions as well as digitalization of cancer services. One of the goals of this strategy is to ensure the timely initiation of comprehensive treatment, strengthening access to quality sustainable care and improving the quality of life for cancer patients.

Bringing advanced radiotherapy to KUTRRH with the CyberKnife System

In September 2023 Kenyatta University Teaching, Referral & Research Hospital (KUTRRH) treated their first patient on the CyberKnife^® System. The vision was to create a Centre of Excellence in oncology by providing end-to-end diagnosis and cancer treatment options at KUTRRH. While the hospital has a linac and brachytherapy suite for the treatment of cancerous tumors, there was a need to move into high precision radiotherapy treatment and hence the government supported the acquisition of a CyberKnife System. This decision was made to decrease outbound medical tourism and increase inbound medical tourism. Now patients can experience world-class treatment at KUTRRH’s CyberKnife Centre.

Interview with Ruth Manyagi at KUTRRH

We interviewed Ruth Manyagi, Manager of the CyberKnife Centre at KUTRRH to learn how patients access radiotherapy in Kenya and how the CyberKnife System has changed their radiotherapy department

Kenya is a developing country in Africa, with a GDP of $110,519 million in 2021, ranking Kenya the 7^th country in Africa. In 2020, there were 42,000 new cancer cases diagnosed and 27,000 cancer related deaths. Due to late presentation the mortality rates are high. At KUTRRH radiotherapy centre we predominantly treat cancers of the prostate, esophagus, cervix, breast, rectum, head and neck and lung. We often treat more advanced stages of disease because of late presentation.

How easy is it to access radiotherapy in Kenya?

For those patients who are Kenyan and employed, they can apply for NHIF, where the government contributes towards treatment, including radiotherapy on the CyberKnife System. But, one of the issues is that not everyone is registered with NHIF. For many Kenyans they do not have the means to pay for basic needs and are unable to apply for NHIF. For these people they often fall into a situation where they are unable to afford treatment and often rely on help from others including funding from hospitals. There are private hospitals available, but they are much more expensive than the government hospitals.

Another factor that leads to problems accessing care is that NHIF will contribute to cancer treatment but no other supportive needs like travel or accommodation. If patients are travelling from far away it becomes very difficult for them to gain access to treatment when needed and contributes to late presentation of their disease.

Lack of education and awareness of cancer is also a major hurdle. Unfortunately, many people do not know what symptoms or treatment options are available and therefore they just don’t know what to do.

How far do people come to your center?

Kenya is very densely populated, with most people living outside of the capital city of Nairobi in villages. Some patients travel a very long distance to receive their treatment. For example, some people will travel three days to come to KUTRRH to receive radiotherapy.

How many patients receive radiotherapy daily at KUTRRH?

KUTRRH is one of the biggest government hospitals in Kenya. At the moment we have just 1 conventional linac, a brachytherapy unit and the CyberKnife System. On the conventional linac we treat 100 patients per day. We have three shifts of staff spread out from the morning until midnight when the last patient is treated.

What was the reason behind purchasing a CyberKnife System?

One of the reasons for purchasing a CyberKnife System was to be able to provide treatments that were not available in Kenya. Now, with the CyberKnife System we are able to treat patients with intracranial lesions, including meningioma, arterial venous malformations (AVM), acoustic neuromas and other cancerous and benign conditions in the brain and spine. We also treat inoperable intracranial tumors, where surgery was not possible due to the location of the disease or because in some situations the patients refuse surgery.

Before the CyberKnife System was installed a lot of these patients were treated abroad, in parts of Europe and India. But the government wanted to improve access to these patients in Kenya and from surrounding areas, so now with the CyberKnife System patients can receive this treatment more easily. Our CyberKnife System is the second system in Africa. So, we are expecting patients to be coming from other surrounding countries like Ethiopia, Somalia, Sudan, Tanzania, Nigeria. and other countries in Africa.

We can also treat patients with fewer fractions, for example we can now treat people in 5 treatments compared to 30 treatments. This helps to reduce the cost to the patients that are coming far from home, and is one of the reasons now that patients come to KUTRRH for their treatment. Due to the high precision of the CyberKnife System we are also able to treat with smaller treatment margins which helps to improve outcomes such as better tumor control and reduced side effect for the patients.

What was it like to get a team together to work on the CyberKnife System?

One of the main agendas when introducing the CyberKnife System was to ensure we had a qualified team to run the unit. I was trained on the CyberKnife System before coming to KUTRRH so I was able to help support the team. But for most there was no expertise in this area. Accuray were really supportive to us from commissioning to treating the first patient. They didn’t just come and go, even now they help us if we are stuck with something, and we are very grateful for that.

Some of the doctors, physicists and radiation therapists were sent to India for their training to learn how to operate and utilize the CyberKnife System. It was a big change for us at KUTRRH, and there was a lot of training. But it was important for us to have gradual training to become confident in different treatment delivery techniques including real-time tracking with Synchrony®.

What are the future aspirations of the CyberKnife System at KUTRRH?

As we have more time on the CyberKnife System our expertise will increase, and we are hoping to treat more intracranial cases and extracranial cases. At the moment Kenya does not have anyone qualified in prostate fiducial marker insertion and we are currently looking for someone to help with this so we can start to treat prostate cancer patients. Prostate cancer patients make up the highest number of patients we treat with radiotherapy at KUTRRH. There is a long waiting list, and we believe we could help to treat these patients on the CyberKnife System.

We also need to make sure that there is awareness in Kenya of the CyberKnife System. People need to be aware as well as referring clinicians that this system is available to help ensure more people have access to it.

After the first couple of months we successfully treated 80 patients and we know we have capacity to treat more. When we are able to treat prostate cancer patients we know the numbers will shoot up and we will be celebrating that once we have someone to help us with the fiducial marker insertion.

In one way or another, cancer will affect us all. And it has immense impact on patients and their families as well. In Kenya, we are so proud to have the most modern device, the CyberKnife System, from Accuray in our oncology department. The CyberKnife System has the ability to track the treatment in real-time, ensuring high level of precision, and it delivers stereotactic treatments for a range of different sites, such as lungs, prostate and other metastatic diseases, which, right now we are dealing with in Kenya. And, although there are various oncology treatments, having the opportunity with the CyberKnif^® System allows us to work with smaller margins, allowing complete precision and lower toxicity levels to the patient. So here in Kenya, it will give us an opportunity to generate income through private and overseas patients. The CyberKnife System is a well-known non-invasive treatment which we hope will attract more patients here in Kenya, mostly from overseas and also, the neighboring countries and also our own Kenyan people.’

Ruth Manyagi

References

Pankaj, G et al. (2021) Cancer on the Global Stage: Incidence and Cancer-Related Mortality in Kenya. WORLD HEALTH ORGANIZATION REGION: AFRICA. The ASCO post. Available at: https://ascopost.com/issues/february-25-2021/cancer-on-the-global-stage-incidence-and-cancer-related-mortality-in-kenya/
Nydone et al. (2022) Current Status of Radiotherapy Services in Kenya. Scientific Research. Available at: https://www.scirp.org/journal/paperinformation?paperid=116852#t1
Makau-Barasa et al. (2017) ‘Improving access to cancer testing and treatment in Kenya’ American Society of Clinical Oncology. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180746/pdf/JGO.2017.010124.pdf
Ministry of Health Kenya ‘The National Cancer Control Strategy (2023-2027). Available at: https://www.iccp-portal.org/system/files/plans/NATIONAL%20CANCER%20CONTROL%20STRATEGY%202023-2027_compressed.pdf

The views contained and expressed in this blog, are those of the author and do not necessarily reflect the views or policies of Accuray Incorporated or its subsidiaries. No official endorsement by Accuray Incorporated or any of its subsidiaries of any vendor, products or services contained in this blog is intended or should be inferred.

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Bringing Together Leading Liver Cancer Experts in the 7th APAC Liver Roundtable

K Carr — Mon, 08 Jul 2024 15:15:25 +0000

Hepatocellular carcinoma (HCC) is the third leading cause of cancer‐related deaths globally. Nearly 80% of the patients with HCC are in the Asia region. Although radiation therapy (RT) is a frequently used treatment option for HCC, the recognition of RT differs according to the guidelines.

Liver Cancer Roundtable Members in Action

The 7th APAC (Asia-Pacific region) liver roundtable was held in Hiroshima, Japan on May 25th, 2024. Accuray started the liver cancer roundtable collaboration back in 2016. Each year leading experts in the field of liver cancer in Asia have joined together and work together to better understand the role of RT in the treatment of liver cancer.

Historically, RT has been less commonly used in the treatment of HCC due to concerns about liver toxicity and the risk of radiation-induced liver disease. Even with the recent advances in radiation techniques and technologies the therapeutic high dose of radiation delivered via stereotactic body radiation therapy (SBRT) are not well recognized.

What Clinical Evidence Have the Members of Liver Roundtable Achieved?

The meetings have allowed the members of the roundtable to build up clinical evidence of radiotherapy, especially SBRT in the treatment of liver cancer. It has also helped to facilitate improved radiotherapy clinical practice by producing a set of consensuses, guidelines and clinical evidence generation.

2017: Consensus on SBRT for small-sized HCC has been reached and published.
2020: Members from the group evaluated the current HCC practice guidelines and published views from radiation oncologists’ perspective in the Green Journal.
2020:The multi-national multi-center study on SBRT versus radiofrequency ablation in Asian patients with HCC was published with large cohort data in the Journal of Hepatology.
2021: Dose-response relationship in SBRT for HCC: a pooled-analysis of an Asian liver radiation therapy group study was published in the Red Journal. And another multi-center retrospective study on radiotherapy for HCC in the caudate lobe was published in Frontiers in Oncology.

The Therapeutic Landscape is Evolving in the Treatment of Liver Cancer

As RT has been integrated into multi-modality treatment for HCC, the therapeutic landscape of HCC has evolved. The role of locoregional treatment has been well defined and the use of combined immunotherapy has been the standard of care in advanced disease. During the 7^th APAC liver roundtable, immunotherapy combined radiotherapy for HCC were discussed in depth.

The members of the roundtable continue to drive the status of radiotherapy in the treatment of liver cancer.

Want to see more clinical evidence - visit our 30 years of clinical evidence page HERE

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Experts Gather in Bangkok to Advance Precision Radiation Therapy for Breast Cancer Treatment in ASEAN Region

K Carr — Fri, 28 Jun 2024 11:50:31 +0000

Medical experts, researchers, and healthcare professionals from across the ASEAN (The Association of Southeast Asian Nations) region recently convened in Bangkok, Thailand, for the 6th Breast Roundtable, supported by Siriraj Hospital. The event, which took place on June 1st, 2024, aimed to help drive the sharing of best clinical practices and drive advancements in precision radiation therapy for the treatment of breast cancer.

Bringing Together Leading Breast Cancer Experts

The roundtable brought together leading breast specialists from various ASEAN countries such as Thailand, the Philippines, Singapore, Malaysia and Indonesia. Dr. Jiayi Chen from China, a renowned expert in the field, also contributed to the discussions. In total, 12 distinguished experts presented their insights at the event, which was co-chaired by Dr. Chomporn Sitathanee from Ramathibodi Hospital, Thailand and Dr. Muthukkumaran Thiagarajan from Hospital Kuala Lumpur, Malaysia. The meeting drew over 100 participants, including healthcare professionals, researchers and industry representatives.

Roundtable presenters and moderators

Key Focus Areas

One of the key focus areas of this year’s roundtable was the in-depth discussion on hypofractionation and ultrahypofractionation in breast cancer treatment. With a growing number of breast cancer patients in the ASEAN region requiring postmastectomy radiotherapy (PMRT), the experts emphasized the importance of effective hypofractionated PMRT. They presented clinical studies demonstrating the efficacy and safety of hypofractionated radiotherapy regimens for postoperative breast cancer patients in Southeast Asian countries.

A Platform for Comprehensive Discussions

Furthermore, the event provided a platform for comprehensive discussions on the utilization of hypofractionated radiation therapy for breast cancer in various ASEAN countries. Topics ranged from public health coverage and reimbursement to patient access to advanced technologies, with experts from Indonesia, the Philippines, and Thailand sharing their valuable insights.

A Journey Towards Advancing Breast Cancer Treatment

The 6th Breast Roundtable marked an important milestone in the journey towards advancing breast cancer treatment. Dr. Imjai, the leader of the roundtable, reflected on the 6 years’ progress and hinted at future plans to expand the scope of the event to cover more indications treated with Accuray technology. Attendees expressed eagerness for a future roundtable program dedicated to ASEAN countries, signaling the anticipation for continued collaboration and innovation in the field of oncology.

The collaborative efforts and knowledge exchange at the 6th Breast Roundtable have paved the way for further advancements in precision radiation therapy for breast cancer treatment, nurturing hope for improved patient care and outcomes in the ASEAN region and beyond.

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ISRS 2024 News

K Carr — Fri, 24 May 2024 12:32:26 +0000

This year the International Stereotactic Radiosurgery Society (ISRS) 2024 was hosted in New York City. More than 340 abstracts were accepted, and over 630 attendees representing 53 countries and specialties including neurosurgeons, radiation oncologists, physicists, and more took part to learn, share, and excel!

We met up with Prof. Marc Levivier former President of ISRS and Arjun Sahgal, new President of ISRS to get their insights on the purpose of ISRS, benefits to members, ISRS certifications and what the future holds. Insert videos here.

Highlighting Abstracts for Brain Cancer Awareness Month

Safety and efficacy of CyberKnife radiosurgery for limited number of large volume brain metastases: analysis of single center real-world data¹

This study aimed to assess the effectiveness of hyperfractionated radiosurgery on the CyberKnife® System as a treatment approach for a limited number (<3) of large-volume brain metastases patients. A prescribed dose of 21-34 Gy was delivered in 3-5 fractions using the CyberKnife System. The primary objective was to identify the overall survival after salvage treatment. Forty patients were included in the study. The one-year overall survival rate following fractionated SRS (FSRS) was 75%. Positive imaging responses were observed in 90% of the cohort and a significant clinical improvement was seen, as evidenced by the best Karnofsky performance scale score. Toxicity remained low with 12 patients experiencing grade 1 or 2 fatigue, and 4 patients reported Grade 3 headache. Additionally, progression-free survival for brain metastases from non-small-cell lung cancer (NSCLC) was significantly longer compared to other cancer types. FSRS with the CyberKnife System showed favorable clinical and radiologic control for limited number large volume brain metastases. An ongoing multicenter prospective observational study is being conducted to assess the efficacy of FSRS for limited brain metastases from NSCLC.

Safety and efficacy of CyberKnife radiosurgery plus anlotinib hydrochloride in patients with recurrent glioblastoma: a prospective phase II single-arm study²

Glioblastoma (GBM) is a highly vascular tumor with limited treatment options, especially upon disease recurrence. Targeted therapies such as bevacizumab aim to slow the growth of new blood vessels and is an established drug for treating recurrent glioblastoma (rGBM). A different targeted therapy drug called anlotinib is a multi-target tyrosine kinase inhibitor that can directly target the vascular endothelial growth factor receptor, platelet-derived growth factor receptor, and fibroblast growth factor receptor. In this study it was proposed that the anti-angiogenic effect of anlotinib may exceed that of bevacizumab, indicating promising treatment potential. This prospective phase II study reported the treatment effectiveness of combining anlotinib with SRS using the CyberKnife System treating 22 patients with rGBM. Patients who underwent surgery, standard radiotherapy, and temozolomide who were diagnosed with recurrence were selected for treatment. Each patient underwent SRS with 25Gy in 5 fractions in combination with oral administration of anlotinib (12 mg, daily, days 1–14/3 weeks). The primary objective was median overall survival (OS). Twenty-one patients exhibited tumor response, with 6 achieving complete response, resulting in an objective response rate of 95.5%. Median overall survival was 19.5 months. The combination of salvage SRS with anlotinib demonstrated promising outcomes and manageable toxicity in managing recurrent GBM.

10-year outcome after central dose optimized robotic stereotactic radiotherapy for brain metastases from different histologies³

SRS and FSRS have become the standard of care for limited brain metastases over the last decade. This study evaluated SRS and FSRS with the CyberKnife System over the past 10 years. Three hundred and twenty-three patients of different histologies with a total of 1164 brain metastases (BM) were treated. Targeted therapies and/or immunotherapy were given in 25.1% of cases. The number of brain metastases ranged from 1, 2-10 and >10 in 110, 195 and 18 cases, respectively. Eighty-one had received whole brain radiotherapy (WBRT) before SRS/FSRT. The mean follow-up period was 14.8 months and the median OS was 8.7 months. The most significant prognostic factor for longer OS was Karnofsky performance status of ≥90%. Overall PTV <2.6ccm was also associated with a longer OS of 15 months vs. 10 months with overall PTV ≥2.6ccm. Application of targeted therapy led to prolonged OS of 14.5 vs. 10.6 months. Local control after 12 months was 92.4%. The conclusion found that SRS and FSRT with the CyberKnife System is effective.

CyberKnife stereotactic radiosurgery for vestibular schwannoma: meta-analysis of long-term tumor control and hearing preservation outcomes⁴

This study reviewed literature describing outcomes of radiosurgery using the CyberKnife System for vestibular schwannoma, with particular focus on tumor control, hearing preservation, and dosing schema. Fifteen studies were included in the final analysis comprising 2,018 treated patients, of whom 64 had neurofibromatosis type 2 and the remaining had sporadic lesions. Three hundred nine patients had undergone prior treatment – surgical resection and/or radiosurgery and mean follow-up for the entire cohort was 40.0 months. Fractions ranged from 1-5 and isodose lines were reported in 13/15 studies and ranged from 55%-95%. The average local control across all studies was 96.0%. For patients with serviceable hearing pre-treatment, 73% had preserved hearing at the last follow-up. This meta-analysis demonstrated that SRS with the CyberKnife System offers high rates of local control and hearing preservation in patients undergoing SRS for vestibular schwannomas.

CyberKnife Stereotactic Radiosurgery for Extramedullary Plasmacytoma in the External Auditory Canal: A Clinical Case Report⁵

A case report of a 72-year-old man with a history of multiple myeloma, presenting with recurrent left external auditory canal plasmacytoma. The patient received initial conventional radiotherapy then developed a recurrence seven years later. The patient underwent stereotactic radiosurgery with the CyberKnife System, leading to complete resolution of the lesion without any long-term adverse effects or irradiation-related complications over a 45-month period. The case report highlights SRS as an effective approach in managing complex plasmacytomas.

We had the opportunity to interview clinicians and physicists at ISRS on more indications – to watch the interviews - click here

Thought-Provoking Sessions at ISRS

AI in radiosurgery

At an ISRS session attendees learned about the current and potential applications of artificial general intelligence (AGI) in medicine and radiation oncology. AGI’s ability to process multimodal clinical data spanning visuals and text enables support at every stage from consultation to follow-up.

However, realizing AGI’s potential requires seamless integration with existing medical systems. A key limitation is AGI’s dependence on domain-specific knowledge, which can be addressed by incorporating comprehensive clinical datasets and interdisciplinary collaboration.

While current large language models (LLMs) and vision models are trained on general web data, fine-tuning them with high-quality medical data holds promise. Challenges include data standardization, sharing individual patient data due to privacy concerns, and interpretation of complex clinical data.

User-centered design involving interdisciplinary teams with radiation oncologists and medical physicists is crucial for clinical usability. While challenges remain regarding datasets, regulation, and collaboration, the opportunities for AGI to advance radiotherapy automation and improve clinical outcomes are significant.

The key takeaway was that introducing AGI has the potential to revolutionize radiation oncology by enhancing safety, precision, efficiency, and patient outcomes throughout the radiotherapy workflow. But it does not replace health care professionals, it should be used as an aid and not as an alternative to the medical profession. This is a rapidly evolving field, stimulating advancements and discussions for the benefit of healthcare.

Access disparities

Another session explored the disparities in access to SRS and stereotactic body radiotherapy (SBRT) across regions. One study delved into the variability of prescribing practices for central nervous system (CNS) metastases in Latin America and Spain.

The researchers conducted a survey among 106 SRS specialists, with 93.4% of participants from Latin America and 6.6% from Spain. The respondents included 87% radiation oncologists and 13% neurosurgeons, utilizing various technologies. The survey focused on specific questions regarding SRS dosing for CNS metastases of breast and renal cancers, particularly in the context of single-fraction SRS practice.

The findings revealed a striking variability in dose prescription for the same histological types, highlighting the need for a consensus in SRS practice for CNS metastases, at least within the Latin American region. The results underscored the importance of establishing international guidelines for standardization in SRS dosing for single-fraction CNS metastases.

By achieving uniformity in prescription practices, more homogeneous comparisons between studies and technologies can be facilitated, ultimately leading to more robust and reliable results. This presentation shed light on the critical need for consistent guidelines to ensure equitable access and optimal treatment outcomes across diverse geographical regions.

Learn more about ISRS and the benefits of being a member with Birgit Fleurent, ISRS Strategy Leader

Learn more about the CyberKnife System

Precise Robotic raiation treatment as individual as every patient

References

E39Safety and efficacy of cyberknife radiosurgery for limited number of large volume brain metastases: analysis of single center real-world data. Yun GUAN (Shanghai, China), Wei ZOU, Li PAN, Enmin WANG, Yang WANG, Xin WANG
39602 OR053 Safety and efficacy of cyberknife radiosurgery plus anlotinib hydrochloride in patients with recurrent glioblastoma: a prospective phase II single-arm study (HSCK-002). Yun GUAN(Shanghai, China), Wei ZOU, Li PAN, Enmin WANG, Yang WANG, Xin WANG
E6910-year outcome after central dose optimized robotic stereotactic radiotherapy for brain metastases from different histologies. Olaf WITTENSTEIN (Kiel, Germany), Fabienne DUY, Melanie GREHN, Robert WOLFF, Michael SYNOWITZ, Juergen DUNST, Hajrullah AHMETI, Oliver BLANCK, David KRUG
E3CyberKnife stereotactic radiosurgery for vestibular schwannoma: meta-analysis of long-term tumor control and hearing preservation outcomes. Nolan BROWN (Los Angeles, USA), Zachary PENNINGTON, Brian LIEN, Redi RAHMANI, Julian GENDREAU, Josh CATAPANO, Michael LAWTON
E229CyberKnife Stereotactic Radiosurgery for Extramedullary Plasmacytoma in the External Auditory Canal: A Clinical Case Report. Surya PATIL, Elaheh SHAGHAGHIAN, Lorenzo YUAN, Aaryan SHAH (Stanford, USA), Neelan MARIANAYAGAM, David PARK, Scott SOLTYS, Anand VEERAVAGU, Iris GIBBS, Gordon LI, Steven CHANG

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ESTRO 2024 NEWS

K Carr — Fri, 17 May 2024 09:41:22 +0000

At ESTRO 2024, we commemorated 30 years of transformative progress in the field of radiation therapy. Thirty years ago, the first patient was treated on the CyberKnife® System at Stanford University, USA. This groundbreaking technology has transformed radiation medicine. It was also three decades ago that the concept of dynamic helical delivery, utilized in the Radixact® System was conceived, pushing IG-IMRT possibilities well ahead of its time. Since then, a continuous focus on innovation and partnerships with clinicians and industry teams have helped to advance care worldwide.

Over the past three decades*, the CyberKnife System has amassed over 5,000 contributions in the literature, covering a diverse range of anatomical regions and therapeutic applications. In the same period, the TomoTherapy® System has similar contributions of over 4,500.

ESTRO 2024 Theme: Radiation Oncology - Bridging the Care Gap

This year’s ESTRO theme concentrated on bridging the care gap. This topic is highly important to help reinforce the position of radiotherapy as an essential cancer treatment that should be available to everyone. Everyone has the right to health and good quality care – but challenges lay ahead and unfortunately access to quality care is not always straightforward.

The Presidential symposium, “Bridging the care gap,” focused on several topics including addressing socio-economic gaps, national disparities, the East-West divide in Europe, and global considerations.

The 6 A’s of access were discussed:

Availability – equipment and staff
Accommodation – the need to stay nearby to the clinic during treatment
Affordability – affordability of treatment itself, affordability of travel to the clinic, consequences of missed work
Awareness – referring physicians awareness of radiotherapy indications, and a person diagnosed with cancer awareness of radiotherapy itself
Spatial Accessibility – refers to the geography of centres (their location)
Temporal Accessibility – timely access to care

All these points are related to the structure and process involved in developing good quality care for a patient. And to achieve good outcomes for people diagnosed with cancer, all of these points above need to be addressed.

Another consideration discussed was the need for national cancer plans which is a critical component to a country’s health care system. It is hard to believe but radiotherapy is often neglected when cancer plans are developed and this needs to change. The Global Coalition of Radiotherapy (GCR) has developed a framework of the key components needed in a national cancer plan to help ensure important aspects are included, whether creating a new plan or updating an existing one.

Listen to Darien Laird, Executive Director of GCR talk about the story behind GCR, and its aims to help improve equitable care for everyone around the globe.

Navigating The Oligometastatic Frontier: Strategies for Adaptation and Personalized Management

Oligometastases has emerged as a distinct and potential curable disease, where a shift from systemic and palliative only treatment focus to more targeted ablative therapies are occurring. And, there is evidence of improved outcomes with metastases directed-therapy. This year at ESTRO approximately 155 abstracts mention oligometastatic disease, clearly demonstrating it as an area of growing interest. In line with this, Accuray hosted a symposium on the management of oligometastatic disease. As people are surviving longer after their diagnosis of cancer it is imperative that ways to improve survival continue to be investigated. The symposium included insights and experience from Prof. Piet Ost, Prof. Nick van As, Prof. Barbara Jereczek-Fossa and Prof. Umberto Ricardi.

Many technology advances have allowed the progress and development of effective treatments for oligometastatic disease, in particular using imaging to characterize and identify patients suitable for this treatment. Personalizing the oligometastatic approach requires rigorous patient selection, and there must be a balance of safety considerations and navigating the interplay between systemic therapies with locoregional treatments. Make sure you watch the symposium to find out more.

Harnessing the Power: Radixact System and Surface Guided Radiation Therapy (SGRT)

Sofie Ceberg, Associate Professor, Medical Physicist from Lund University, Sweden presented a live webinar from ESTRO on the use of SGRT on the Radixact System. The research group at Skane Univerity Hospital have been instrumental in the early clinical development and implementation of optical surface-guided radiotherapy and have conributed to both ACROP-ESTRO and AAPM TG-302 guidelines, published in 2022. The benefits of SGRT on the Radixact System include:

Real-time feedback on patient position
Increased reproducibility
Imaging without additional dose
Sub-millimeter spatial resolution in 3D
Largest field of view (FOV) in radiotherapy (135 cm length)
- Harnessed for total marrow iradiation (TMI) and deep inspiration breath hold (DIBH) positioning
Possibility of margin reduction

An abstract by Mustafa Kadhim et al. from Skane University Hospital, Sweden also demonstrated SGRT with DIBH on the Radixact System helps to minimize dose to the heart and left anterior descending artery in breast cancer patients significantly compared to free-breathing techniques. This helps to support the feasibility and dosimetric benefits of combining SGRT and DIBH with TomoDirect on the Radixact System

ESTRO 2024 Abstract Highlights

CyberKnife System

613¹: A phase 2 trial (STEAL study) on high-dose online adaptive SBRT for 52 patients with abdominal oligometastases using the CyberKnife System was presented. The team demonstrated a 1-year local control rate of 96% with minimal toxicity – this approach has become their new standard of care for these patients.
2829²: Seventy-three patients with gynecological recurrence of which 53 were treated on the CyberKnife System. They found SBRT to be effective providing good local control and delayed time to systemic therapy by 12 months. This helps patients maintain a good quality of life for longer.
491³: The SPARC trial (Stereotactic prostate augmented radiotherapy with CyberKnife) is a phase 2 prospective trial treating the dominant intraprostatic lesion with a simultaneous integrated boost on the CyberKnife System. Twenty patients were treated with a median 30-month follow-up, with the primary outcome looking at acute toxicity. They showed this treatment is feasible and well tolerated.

Radixact/TomoTherapy System

757⁴: An independent evaluation of Synchrony® real-time tracking on the Radixact System was performed. By using a phantom and an independent monitoring device the team from Skane were able to determine that Synchrony accurately detected intrafraction motion of prostate tumors. The benefit of real-time tracking is that it allows a potential reduction in target margins during treatment. This not only helps to minimize dose to normal tissue but could also allow for dose escalation. Research that demonstrates accuracy helps increase confidence that what is planned is accurately delivered to the patient.
3109⁵: Ten high-risk patients undergoing allogeneic hematopoietic stem cell transplantation with refractory leukemia were treated with a higher dose to the bone marrow (20 Gy versus standard 13,5 Gy) on the TomoTherapy System. At 22 months post-transplant none of the patients experienced a relapse. They concluded that 20 Gy is feasible in total marrow irradiation (TMI) with acceptable toxicity for these high-risk patients. This is important for patients with chemotherapy-resistant leukemia, offering them an alternative treatment path.
3407⁶: A randomized phase 3 trial on the efficacy and toxicity of 60 Gy in 30 fractions versus 60 Gy in 20 fractions in 146 stage 3 non-small cell lung cancer patients using the TomoTherapy System. No significant differences in grade 2 or greater toxicity were found between the 2 groups. The clinical trial showed moderately hypofractionated radiotherapy improves overall survival in this category of patients. It also continues to help patients benefit from shorter overall treatment times, which can help increase patient throughput.

Learn more about the abstracts that mentioned Accuray technology on our 30 years of evidence page

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References

Lucy A. van Werkhoven et al ‘Outcomes of a phase II trial of high-dose online-adaptive SBRT for abdominal oligometastases’ ESTRO 2024
Benjamin J Thomas et al. ‘Outcomes of pelvic reirradiation with stereotactic radiotherapy for gynaecological cancer recurrence’ ESTRO 2024
Binnaz Yasar et al ‘SBRT Focal Boost for Localised Prostate Cancer: Primary Outcomes of the SPARC Prospective Trial’ ESTRO 2024
Klara Stefansson et al ‘Independent validation of real-time prostate localization for MLC tracking in phantoms and patients’ ESTRO 2024
Simonetta Saldi et al ‘Intensified total marrow irradiation in high-risk HSCT patients’ ESTRO 2024
Huang Wenhan et al ‘Efficacy and toxicity of moderately hypofractionated radiotherapy via helical TomoTherapy versus conventional radiotherapy combined with concurrent chemotherapy for patients with unresectable stage III non-small cell Lung Cancer: a multicenter, randomized phase III trial’ ESTRO 2024

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Accuray Innovation & Partnership Hub

K Carr — Fri, 19 Apr 2024 09:21:10 +0000

On April 16, Accuray inaugurated its Innovation & Partnership Hub in Genolier, Switzerland, reaffirming its commitment to the radiotherapy field as well as the Canton of Vaud. Positioned strategically within the Genolier Innovation Hub, the new facility capitalizes on the proximity of hospital groups and many investments by the Canton of Vaud making it a region of excellence in the management of benign and malignant tumors. This environment is expected to foster collaborations driving cancer treatment innovation.

Spanning 500m², the Hub is serving as a crucial training center for Accuray systems renowned for their precision and accuracy in the delivery of radiation. It features today the Radixact® Systems, along with two training rooms and a high-tech studio for online training. In the summer, the CyberKnife® System will be installed.

The event gathered approximately 80 people who enjoyed presentations, a cutting-ribbon ceremony and a guided tour of Accuray facility. We want to thank André Darmon, Mr Le Syndic, City of Genolier, Antoine Hubert, Delegate of the Board of Directors, AEVIS Victoria, Anna Gräbner, CEO of the Genolier Innovation Hub, Prof Oscar Matzinger, Medical Director of the Swiss Radio Oncology Network, and all our guests who honored us with their presence at this crucial milestone in our journey. The support and enthusiasm made this day unforgettable.

Find out more about Accuray Innovation & Partnership Hub

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Accuray Hosts Successful Northern Europe User Meeting

K Carr — Fri, 19 Apr 2024 08:27:43 +0000

Accuray recently hosted a Northern Europe User Meeting in London, United Kingdom (UK). The event, which marked the first occasion since 2019 for users from the Northern Europe region to meet in person, was a pivotal moment for the community. Over 40 registrants from seven countries, including the UK, Ireland, Sweden, and the Netherlands, seized the opportunity to learn about the remarkable work and research being done by users. The event also fostered re-engagement and the creation of new collaborations among the attendees.

Clinicians, medical physicists, and therapeutic radiographers came together to share their insights and experiences, creating a rich environment for knowledge exchange. The user committee designed a comprehensive program featuring sessions that spanned a wide range of topics, from the latest developments to clinical case studies and treatment protocols.

During the event, several presentations were given, including a talk by Professor Helen McNair on adaptive radiotherapy workflows. Her presentation highlighted the importance of considering roles, responsibilities, and training when implementing an adaptive workflow in the clinical department.

Radixact® System Session

In the Radixact® System session, four presentations were given:

Andre Haraldsson, Ph.D., shared their initial experience with Radixact Synchrony® tracking cancer in the prostate and lung. Dr. Haraldsson concluded that Synchrony tracking has a high level of accuracy and the tracking algorithm is robust.
Andrew Dumbill and Sallie Melsom from University Hospitals Birmingham, UK, discussed Total Body Irradiation (TBI) with TomoDirect. They presented their move from using extended source-to-surface distance TBI on the C-arm linac to TomoDirect delivery using the Radixact System.

Nathan Corradini, Chief Physicist at Gruppo Ospedaliero Moncucco, Switzerland, evaluated the Radixact MLC with a Real-time Feedback System. The study objectives were to evaluate the measured leaf open time (LOT) errors and plan latencies on the current system for a large patient cohort, to evaluate the variation in sinogram delivery (repeatability test), to determine if a correlation exists between plan latencies and anatomical treatment site and to estimate the clinical impact on target dosimetry due to latencies. Mr. Corrandini concluded that the MLC of the Radixact System is reliable and since January 2024, patient-specific quality assurance (PSQA) optical sensor data report generation & databasing have been implemented.
Sallie Melsom and Charlotte Clifford, University Hospitals Birmingham, UK, presented the commissioning and clinical implementation of ClearRT®. They gave an overview of required calibration and QA, as well as kV CTDI free-air and output, Hounsfield unit, and field of view (FOV) checks. They also shared imaging protocols, results from the MVCT and ClearRT audit and image quality including patients with artificial hips.

CyberKnife® System Session

Four centres presented their work on the CyberKnife® System:

Dr Maris Mezeckis from the University of Latvia presented results from the treatment of intermediate unfavourable, high, and very high-risk prostate cancer with radiosurgery. Dr. Mezeckis found that SBRT can be applied in all risk groups of prostate cancer. Both homogeneous and focally escalated SBRT provide acceptable toxicity and biochemical control results with a minor impact on quality of life. ADT can postpone biochemical relapse after SBRT, but its influence on prostate SBRT long-term results and survival needs further clarification.

Dr Maaike Milder, a medical physicist from Erasmus Cancer Institute in the Netherlands, presented their unique online adaptive technique on the CyberKnife System equipped with in-room CT. She shared previous work on retrospective inter-fraction motion in locally advanced pancreatic cancer (LAPC) and prospective plan of the day for oligometastatic lymph node metastases. The common challenges with these techniques were the underdosage of the tumor due to the location of the organs at risk (OARs) and highly mobile OARs. With these challenges in mind, their new aims were to look at options for adaptive treatment for SBRT of LAPC and increase the dose to the oligometastatic lymph nodes without increasing toxicity. They found that about 30% of fractions did not require adaptation for LAPC. However, for the remaining fractions, a time-restricted replanning technique was comparable to full replanning and solved 90% of the plan violations, allowing replanning within 3 minutes. A library of plans was available for the abdominal lymph node metastases. This was a therapeutic radiographer-led procedure; plans were chosen with the highest dose to target without exceeding OAR constraints. Using Incise MLC and VOLO helped increase delivery times and optimize optimization times faster.
Geoff Hayes and Timothy Jackson from Queen Elizabeth Hospital, Birmingham, presented ‘Out of Plan Doses for Intracranial CyberKnife Treatments’. This extremely interesting presentation examined published data on intracranial cancer risk in distant and proximal brain locations compared to the expected risk in the general population. They found that the risks were higher than expected and that the CyberKnife System was an effective treatment option.
Honorata Chajecka-Szczygielska from the Royal Marsden Hospital presented a way to partially outline the bowel. This novel technique reduced time spent on bowel outlining lowered the sample number and produced a homogeneous dose distribution. Some disadvantages were that optimizing with partial bowel may introduce higher dose spikes and additional clinical goal parameters were required to ascertain that the whole bowel dose is tolerable.

Accuray Northern Europe User Meeting was a resounding success. Attendees shared their research, insights, and experiences, learning from one another. We are excited to meet again next year.

To learn more about Accuray treatment solutions visit our product pages:

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SBRT Highlights from the RSS Scientific Meeting 2024

K Carr — Thu, 18 Apr 2024 07:14:47 +0000

The Radiosurgery Society (RSS) is an international, non-profit society consisting of physicians, physicists, and healthcare professionals dedicated to advancing clinical practice and education of stereotactic radiosurgery (SRS), and stereotactic body radiation therapy (SBRT) and advancing therapies.

Not everyone knows that RSS was actually founded in 2002 as the CyberKnife® Society by a consortium of neurosurgeons, radiation oncologists and medical physicists. In 2011 RSS was expanded to include other therapeutic applications.

Each year RSS hosts a scientific meeting to bring together world class healthcare professionals that are interested in the latest developments in SRS and SBRT. While Accuray technologies were highlighted in a number of abstracts at RSS this year, we are taking the opportunity to highlight 2 abstracts on the benefits of SBRT in patients with intermediate to high-risk prostate cancer treated with the CyberKnife® System.

Robotic SBRT for High-risk Prostate Cancer: The Georgetown Experience

Sharma et al^[1]., reported on gastrointestinal (GI) and genitourinary (GU) toxicities, as well as biochemical failure with targeted SBRT with the CyberKnife System in high-risk prostate cancer patient at 36 months post treatment. 216 patients with high-risk prostate cancer were treated with fiducial guided SBRT. They received 35-36.25 Gy in 5 fractions of either 6, 7, or 7.25 or 8 Gy using the CyberKnife System. They found SBRT for this patient group had excellent GU and GI toxicity alongside promising 3-year biochemical recurrence-free survival rates. Long-term patient reported outcomes for high-risk prostate cancer receiving SBRT is limited, this abstract helps to demonstrate longer term outcomes 3 years post treatment.

Acute Toxicity Following PSMA-Directed Focal Salvage Robotic SBRT for Local Recurrences Following Prior Robotic Prostate SBRT

We already know from previous research that local recurrences of prostate cancer following radiotherapy often originate from the primary tumor site called the dominant intraprostatic lesion (DIL)^[2]. But management of these focal recurrences following prostate SBRT is an area of active clinical investigation.

Wilson et al^[2]., reported the short-term toxicity and safety of focal salvage SBRT with PSMA targeting for locally recurrent prostate cancer after SBRT. Seventeen patients were treated with the CyberKnife System using 30-35 Gy in 5 fractions over 1-2 weeks. At 3 months post-treatment SBRT was found to be well tolerated with low incidences of acute GU and GI toxicities.

Further Research Beyond RSS Demonstrates the Effectiveness of Radiotherapy in High-risk Prostate Cancer Patients

Other published and upcoming studies that have shown progress in the management of high-risk prostate cancer include:

FLAME Trial (focal lesion ablative micro boost in prostate cancer)^[3]: A multicenter, phase III randomized control trial. Comparing external beam radiation therapy (EBRT) of 77 Gy in 35 fractions with or without a focal boost up to 95 Gy. All patients had intermediate to high-risk localized prostate cancer although the study was heavily weighed to high-risk patients. 571 patients were included with 287 in the standard arm and 284 in the focal boost arm. The average follow-up was 5 years. It was found that the focal boost to the intraprostatic lesion improved biochemical disease-free survival from 85% in the standard arm to 92% in the focal boost arm. Both late toxicity and health-related quality of life were small and not statistically significant.
STAMPEDE^[4]: To date the STAMPEDE trials have changed the standard of care for men with metastatic prostate cancer. The referenced publication from 2022 is a meta-analysis of 2 RCTs conducted in the STAMPEDE platform randomizing non-metastatic patients between ADT and ADT with abiraterone and prednisolone or ADT and ADT with abiraterone, prednisolone, and enzalutamide. This has been by the addition of docetaxel or abiternone and prednisolone to ADT and radiotherapy to the primary tumor in low burden metastatic disease. The interpretation of their analyses:
- Among men with high-risk non-metastatic prostate cancer, combination therapy is associated with significantly higher rates of metastasis-free survival compared with ADT alone. Abiraterone acetate with prednisolone should be considered a new standard treatment for this population.
- Abiraterone for 2 years should now be considered a standard treatment option in addition to 3-year ADT for newly diagnosed non-metastatic prostate cancer with high-risk features
- In summary, men with high-risk non-metastatic prostate cancer who receive ADT with combination therapy have significantly better metastases-free survival and overall survival than those who receive ADT alone. 2 years of abiraterone and prednisolone added to ADT and, if indicated, radiotherapy should be considered a new standard treatment for non-metastatic prostate cancer with high-risk features.
SPARC (Stereotactic Prostate Augmented Radiotherapy with CyberKnife)^[5]: A single phase 2, prospective study evaluated GU and GI toxicity and quality of life with CyberKnife based SBRT and simultaneous integrated boost in localized unfavorable intermediate to high-risk prostate cancer patients. It has been described that a dose response relationship exists for EBRT in this patient category. However, dose escalation beyond 80 Gy to the prostate gland is associated with increased toxicity. Intensifying dose to the DIL can be an alternative strategy to maximally ablate the area most at risk without exceeding organs at risk constraints. The study treated 20 patients with 36.25 Gy in 5 fractions with a simultaneous boost up to 47.5 Gy. At 30 months follow up there were no late G3 GU or GI toxicities reported and grade 2 GU and GI acute and late toxicities were comparable to other studies. They concluded that SBRT with the CyberKnife System was well tolerated.
PACE-C^[6]: The prostate advances in comparative evidence trials (PACE A and B) have made huge leaps in cancer management in low and intermediate-risk prostate cancer patients. However, the PACE-C trial investigates the clinical outcomes in intermediate- high-risk prostate cancer patients, indicated for 6 months of ADT and randomized to either conventional fractionation (60 Gy in 20 fractions) or SBRT (36.25 Gy in 5 fractions). These results are still to be released but are anticipated to make an impact in the management of high-risk prostate cancer patients.

The role of SBRT in high-risk prostate cancer patients is an area of active clinical study

For further information read the press release

References:

https://www.rssevents.org/fsPopup.asp?PosterID=658464&mode=posterInfo
https://www.rssevents.org/fsPopup.asp?PosterID=658489&mode=posterInfo
Kerkmeijer LGW, Groen VH, Pos FJ, Haustermans K, Monninkhof EM, Smeenk RJ, Kunze-Busch M, de Boer JCJ, van der Voort van Zijp J, van Vulpen M, Draulans C, van den Bergh L, Isebaert S, van der Heide UA. Focal Boost to the Intraprostatic Tumor in External Beam Radiotherapy for Patients With Localized Prostate Cancer: Results From the FLAME Randomized Phase III Trial. J Clin Oncol. 2021 Mar 1;39(7):787-796. doi: 10.1200/JCO.20.02873. Epub 2021 Jan 20. PMID: 33471548.
Attard G, Murphy L, Clarke NW, Cross W, Jones RJ, Parker CC, Gillessen S, Cook A, Brawley C, Amos CL, Atako N, Pugh C, Buckner M, Chowdhury S, Malik Z, Russell JM, Gilson C, Rush H, Bowen J, Lydon A, Pedley I, O’Sullivan JM, Birtle A, Gale J, Srihari N, Thomas C, Tanguay J, Wagstaff J, Das P, Gray E, Alzoueb M, Parikh O, Robinson A, Syndikus I, Wylie J, Zarkar A, Thalmann G, de Bono JS, Dearnaley DP, Mason MD, Gilbert D, Langley RE, Millman R, Matheson D, Sydes MR, Brown LC, Parmar MKB, James ND; Systemic Therapy in Advancing or Metastatic Prostate cancer: Evaluation of Drug Efficacy (STAMPEDE) investigators. Abiraterone acetate and prednisolone with or without enzalutamide for high-risk non-metastatic prostate cancer: a meta-analysis of primary results from two randomised controlled phase 3 trials of the STAMPEDE platform protocol. Lancet. 2022 Jan 29;399(10323):447-460. doi: 10.1016/S0140-6736(21)02437-5. Epub 2021 Dec 23. PMID: 34953525; PMCID: PMC8811484.
Yasar B, Suh YE, Chapman E, Nicholls L, Henderson D, Jones C, Morrison K, Wells E, Henderson J, Meehan C, Sohaib A, Taylor H, Tree A, Van As N. Simultaneous focal boost with stereotactic radiotherapy for localised intermediate to high-risk prostate cancer: Primary outcomes of the SPARC phase II trial. Int J Radiat Oncol Biol Phys. 2024 Mar 16:S0360-3016(24)00425-5. doi: 10.1016/j.ijrobp.2024.03.009. Epub ahead of print. PMID: 38499253.
https://classic.clinicaltrials.gov/ct2/show/NCT01584258

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Introducing Jeffrey Carpenter, Accuray Deputy Chief Information Security Officer

K Carr — Tue, 26 Mar 2024 15:47:50 +0000

Recently Jeffrey Carpenter, the deputy Chief Information Security Officer (CISO) at Accuray was invited to the Open Cyber Security Conference (OCSC), at Auditorio de Tenerife “Adam Martin”, to present the closing keynote speech

What was the purpose of the Open Cyber Security Conference?

The OCSC 2024 was a unique event to celebrate 30 years of international collaboration of cyber security and incident management teams within a global community of trusted practitioners. The aim of the meeting was to focus on future security incident management and how to address the challenges ahead. The majority of people attending the event manage or work in Computer Security Incident Response.

Jeffrey’s closing keynote speech and workshop

Jeffrey’s closing keynote speech included looking back over the past thirty years. And what has been learned as an incident response community, as well as what he has learned from personal experience. The day after the conference Jeffrey delivered a workshop on communication skills for incident responders, teaching alongside his long-time collaborator Don Stikvoort, of the Netherlands.

The workshop was attended by thirty-five cyber security professionals, which was the largest number of attendees in any of the workshops at the conference. The workshop was designed to help technical cybersecurity professionals improve their communication skills when briefing non-technical audiences. It included a series of exercises such as a short executive-level briefing about an incident.

“For me, the best part is talking to people to understand what has changed in incident response, what their challenges are, and new things they have learned. Two things I hear a lot more about is the impact of artificial intelligence on incident response, and the increased aggressiveness of adversaries perpetrating ransomware.”

Jeffrey Carpenter

Three reasons why it is important to attend these events?

To learn from the experiences of others, including the issues people are currently having and how they have addressed them
Give advice and help others overcome problems
Address common challenges faced in the industry

About Jeffrey

Jeffrey brings to Accuray more than thirty-five years of dedication to improving the state of information security in roles such as incident responder, product security officer, information security officer and leader. He currently is the deputy CISO at Accuray. As deputy CISO, Jeffrey has enterprise security and product security responsibilities.

He worked for almost two decades at the CERT^®Coordination Center, located at Carnegie Mellon University’s Software Engineering Institute, as an incident response analyst and technical manager. He oversaw applied research and operational analysis with a focus on incidents, software vulnerabilities, network monitoring, malicious code, vulnerability discovery, and secure coding.

Jeffrey has presented in various forums and served on Forum of Incident Response and Security Teams (FIRST) committees and working groups. Jeffrey was the Secureworks Senior Director of Incident Response Consulting and Threat Intelligence. Just before joining SecureWorks, Jeffrey was a product security and information security officer in the healthcare division at Royal Philips.

In 2021, Jeffrey was inducted into the Incident Response Hall of Fame by the Forum of Incident Response and Security Teams (FIRST). In his spare time, Jeffrey responds to other kinds of incidents as a volunteer firefighter and fire police officer. He has been an administrative officer at his fire company for most of his service, serving as recording secretary, president, and vice president.

Learn more about Accuray Cybersecurity Policy

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Addressing the Disparities in Radiotherapy in Asia-Pacific Region: Perspectives from Dr. Imjai Chitapanarux

K Carr — Tue, 12 Mar 2024 08:24:26 +0000

Asia and the Pacific region are home to 60% of the world’s population – some 4.3 billion people^[1]. There are estimated to be over 25 thousand islands, containing some of the smallest populations on the planet^[1,2]. Whilst some countries are better resourced, there are still many classed as developing with limited financial resources^[3], leading to disparities in radiotherapy.

Over 60% of cancer patients need radiotherapy alone or in combination with surgery and/or chemotherapy, and therefore, radiotherapy is the main and essential modality of cancer treatment.

Meeting the demand for radiotherapy services

From these statistics, it may come as no surprise that the Asia-Pacific region has a higher cancer burden than any other region. Unfortunately, in low-income countries (LICs) cancer patients often seek treatment when they are at an advanced stage of disease due to lack of education, prevention and screening. It is these patients who benefit from radiotherapy over other treatment techniques to reduce pain and help control disease for a better quality of life.

In a recent analysis, it was found that the region has only 43.9% of megavoltage machines needed to meet radiotherapy demand. This ranges from 9.9-40.5% in low- middle- income countries (LMICs) compared with 67.9% in high income countries (HICs). To put it in another way, in parts of South East Asia the number of radiotherapy machines per million population is as low as 0.1. Where in more developed countries like the US there are 11.7 radiotherapy machines per million population. This means that some countries in the Asia-Pacific region, do not have enough radiotherapy centres to meet patient demand^[4].

A study from 2022 found that the total linear accelerators required to meet patient demand in 21 countries in the region was 11,039. However, currently there are only 4924, a shortfall of 6115 (55.4%)^[5].

Cancer places its heaviest burden on low- and middle-income countries, where over 70% of cancer deaths are expected to occur, yet these countries receive only 5% of global spending in this area^[6]. Concerted efforts to expand resources for underserved populations are crucial to providing millions access to quality cancer interventions. The goal of the Federation of Asian Radiation Oncology (FARO) is to help combat this by growing radiation oncology in all aspects to improve the level of radiation therapy across Asia.

What is FARO?

To address the knowledge and resource needs of the Asian region, a ground-breaking collaboration was forged. In November 2014 National Radiation Oncology Societies from 11 Asian countries came together. These included the Indonesian Radiation Oncology Society (IROS), the Japanese Society for Radiation Oncology (JASTRO), Association of Radiation Oncologists of India (AROI), Malaysian Oncological Society (MOS), Philippine Radiation Oncology Society (PROS), Singapore Radiological Society (SRS), Sri Lanka College of Oncologists (SLCO), Thai Association of Radiation Oncology (THASTRO), the Korean Society for Radiation Oncology (KOSRO), Chinese Society of Therapeutic Radiation Oncology (CSTRO) and the Bangladesh Society of Radiation Oncologists (BSRO). They came together to form the Federation of Asian Organizations for Radiation Oncology (FARO).

It aims to enable resource-constrained centres to ‘level-up’ to meet the needs of their patients. With a mission to provide a platform to promote education and training, scientific exchange and research in radiation oncology. Enabling continuous cooperation and communication amongst member countries^[3]. As of 2024, FARO has 14 official members organizations. This includes the addition of Pakistan Society for Clinical Oncology (PSCO), Myanmar Society for Radiation Oncology (MSTRO), and Mongolian Society for Radiation Oncology (MOSTRO)

We interviewed Dr Imjai Chitapanarux, Professor in Radiotherapy Oncology at the Faculty of Medicine, Chiang Mai University, Thailand and President of FARO, on the biggest challenges in access to cancer care in the Asia-Pacific Region.

Intersectional disparities within Asian nations contribute to the complexities of the cancer care gap. There is no ‘biggest gap’, unfortunately, it encompasses every aspect from diagnosis to treatment, including public awareness and education. In particular, the population is vast which contributes to the disparities as each nation is very different. And again, the gaps vary in all aspects of cancer care, depending on the income status of these countries.

What is the status of public awareness and screening in this region?

Education and public awareness depend on the economic status of each country. Public awareness is very good in MIC-HIC, and even in some LMICs. Public awareness and screening have improved but for many LICs these services remain very limited. Gaps are especially found in rural areas compared to urban/semi-urban areas in each nation. But, this is not just to do with distance. Nowadays it is much easier to spread public awareness by using online technology. However, in some LICs online infrastructure is not yet available, and this can cause problems. Despite this, public awareness remains an easier challenge to combat than improving cancer screening.

From the patient's perspective, what do you see as the biggest barriers to closing cancer gaps?

From the patient’s perspective – affordability is the biggest barrier. Five to six years ago some countries in Asia, could not afford to provide patients with any paid-for cancer care. Therefore it had to be paid out of the patient’s pocket. Patients who can afford it can have screening and treatment. But for those that cannot afford it and the government is unable to contribute, it becomes impossible for these patients to have any cancer treatment.

What about geographic distance?

Access to care in rural areas in very important. People in urban or semi urban areas can easily access treatment like chemotherapy, radiotherapy and immunotherapy etc. However, this would be difficult for people in very rural areas. Hypofractionation – is a way to help solve some problems in access to radiotherapy. This is because it reduces the number of times a patient has to visit the hospital and increases resources for more patients too.

“Hypofractionation – a way to help solve some of the problems in access to radiotherapy”

From a healthcare provider's perspective what challenges are there in providing advanced radiotherapy services?

But for some cancer centres in this region, only 3D-conformal radiotherapy or IMRT is available. This means not all centres can perform SRS and SABR. In LIC they may only have 1 radiotherapy centre – making it extremely difficult to install advanced treatment technology that would serve millions of people. Some countries in South-East Asia have universal health coverage (UHC), where the government ensures people get the quality health services they need, without experiencing financial hardship.

UHC has two dimensions – access to needed health care, and financial protection. The Regional average for the UHC essential health services index is 61% in 2019 compared with 46% in 2010. On the other hand, over 65 million people are pushed into poverty because of health expenditure^[8].

But, there is not one barrier for healthcare providers. There is also significant shortages of radiation oncologists and medical physicists. As an example the International Atomic E Association (IAEA) mandated one medical physicist per 400 patients annually. But in a study from 2022 it was found there was a shortfall of 43%. Education is also key to ensure availability of qualified staff. In a white paper from Abdel-Wahab et al it is said that trained professionals are key for the sustainable growth of radiotherapy and should be a strategic consideration in any National Cancer Control Plan^[8].

Which of these barriers is easiest/hardest to address?

The easiest barrier to address is training – but the hardest to address are staff shortages, financing, and increasing UHC. To improve the reach of UHC in more countries, collaboration is vital with policy makers.

Thailand is a MIC-HIC and has had UHC for nearly 20 years. It focuses on cancer care – ensuring that radiotherapy is free of charge for patients that require it in public hospitals. In public hospitals the government pay for new facilities and the radiotherapy machines – but changes to UHC now allow patients access to treatment in private hospitals too. This improves access to care as it allows patients who are closer to private hospitals to receive treatments there instead of travelling to the nearest public hospital. The government then reimburse the private hospitals for the treatment the patient received at a set cost. This means in Thailand there is a radiotherapy centre available every 100-200 km improving health care coverage.

Where have you seen the most promising progress?

In Thailand the progress has accelerated over the last 10 years. New radiotherapy technology and the number of radiotherapy centers have increased dramatically. The number of healthcare professionals are gradually increasing – and the knowledge in our country is good. In South-East Asia, progression in education for medical physicists, radiation therapists, and radiation oncologists is being made with free monthly FARO webinars. This helps provide healthcare professionals in hospitals with very limited resources, with good practices and standards of care to deliver radiation therapy treatments more safely.

There is still some resistance from radiation oncologists to change to hypofractionation. But it is important to educate health professionals on the benefits of hypofractionation. In Thailand hypofractionation is a standard of care for breast cancer and we are now expanding this to prostate cancer, and early-stage lung cancer. It can take a long time to change practice, but we must persist.

To learn more about gaps in cancer care, read our Radiotherapy UK blog

References:

UNFPA Asia and the Pacific Population Trend (2024)
Diversity Inc (2020) Defining Asia and the Pacific Islands.
Regional collaboration to improve quality of radiation therapy in Asia – PubMed (nih.gov)
https://dirac.iaea.org/Query/Map
https://www.who.int/southeastasia/health-topics/universal-health-coverage
Rays of Hope | IAEA
Status of cancer treatment by radiotherapy and requirement of radiation oncology medical physicists in Asia Oceania federation of organizations for medical physics region. PubMed (nih.gov)
Abdel-Wahab M et al. Global Radiotherapy: Current Status and Future Directions-White Paper. JCO Glob Oncol. 2021 Jun;7:827-842. doi: 10.1200/GO.21.00029. PMID: 34101482; PMCID: PMC8457786.

The post Addressing the Disparities in Radiotherapy in Asia-Pacific Region: Perspectives from Dr. Imjai Chitapanarux appeared first on Accuray.

Radiotherapy – An Overlooked Pillar of Cancer Care: Learn how Radiotherapy UK is driving change for a better future

K Carr — Fri, 23 Feb 2024 08:25:45 +0000

Radiotherapy remains a cornerstone of cancer treatment alongside surgery, chemotherapy, and immunotherapy – more than 50% of cancer patients require radiotherapy at some point following their diagnosis^[1]. It is needed in 40% of cancer cures. However, in the UK, access consistently trails behind other developed countries. Underinvestment, staff shortages and loss of a dedicated National Cancer Control Plan (NCCP) are exacerbating regional and socioeconomic care inequalities^[2]. Stark disparities jeopardize timely treatment for many, contradicting radiotherapy’s classification as a “core” modality by UK oncology leaders.

Barriers to cancer treatments in the UK span beyond proximity

Recent alarming headlines have shone a spotlight on scarcity^[3], with “postcode lotteries” (unequal provision of services such as healthcare depending on the geographic area) leaving survival odds heavily dictated by location. But barriers span beyond proximity, with systemic pressures across workforce, equipment and infrastructure domains converging to hamper this critical service.

“The UK is in the deepest cancer crisis in my 30 years as an oncologist. Let this be the end of accepting the unacceptable when it comes to cancer. Hundreds of thousands of cancer patients continue to face deadly delays to lifesaving cancer treatment. Every 4 weeks of delay in receiving treatment can increase the risk of death by 10%. By not having a cancer plan the Government are going against all the international evidence. This must sound the alarm in every political office in the land, all the way up to the Prime Minister. We’re calling on all parties to acknowledge the cancer crisis and commit to delivering a plan to tackle it”

Professor Pat Price – Academic Clinical Oncologist at Imperial College London, Chair of Radiotherapy UK and co-founder of Catch Up With Cancer Campaign

Radiotherapy UK is the only charity dedicated to improving radiotherapy treatment throughout the UK. The charity recently published a report ‘World-class radiotherapy in the UK: Right Patient, Right Treatment, Right Time, which was launched in Parliament to mark World Cancer Day 2024

What do you see as the biggest gaps in cancer care in the UK?

Unfortunately, one of the most serious gaps in cancer care is the unacceptably long time cancer patients are waiting to be treated.

In 2023, the length of time cancer patients waited for treatment in the UK reached record highs. Over 225,000 cancer patients in England alone have waited too long for their cancer treatment since 2020. This is deeply concerning because we know that every 4 weeks delay can lead to a 10% increase in mortality. Recent cancer policy has focused on early diagnosis which is incredibly important, but without a similar focus and matched investment in cancer treatment capacity, these patients are simply being added onto an ever-lengthening line for treatment.

Cancer incidence is rising, and it is expected that by 2040 the number of people in the UK diagnosed will increase by a third from 384,000 to 506,000.

Long-term strategic planning is required to deal with the current backlog of patients waiting to be treated and to deal with the rising incidence in the coming decade. Radiotherapy can play a significant role in providing solutions to some of these key treatment capacity challenges. It is a highly effective treatment to cure early-stage disease and is the most cost-effective treatment available, costing on average £3,000 – £4,000 (3,780 – 5,042 USD) per patient. As a high-tech and innovative treatment radiotherapy is primed to harness digital and technological advances to the benefit of cancer patients. It is delivered by a small, highly skilled workforce of only 6,500, providing care to over 160,000 patients across the UK. The current workforce shortage is about 9% or 600 professionals. That is a small number and investing in recruitment and retention could have a huge return on patient capacity and care.

What has caused such a disparity in access to radiotherapy in the UK compared to other high-income countries?

In the UK we have relatively low levels of access to radiotherapy at 24 – 27% in comparison to international standards (52-53%)^{[4, 5]}. Lack of long-term planning and investment has led to piecemeal implementation of new technologies and innovations. Radiotherapy in the UK has been systematically under-funded for decades with only 5% of the cancer budget directed towards it.

There are an estimated 5.1 radiotherapy treatment machines per million population in the UK – below comparative European countries, which have an estimated equivalent number of between 7-10 machines per million. Analysis undertaken by Radiotherapy UK estimates between 13 – 20% of machines are coming to the end of, or exceeding their recommended lifespan. This can mean slower treatments, more treatment interruptions with breakdowns and a lack of technological capability to undertake modern radiotherapy.

We now need a National Plan for Radiotherapy to implement solutions to the current cancer crisis and inform long term planning. Patients need equality of access to high quality radiotherapy on time and that provides the best outcomes and quality of life. This means intelligent investment in workforce, equipment and new technologies. Ultimately, this National Plan needs leadership with a new independent and accountable strategic group supported by the healthcare commissioners across the four nations.

What are the biggest barriers to getting funding for Radiotherapy Services?

Funding for radiotherapy services can be bureaucratic, as existing systems often fail to keep pace with the substantial technological progress in planning and delivering radiotherapy treatments. The absence of financial support for the collection of Patient-Reported Outcome Measures (PROMs) data is a significant barrier to gathering patient-focused data, which could reveal discrepancies in toxicity outcomes.

The provision of funds for radiotherapy equipment, along with the necessary IT infrastructure and software, is inconsistent and does not ensure the routine replacement or enhancement of machines, or consider the expansion of service capacity based on population and anticipated increase in incidence.

What role should government play in addressing these challenges?

Addressing these challenges and improving services for cancer patients should be a Government priority. 1 in 2 of us will get cancer and it impacts every facet of our lives^[6]. We need the government and opposition parties to implement a National Cancer Control Plan (NCCP) with intelligent investment and consistent policies.

Radiotherapy must be a central element of any NCCP and through our work as Secretariat of the All Party Parliamentary Group for Radiotherapy (APPG-RT), Radiotherapy UK have collaborated with the radiotherapy community to develop an evidence-based vision for radiotherapy that could lead to improved patient survival and quality of life ‘World-class Radiotherapy in the UK: Right Patient, Right Treatment, Right Time’. It is in the power of politicians, NHS and healthcare commissioners to take this plan and transform the actions set out into positive change for cancer patients.

Are there examples of policy in other countries that you see as successful or a model for others?

Yes, in the late 1990s, Denmark’s 5-year cancer survival rates were notably lower than those of its European neighbours^[3]. In response, the Ministry of Health initiated a comprehensive campaign to enhance outcomes, which involved reorganising services, enhancing access, and improving screening procedures. A parallel political emphasis and investment in radiotherapy resulted in Danish services offering advanced treatments with minimal waiting lists.

How do you see advanced radiotherapy solutions affecting access to care in the UK?

Advanced radiotherapy can improve access to the most appropriate, accurate and precise treatment for patients, thus improving outcomes and quality of life.

Hypofractionation is growing in evidence for many cancer sites, do you think it is possible this type of treatment regime can help reduce the burden of patients and departments?

Hypofractionation is a key advance in radiotherapy and can have a positive impact on patient experience as it reduces the amount of time patients need to spend receiving treatment, for example from 25 days to 5. This can also have a positive impact on treatment capacity for a department, but it must be recognised that hypofractionation is an increasingly complex image-guided treatment technique that requires careful planning and increased workforce capacity to deliver.

How is Radiotherapy UK helping to drive change in better access to cancer care?

Radiotherapy UK is the only charity in the UK dedicated to improving access to high-quality radiotherapy treatment and support. We work really hard to achieve this through advocacy and campaigning for a world-class radiotherapy service for patients, patient information services and supporting the development and engagement of a highly skilled and dynamic radiotherapy workforce. We are a tiny charity punching way above our weight.

Our campaigning work seeks to evidence the difference that a fully funded and sustainable world-class radiotherapy service could have for cancer patients’ survival rates and outcomes.

How this makes a difference to patients - A patient perspective

"I am one of only 12% of people in this country that survive longer than five years after being diagnosed with a brain tumour. I got the treatment I needed on time, both surgery and radiotherapy, and everyone deserves the same. It shouldn't be a postcode lottery. Campaigning with Radiotherapy UK and the #CatchUpWithCancer campaign is something I am very proud to be part of. We are a powerful voice, with the patient at the heart of everything, and the progress we are making is well worth supporting."

Patient Advocate

What has been the most promising progress so far?

Our work advocating for equality of access to high-quality radiotherapy has produced the award-winning Catch Up With Cancer campaign. We were the first to highlight the vast numbers of patients caught up in the cancer backlog due to the pandemic, the devastating impact these waits are having and the solutions available. Our considered position, backed up by our analysis and information frequently features in nation-wide media, and informs parliamentary questions, debates, and documents.

We recently facilitated and co-authored the report ‘World-class radiotherapy in the UK: Right Patient, Right Treatment, Right Time’, which we launched at the House of Commons in February 2024. We are really proud to have led the way on this report, collaborating with all stakeholders within the radiotherapy community to highlight how by 2034, world-class radiotherapy could be a reality nationwide. This is a huge achievement for a tiny charity.

Our high-profile campaigning has also translated into positive practical impact, securing additional funding for radiotherapy equipment in 2021 and in 2023 an £89M (112M USD) investment in radiotherapy services by the Welsh Government. But there is much more to do to adequately address the current postcode lottery for access to high-quality cancer treatment.

We are proud to have a strong history of speaking up with integrity and passion for and with cancer patients and the radiotherapy workforce, with arguments based on evidence, data and front-line experience.

What can people do to help?

We are a small charity and struggling to do all the things we want to do and that we can see need to happen. We would be really grateful if people could donate to help us continue our important work for cancer patients in the UK.

Radiotherapy cures cancer and is the most cost-effective cancer treatment. It has the potential to transform cancer treatment, deliver extra capacity and enhance patient outcomes in the UK but to do so requires clear and focused direction and a national ambition to deliver world-class services. At Radiotherapy UK we believe that cancer patients deserve more – more ambition, better chances of survival and better quality of life.

“It’s time to realise the immense potential of radiotherapy by harnessing proven technical advances and innovation to improve patient outcomes. Let us prioritise this cost-effective and curative treatment, where a modest investment could yield a huge leap in progress. If we do this, the world will watch, and we will all be empowered.”

Professor Pat Price – Academic Clinical Oncologist at Imperial College London, Chair of Radiotherapy UK and co-founder of Catch Up With Cancer Campaign

Read our blog from Dr Ajaikumar to learn more about gaps in cancer care

References:

The post Radiotherapy – An Overlooked Pillar of Cancer Care: Learn how Radiotherapy UK is driving change for a better future appeared first on Accuray.

Understanding the Global Cancer Care Gap – World Cancer Day

conor — Wed, 14 Feb 2024 19:33:53 +0000

Understanding
the Global Cancer Care Gap

For the last three years, the call-to-action of World Cancer Day — “Close the Care Gap” — has focused on health equity challenges.

It is estimated that 50-60% of patients with cancer will need radiotherapy⁸. Radiotherapy provides excellent local tumor control and is used to cure localized disease, palliate symptoms, and control disease in incurable cancer. There are serious limitations worldwide in the availability of radiotherapy services. Even in some high-income countries such as Canada, Australia and the UK, access to radiotherapy facilities and equipment is still inadequate due to lack of investment. While advances in treatment technologies have dramatically enhanced treatment capabilities, leading to celebrated improvements in outcomes across many countries, much of the global population has thus far been left out of this cancer care revolution:

Tremendous Gaps in Access to Treatment Resources

14,875 linear accelerators globally¹ *

0 %

are in high-income
countries

0 %

are in middle-income
countries

ONLY 0 %

are in low-income
countries

High-income countries only account for <20% of the global population

80 %

of the world’s patients with cancer have access to only of global radiotherapy resources.²

30

countries still have
NO RADIOTHERAPY
TREATMENT CENTERS.³
Half of these countries are in Africa

Access Gaps Produce Outcome Disparities⁴

In 2020, 70% of the almost 10 million cancer- related deaths worldwide were in LOW-AND-MIDDLE-INCOME COUNTRIES

Childhood Cancer Survival Rates⁵

High-Income Countries:

>80% of children are cured

Low-Income Countries:

<30% of children are cured

Growing Cancer Burden Will Magnify Equity Issues⁶

Low-Human
Development Index (HDI)
Countries
96%
increase
in cancer cases

High-Human
Development Index (HDI)
Countries
32%
increase
in cancer cases

Major Disparities Within
Developed Nations, Too⁷

>70%
of U.S. counties have

NO MEDICAL ONCOLOGISTS

40%
of Americans living in rural areas say they

LACK REASONABLE ACCESS TO CANCER SPECIALISTS

Closing radiotherapy access gaps could save

1 MILLION

LIVES ANNUALLY

Important Safety Statement:

Most side effects of radiotherapy, including radiotherapy delivered with Accuray systems, are mild and temporary, often involving fatigue, nausea, and skin irritation. Side effects can be severe, however, leading to pain, alterations in normal body functions (for example, urinary or salivary function), deterioration of quality of life, permanent injury, and even death. Side effects can occur during or shortly after radiation treatment or in the months and years following radiation. The nature and severity of side effects depend on many factors, including the size and location of the treated tumor, the treatment technique (for example, the radiation dose), and the patient’s general medical condition, to name a few. For more details about the side effects of your radiation therapy, and to see if treatment with an Accuray product is right for you, ask your doctor.

Sources:

1. Maitre P, Krishnatry R, Chopra S, Gondhowiardjo S, Likonda BM, Hussain QM, Zubizarreta EH, Agarwal JP. Modern Radiotherapy Technology: Obstacles and Opportunities to Access in Low- and Middle-Income Countries. JCO Glob Oncol. 2022 Jul;8:e2100376. doi: 10.1200/GO.21.00376. PMID: 35839434; PMCID: PMC9812473.
2. Court L, Aggarwal A, Burger H, Cardenas C, Chung C, Douglas R, du Toit M, Jaffray D, Jhingran A, Mejia M, Mumme R, Muya S, Naidoo K, Ndumbalo J, Nealon K, Netherton T, Nguyen C, Olanrewaju N, Parkes J, Shaw W, Trauernicht C, Xu M, Yang J, Zhang L, Simonds H, Beadle BM. Addressing the Global Expertise Gap in Radiation Oncology: The Radiation Planning Assistant. JCO Glob Oncol. 2023 Jul;9:e2200431. doi: 10.1200/GO.22.00431. PMID: 37471671; PMCID: PMC10581646.
3. https://ncdalliance.org/resources/closing-the-cancer-divide-a-blueprint-to-expand-access-in-low-and-middle-income-countries-by-the-global-task-force-on-expanded-access-to-cancer-care
4. https://www.cancer.org/about-us/our-global-health-work/global-cancer-burden.html
5. https://www.who.int/news-room/fact-sheets/detail/cancer-in-children
6. https://www.wcrf.org/differences-in-cancer-incidence-and-mortality-across-the-globe/#:~:text=The%20number%20of%20new%20cases,in%20very%20high%20HDI%20countries.
7. Kenamond MC, Mourad WF, Randall ME, Kaushal A. No Oncology Patient Left Behind: Challenges and Solutions in Rural Radiation Oncology. Lancet Reg Health Am. 2022 Sep;13:100289. doi: 10.1016/j.lana.2022.100289. Epub 2022 Jun 3. PMID: 35692288; PMCID: PMC9170528.
8. Atun R, Jaffray DA, Barton MB, Bray F, Baumann M, Vikram B, Hanna TP, Knaul FM, Lievens Y, Lui TY, Milosevic M, O’Sullivan B, Rodin DL, Rosenblatt E, Van Dyk J, Yap ML, Zubizarreta E, Gospodarowicz M. Expanding global access to radiotherapy. Lancet Oncol. 2015 Sep;16(10):1153-86. doi: 10.1016/S1470-2045(15)00222-3. PMID: 26419354.

The post Understanding the Global Cancer Care Gap – World Cancer Day appeared first on Accuray.

Driven to Make a Difference: Women of Accuray Share their Career Journeys

K Carr — Mon, 12 Feb 2024 09:52:55 +0000

In honor of International Day of Women and Girls in Science, we invited some of the women in Accuray to tell us why they chose to pursue a career in STEM (science, technology, engineering, and mathematics). You will learn about what inspired them, the challenges they overcame, and advice on how you too can embrace a career in science and technology.

Lauren Auerbach

Motion Control Engineer

I am a Motion Control Engineer which is at the intersection of software, hardware, and electrical systems. In my role I write software that moves the robot of the CyberKnife® System safely throughout its workspace and help design the hardware and electrical interfaces that connect to the rest of the CyberKnife system.

‘Learn as much as you can, ask questions, and stay curious’

What originally inspired you to pursue a career in science and technology?

I was always drawn to math and science in school, so pursuing a career in STEM was never a question for me. I loved working with my hands and have always learned best with physical lab-style work rather than a lecture. My dad was an engineer, too, and from a young age, I knew I wanted to follow in his path. Tinkering and building were a huge part of our relationship and our mutual love for math and science was another thing for us to bond over.

Did you have any role models who influenced your path?

My dad was my biggest role model. He was a mechanical engineer by trade, and he always encouraged me to be curious and question everything when I was young. He would help with my math homework and bring me to his office to show me his designs and models. He taught me how to use power tools and build things. Together we rewired the electrical system of an old ’68 Mercedes, we built computers together, and we always loved bouncing our ideas off one another.

How can we encourage more girls to explore STEM?

Exposure and encouragement! Starting science and technology-based education from a young age can play a major role in confidence and interest. It was a major influence on my interest in STEM. With more exposure comes more curiosity and exploration, and it’s important to encourage that process.

What advice would you give to women and girls interested in STEM careers?

Go for it! If you’re interested in something, keep seeking it out. Learn as much as you can, ask questions, and stay curious. There are so many resources out there now. Exploring the various fields of math, science, and technology can be an endless journey. Find what piques your interest and keep probing.

Cristina Negrut

User Experience Design and Usability Engineer

As a User Experience (UX) Designer and Usability Engineer, I focus on designing safe and easy-to-use applications for our Treatment Delivery and Planning Systems.

‘Don’t be afraid to change paths – listen to passions call’

Embrace New Beginnings

For four years in graduate school in Economics, I pored over optimization problems and filled up notebooks with math equations. While I enjoyed solving complex problems, I increasingly listened to the soft but persistent voice telling me that this was not what I wanted to be doing for the rest of my life. But how could I change my path after all the time and effort I had invested?

Somehow, I mustered the courage to let it all go. Computers and mobile technologies were just taking off, and even though I did not know what my new job could be, I enrolled in yet another graduate school in Information Science at the University of Michigan. I let myself pick the class that motivated me the most and ended up taking my first course in Human-Computer Interaction, a class that would lay the foundation of my career as a User Experience Design Engineer. I have finally found what I love doing. It makes a huge difference being in a field that you are passionate about – don’t be afraid to change paths.

Consider the Industry

Let’s say you already know what profession or job role best suits you. I found that a very important aspect is the industry you choose. You could do the same role working for an uninspiring industry, or like in my case, work in the healthcare industry. During the toughest days at work that are inevitable over one’s career, reminding myself that ultimately, the work I do will help clinicians and patients worldwide is so meaningful and rewarding makes everything worth it.

Cultivate a Passion Project

My youngest son was only a year old when I started a website collecting graduation speeches. I was passionate about learning and sharing the nuggets of wisdom that accomplished commencement speakers were sharing with young graduates. In addition, this project would allow me to keep my skills up to date in web design and web usability which were not part of my day job. Keeping abreast with all design platforms through a project that I was deeply passionate about gave me a lot of satisfaction, and I felt it also gave me a safety net. Little did I know that this work of love would allow me to land media interviews in print, radio, and live TV. I worked on this project for over 15 years, and even now after it ended, I still get to share what I learned, more recently on the Apple News in Conversation podcast.

Angela Arts

Senior Director of Global Clinical and Service Training

I lead global programming to support the education of Accuray’s field service personnel and clinicians utilizing Accuray technology

‘Recognise and be open to new opportunities when they arise’

What originally inspired you to pursue a career in science and technology?

I didn’t set out with a specific career goal to work in science and technology. My passions and focus were in areas of organizational communication, and leadership. Like many young professionals I knew I wanted to do work that made a difference. I found my way to the training space early in my career and have worked in those functions ever since. Getting to work in the med tech industry allows me to leverage my strengths, work alongside brilliant people, and make an impact on the lives of cancer patients.

What have been some of the biggest challenges you’ve faced as a woman working in a technical field? How did you overcome those obstacles?

At times throughout my career, it wasn’t uncommon to be the only female voice in the room. Those situations can be intimidating, as if your responses are under a different level of scrutiny simply because you’re female. Over time I’ve realized that in those situations, your perspective as the minority is even more important to the success of the conversation, and that sharing your views is a way that you can bring value to your organization. To build this confidence, become an expert in your area, and learn how your function fits into the rest of the organization. Be intentional about sharing your thoughts in meetings. It gets easier, and people will come to expect it from you going forward.

What excites you most about the innovations happening now in radiation therapy?

The field of Radiation Therapy technology is quickly evolving, and the increasing focus on patient outcomes and patient experience is an area that I find exciting. This change in focus requires us to think beyond the technical specifications of the product, and instead think more holistically about how we can be the best possible partners for clinicians.

What are you most proud of accomplishing over your career?

A specific recent accomplishment was my oversight of the design and construction of our new global training facility. This initiative allowed me to lead strategically, learn some new skills and think creatively about the future of our training organization.

Occasionally I’m privileged to hear from patients whose lives were improved with our technology. Each time, I’m reminded of how fortunate I am to be a part of this industry. To see our collective efforts, have such a profound impact on their lives is incredibly fulfilling.

What advice would you give to women and girls interested in STEM careers?

My career is an example of how someone with strengths outside of traditional areas of STEM can be successful in a technical industry. Fortunately, more doors are open for women to make an impact in this space than ever before. Different perspectives allow conversations to be more robust, and solutions sounder. Women are not just deserving of a seat at the table, they are essential to the success of what’s being discussed around it. It’s the responsibility of everyone, not just other women, to encourage more girls to be interested in technical careers.

If you could give your younger self career advice, what would you say?

Recognize and be open to new opportunities when they arise. I think it’s easy for young professionals to be caught up in wanting to follow the right career path, and that career growth only comes in the form of a promotion. In my experience, there is no “right path,” and growing within your current role can also be a powerful learning experience. New projects, assignments, or working with different teams can hone new skills and potentially identify strengths you didn’t know you had.

Karen Crowther

Global Radiotherapy Manager

I am a Therapeutic Radiographer and the manager of the Accuray User Community (Accuray Exchange) and the Accuray Exchange Webinar Series for the radiotherapy and radiosurgery communities. It is my honor to help facilitate the sharing of knowledge and expertise among our community members.

'Believe in yourself and just go for it’

What originally inspired you to pursue a career in science and technology?

I enjoyed studying science during my school days with a natural inquisitiveness and curiosity. Personally, I have experienced the profound impact that cancer can have on a family. Losing my father has been a significant motivating factor for me to dedicate my career to working in oncology and radiotherapy. It was and is important to me to ensure every patient can access the best treatments available.

What have been some of the biggest challenges you’ve faced as a woman working in a technical field? How did you overcome those obstacles?

Balancing work and personal life is one of the most significant challenges. In my opinion, Accuray is a company that promotes a culture of diversity, inclusivity and work-life balance, making this balancing act a little easier.

What are you most proud of accomplishing over your career?

During my career, I have been fortunate enough to have experienced several proud moments. One that stands out is when I achieved a distinction in my MSc while working full-time and raising two young children. Another proud moment was presenting my research at ESTRO in 2019. I am thrilled to be able to repeat this achievement at ESTRO 2024 in Glasgow, where I will share the initial results of my PhD research. Joining Accuray was also a major accomplishment for me, as it was always a dream of mine to work in this industry.

How can we encourage more girls to explore STEM careers?

There are many ways to encourage girls to pursue STEM careers, including efforts by parents, teachers, and industry.

Exposure to Role Models: Introduce young girls to successful women in STEM fields through mentorship programs, talks, or workshops. Highlight the achievements and contributions of women scientists, engineers, and technologists in various fields.

Educational Initiatives: Support STEM education programs that provide hands-on experiences, experiments, and projects, making learning engaging and fun. Encourage participation in science fairs, robotics competitions, coding clubs, or STEM-related extracurricular activities.
Break Gender Stereotypes: Challenge stereotypes by showcasing diverse role models and emphasizing that STEM is for everyone, regardless of gender. Promote a growth mindset, encouraging girls to see challenges as opportunities to learn and grow.

Hands-On Experiences: Provide opportunities for girls to participate in hands-on activities and experiments, fostering a love for discovery and problem-solving. Organize field trips to science centers, tech companies, or research institutions to expose girls to real-world applications of STEM.

Supportive Communities: Establish supportive communities or clubs where girls can share their interests, collaborate on projects, and receive encouragement from peers and mentors.
Parental and Teacher Support: Encourage parents and teachers to actively support girls’ interest in STEM by providing resources, encouragement, and positive reinforcement.

Jiuhong Chen

Director of Medical Affairs, APAC

I execute medical strategy within the APAC region to develop and expand clinical utilization and clinical research in the radiation therapy field. Creation and execution of a strategy to build and strengthen relationships with KOLs in the oncology community in the APAC region and support customers to design research projects and publications is key.

‘Learning is key… stay interested, passionate and ambitious’

What originally inspired you to pursue a career in science and technology?

Originally, I went to Medical School by my parents’ wishes, where it sparked my interest in medical sciences.

Did you have any role models who influenced your path?

Yes, I do have many women role models in my path and the recent one is the former COO of Meta Sheryl Sandburg and her book of “Lean In” inspired me in my career.

What have been some of the biggest challenges you’ve faced as a woman working in a technical field and how did you overcome those obstacles?

Advancing your technical skills is always of the utmost importance and a challenge in the field. I am still working on it and learning from our customers and colleagues who are experts in the field.

What excites you most about the innovations happening now in radiation therapy?

Accuray’s motion management solution of “Synchrony” is the innovation to me that is the most exciting in the radiotherapy field.

How does your work applying complex technology help improve patients’ lives?

It helps to facilitate the clinical utilization of Accuray technologies and clinical proof for innovative treatments to better improve patients’ lives.

What are you most proud of accomplishing over your career?

I am proud to be adaptive and always scouting out ways to improve by learning.

What advice would you give to young women and girls interested in STEM careers?

We don’t have to be a genius to be a scientist, but we do need to be persistent and passionate. Stay the course with your interest, passion and ambition.

If you could give your younger self career advice, what would you say?

Believe in yourself and “Lean in”, to achieve your full potential.

Madhavi Kapa

Senior Director, Product Strategy and Marketing

I leverage my extensive experience in global product management and commercialization to drive the success of the helical treatment delivery systems portfolio used for treating cancer with radiation therapy. This involves working with clinical customer touchpoints to understand their needs, forecast future market trends and demands, develop strategic plans and partnerships, create roadmaps for product development including lifecycle management and new product solutions to ensure the success of the product portfolio.

'Take risks. Embrace uncertainty and view failure as a learning opportunity for future success'

What originally inspired you to pursue a career in science and technology?

Growing up, I was drawn to understanding how things work and solving complex problems. This blend of curiosity and passion for problem-solving led me to pursue a career in science and technology. My education started with electronics, control systems engineering, and computer science. I owe this in large measure to my parents who created an environment that encouraged my inquisitive nature and supported my interests in STEM fields. More importantly, they instilled in me a strong work ethic by example.

I started my career as an Avionics engineer in the aerospace sector, crafting embedded software for transmission controls in the auto industry, and creating solutions in the healthcare space with products that help patients get diagnosed and treated accurately and in a timely manner.

Did you have any role models who influenced your path?

In my career, I’ve been fortunate to have several role models who have influenced my path. Whether it was teachers who encouraged me to pursue my ambitions or mentors who provided guidance and support, they inspired me to push boundaries and strive for excellence.

What have been some of the biggest challenges you’ve faced as a woman working in a technical field and how did you overcome those obstacles?

Some of the challenges I’ve faced as a woman working in a technical field has been breaking through gender stereotypes and biases. At times I have had to work twice as hard to prove my capabilities. What helped me overcome these obstacles was staying focused on my goals, building a strong support network, and continuously challenging myself to excel.

How does your work applying complex technology help improve patients’ lives?

In my role at Accuray, I have the privilege of positively impacting patients’ lives by improving the efficacy and safety of radiation therapy. By leveraging cutting-edge technology, we can deliver more precise treatments, minimize side effects, and ultimately enhance the quality of life for patients undergoing cancer treatment. What excites me most about the innovations happening now in radiation therapy is the potential to enhance cancer treatment and improve patient outcomes. From advanced imaging techniques to precision radiation delivery systems and potential combination with immunotherapy, the strides being made in oncology hold the promise of more effective and targeted therapies for cancer patients.

What are you most proud of accomplishing over your career?

Over the course of my career, I’m most proud of the collaborative projects I’ve led working with talented teams that have resulted in meaningful advancements in healthcare technology. Whether it is developing innovative medical devices or spearheading initiatives to expand access to healthcare services. Knowing that my work has made a positive difference in people’s lives is incredibly rewarding and motivating.

What advice would you give to women and girls interested in STEM careers?

To girls and women interested in STEM careers, my advice is to believe in yourself and don’t underestimate your abilities. Make yourself a priority and surround yourself with supportive mentors and peers who will uplift and empower you along your journey. Don’t be afraid to take risks. Embrace uncertainty and failure as a learning opportunity, and strive for continuous growth and improvement. These are stepping stones to positive impact and success.

Namita Thakur

Physics Customer Support Manager

I am a board-certified Medical Physicist with over 13 years of experience with the TomoTherapy® System and I currently work as Physics Customer Support Manager at Accuray. And I lead the team for both the Radixact® System and the CyberKnife® System product lines. In this role, I work closely with R&D, Engineering, Sales, Marketing, Applications, Field Service and directly support customers and product development.

’Don’t let anyone tell you that you can’t do it’

What inspired you to pursue a career in science and technology?

I come from a family of engineers, and it was almost a given that I would study science. What helped was that I enjoyed science, especially solving math problems. Growing up in India, it was always a competitive environment and if you wanted a good life you had to study science. Of course, as a grown-up, I understand that the measures of a good life and success are different. And have little to do with studying science.

Did you have any role models who influenced your path?

When I was in college, I remember reading a news article about Indra Nooyi. She was the CEO of PepsiCo, and I felt intrigued that an Indian woman could be in such a position. I started reading more about her and learned about her journey. That was partially the reason for my choosing to pursue further studies in the United States.

What have been some of the biggest challenges you’ve faced as a woman working in a technical field?

You will probably not find a single woman who has not faced gender discrimination and bias. There were times when discouraging instances affected my self-confidence. The only way to overcome that was to not let self-doubt get in the way and to speak up for myself. I was fortunate to find a great mentor and leader whose kindness helped me gain confidence. Looking back at some of those unfair experiences I can say that they were valuable life lessons. They shaped the person and leader I am today and taught me what a leader should not be doing.

How does your work applying complex technology help improve patients’ lives?

A lot goes into developing treatment systems that can deliver radiation precisely. For someone diagnosed with cancer, their entire world has changed. The last thing they should worry about is the accuracy of their treatment. The clinical team in a hospital has the responsibility to prescribe and deliver treatments to their patient’s. And our responsibility as the manufacturers of medical devices is to ensure we support the clinical team in that. This allows the clinical team to focus on the most important thing which is patient care. As a Medical Physicist in the support team, my primary concern is to ensure patient safety. And we do that by developing comprehensive Quality Assurance programs.

What are you most proud of accomplishing over your career?

After working in the clinical environment for several years, you get to see the direct impact on patients after they complete their radiation therapy treatment. It is now particularly gratifying to see that I make that difference on a much broader and global scale.

What advice would you give to young women and girls interested in STEM careers?

My one word of advice is to not let anyone tell you that you can’t do it. The Lack of Female Role Models is one of the greatest challenge we face. It is hard to imagine yourself somewhere when you can’t see it. My hope is that one day, we will live in a world where girls are encouraged to study science, that their curiosity is not dismissed. And where women have adequate support to balance the responsibilities of research and motherhood.

If you could give your younger self career advice, what would you say?

“At the end of the day, don’t forget that you’re a person, don’t forget you’re a mother, don’t forget you’re a wife, don’t forget you’re a daughter.” – Indra Nooyi

“The success of every woman should be the inspiration to another. We should raise each other up. Make sure you’re very courageous: be strong, be extremely kind, and above all be humble.”

Serena Williams

To learn more about careers at Accuray visit our careers page

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Closing the cancer care gap: An interview with Dr. B. S. Ajaikumar

K Carr — Mon, 05 Feb 2024 11:06:17 +0000

To honor the call-to-action of World Cancer Day 2024—“Close the Care Gap”—Accuray sat down with a leading voice on cancer care equity to get on-the-ground insights: Dr. B S Ajaikumar, Executive Chairman at HealthCare Global (HCG) Enterprises Ltd., one of the largest comprehensive cancer groups in the world. Dr. Ajaikumar shared his perspective on the multi-faceted nature of the challenge, the essential role of more efficient and effective radiotherapy in bringing better treatments and outcomes to more patients, and where he sees social and technological change showing promising potential.

India as a microcosm for the global cancer care gap

With a rapidly growing population topping 1.4 billion in 2023, India presents a useful case study for health equity in cancer care. Nearly 70% of the population lives in rural areas,^[1] while half of India’s oncologists practice in just 12 major cities.^[2]

In 2003, Dr. Ajaikumar left an esteemed career in the U.S., including working at MD Anderson Hospital and Tumor Institute of the University of Texas, to return to India. “The reason I came back was because I saw the wide gap between India and the advanced countries,” he says.

Remote connectivity bridging physical gaps for patients

“I always say, Cancer is not a disease of convenience. A patient cannot say, ‘I will just stay in my neighborhood and take my treatment.’ Decentralized cancer care will always be a challenge. It is very difficult to replicate centers of excellence. But in my view, there is a place for local treatment: Once the protocol is established, the patient can go to their closest clinic in their hometown and continue to take their treatment.”

“Remote connectivity has helped us a lot in talking to patients in remote areas. Now, we always do a video call initially, so I can explain to the patient why they have to travel to get the treatment they need.”

“We’ve been doing remote consultations from diagnosis to treatment planning since 2008, but the pandemic made everybody more aware, and made patients more accepting. In the past, we would offer remote treatment planning and patients would decline. Now, they understand that I can do more or less the same thing remotely.”

Remote connectivity as a tool for providers

“These technologies are benefitting clinicians, too. Virtual tumor boards, for example, are doing extremely well. In the past, if I had to call a medical oncologist, neurosurgeon, radiation oncologist and molecular pathologist all together to discuss a patient and look at the radiographs, it would have taken several days. Now, within 10 minutes I can get all of them and look at the radiographs online.”

“Remote connectivity technology for remote planning, radiology and digital pathology means you don’t need experts at a local level. But when it comes to surgery and delivering radiation therapy, we are trying to see how we can use technologies to complement the local providers. For example, using VR [virtual reality] lenses allows our more experienced doctors to help colleagues in more rural areas during surgery.”

“We recently had a patient that refused to come in to a main treatment center. So, we used VR lenses. Our surgeon was sitting in Bangalore, directing the surgeon through the successful operation.“

“The recent 2023 World Cancer Equity Report underlines inequities in cancer services leading to delayed diagnosis and advanced stage cancer at presentation. Often, patients resort to poor quality or non-scientific treatment options that are cheaper and invariably worsen the prognosis. Sadly, this delay means that patients whose cancer could have been detected and treated early with current available diagnostics, medicines, and technologies, develop an incurable disease.”

“I think, in the future, this is what we are going to see—technology is going to help us to bridge the gap, because we can’t expect all patients to travel to the major treatment centers.”

“Today we can proudly say that, within 72 to 96 hours, we can get the biopsy report, imaging and start the treatment if recommended by our Multidisciplinary clinic”

Hypofractionation: a powerful tool in addressing access barriers

“Beyond technology advancement in the world of communication, the treatment delivery technologies available have implications for access as well. “We now use hypofractionation with a large number of breast and prostate cancer patients. Treating in fewer sessions cuts down the travel time of coming every day for weeks, and it also possibly gives a better outcome.”

“This kind of precision medicine using high-output machines is the future of radiation oncology. It will be a game-changer in terms of patient tolerance, outcomes, and also, of course, less stress and burden on the patient and the family.”

Hidden barrier: clinician understanding of advanced treatment technologies

“You’ll be surprised to hear that, in some cases, the barrier to better technology is not cost—and it’s not staffing, either. It’s a lack of understanding about the capabilities of this kind of unit.”

“For example, when I first brought the CyberKnife® System to India, people always thought of it like a regular linear accelerator. When I started saying, ‘Hey, I can treat prostate cancer in five fractions,’ there were a lot of nonbelievers.”

“Similarly, when we first started using the TomoTherapy® System, people said, ‘You can’t do more than 30 or 40 patients a day on the couch.’ We are doing 80 patients a day because we have mastered how we can use the efficiency built into the system—using remote planning to enable centralized radiation planning, for example.”

“I see the future of the technologies like CyberKnife and TomoTherapy Treatment Delivery Systems gaining more and more acceptance and replacing the conventional form of radiation.”

AI offers tremendous potential

“We are all talking about AI quite a bit right now. It will help us to bring more precision and more hypofractionation through capabilities like auto-contouring.”

“AI will also help with data analysis. Suppose I have 10 patients, and in five of them, the tumor has shrunk by 50%. Why has the tumor shrunk in five patients, and not in the other five? I’ll be able to study those cases, and we’ll create an algorithm model possibly using Genomics as a base which we’ll use in the future to predict outcomes—I call it bucketing. Does this patient belong to bucket A, B, C or D? And based on that, we’ll treat the patient, rather than treating everybody the same way. We’ll treat the patient the right way the first time—making sure the dose is correct and the side effects are minimized. This could be a form of Radio sensitivity Index.”

What about AI bias?

“AI bias is certainly a consideration. That is why I have been telling our team, ‘Whatever data we get, it’s all Caucasian data. We have to generate our own data.’ In fact, you’ll be surprised to hear that 38% of the patients in our cohort have certain gene expressions which have never been reported.“

“We know the genetic makeup makes a difference in the treatment and the outcome. So, we will generate the data and do comparisons and see what the difference is. In five years, it will make a dramatic difference, because we will have our own data.”

Precision medicine depends on effective diagnosis— and addressing cultural barriers to screening

“I look at the precision medicine transformation like another major change: In the early 2000s, we were in a totally different space. We were just coming out of the cobalt era, and what we did at HCG is take the bull by the horns and say, ‘We are going to bring linacs.’”

“Today, the shift we need to see is proper analysis of the data to make sure the patient gets the right treatment—the first time. When you don’t give the right treatment to the patient and the disease comes back, the cost to treat that patient becomes comparatively high because they keep coming back for treatment. And more importantly, they may not even live.”

“So we are striving hard to really showcase why ‘first time—right treatment’ is actually more cost effective across the lifetime of a patient. Also, healthy patients are more productive, and they live longer, which is what the society wants. It’s not that often that the economic best interest aligns with the quality-of-life best interest—where doing the right thing is also going to save money on the long term.”

The overlooked factor: Changing cultural perceptions of cancer treatment

“If I think about cancer care in India 10 years ago? We’ve certainly seen great improvement. With treatment, there is a dramatic change in some states—areas where the quality of care has improved dramatically and become more accessible because of what the state government is doing there. Whereas if you look at certain other states [that aren’t implementing the same policies], the patients are not receiving the same high quality of care. The important thing is to collect data and showcase why certain states are doing better. That is what we, as a cancer care provider, have been trying to do.”

“But as oncology evolves toward more precision medicine, diagnosis is the key. Genomics become very important. Because maybe half of the patients won’t be treated properly if you don’t do complete diagnosis. One need to understand the actionable genes. What are the pathways? Which patient requires what targeted therapy?”

“A big challenge with diagnosis is cultural perception of cancer. Cancer—the word itself— Cancer means corruption. People talk about the cancer of a society. So, the implication of that on a patient is that cancer is a negative impact on the patients, so the terminology is important to make cancer a chronic disease.”

“But that is gradually changing based on education. More people are reading about cancer—they have access through their smartphones. And particularly in a country like India, word of mouth is very important. When people see that their neighbors or their friends are living for longer, that has brought very positive change to perceptions of cancer treatment. Some people use to think the treatment is worse than the disease, but that is changing.”

“So, we’re breaking these cultural barriers, to some extent. People are recognizing cancer is more of a chronic disease, rather than a death sentence. There are more people are coming forward for treatment, even at an early stage.”

“In the early 2000s, 70% of patients were coming with advanced disease. Today, it is reversed: 72% of the patients come with early-stage disease—particularly with breast cancer.”

“It is certainly a great improvement. But India has a massive 1.4 billion population. So, it’s a Herculean task. But again, we are moving in the right direction.” Dr. Ajaikumar says.

To learn more take a look at ‘Global Gaps in Cancer Care‘.

References

https://www.seattletimes.com/nation-world/world/india-census-says-70-percent-live-in-villages-most-are-poor/
https://www.thinkglobalhealth.org/article/india-needs-cancer-care-outside-its-big-cities

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Navigating the Challenges: Bringing Advanced Radiation Therapy Solutions to the Frontline

Dakota — Wed, 31 Jan 2024 14:59:01 +0000

Radiation therapy faces multifaceted challenges today, including rising patient demand, complex workflows associated with advanced technology, software integration challenges as well as the need for comprehensive training and technical support to ensure confident delivery of radiotherapy. Additionally, there are accessibility barriers that result in huge gaps in patient care today.

Let’s dive into a closer examination of some of these challenges and delve into their intricacies and explore potential solutions.

Increasing patient demand

Global cancer cases are predicted to continue to rise, with 30.2 million cancer cases expected in 2040, a 56% rise from 2020¹. Almost half of these patients will require radiation therapy, posing a daunting capacity challenge in some countries². Meeting demand would necessitate substantive expansion of the current radiotherapy infrastructure and workforce.

Advanced technology

Technology advances such as the introduction of image-guided radiotherapy (IGRT) have enabled smaller treatment volumes, shorter treatment fractionation schedules, improved outcomes, and minimized toxicity². The use of hypofractionation, which uses fewer fractions of radiotherapy with a higher dose per fraction compared to conventional fractionated regimens has grown more common as delivery techniques have become more accurate, helping to boost efficiency. The most common examples are stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS), delivering a full treatment over 1-5 sessions. Although these technological advances in planning and treatment delivery have helped to drive new practices in radiotherapy, the need for precise image guidance, patient immobilization, and motion management may contribute to the perception of complex workflows that can be resource-intensive and prohibitive.

Workflow complexities

Radiotherapy treatment is a complex process that requires the entire radiation oncology team working together to ensure safe and effective treatment of patients. There are many guidelines and recommendations for best practices to help standardize workflows, but it is the unpredictable scenarios that can hinder a well-established routine³. For example, changes to internal anatomy, patient weight loss, and difficulty aligning tattoos to get patients in the treatment position, can all equate to a more prolonged workflow. Additionally, as radiotherapy techniques become more advanced, delivering treatment plans that meet stringent dose criteria has become increasingly complex, and can easily exceed the treatment time allocated, causing delays to other patients. Modalities like adaptive radiotherapy enable tighter dose conformality but involve additional imaging, planning, quality assurance, and delivery steps compared to conventional radiation workflows. Streamlining adaptive workflows requires intricate coordination across physics, radiotherapy radiographers, and physician teams. While reducing side effects and improving tumor control, advancing technologies can overwhelm staff bandwidth. Integration of technology is key to helping streamline these complex workflows.

Accessibility barriers

Barriers to widespread adoption of radiotherapy persist due to resource-limited centers. Sadly, the incidence of cancer is expected to be disproportionately higher in low- and middle-income countries (LMIC), compared to high-income countries (HIC)^4,5. In addition, many cancers such as head and neck and cervical cancer are diagnosed at a more advanced stage, becoming surgically inoperable. This makes the need for radiotherapy even greater in these areas for both definitive and palliative treatment options. The implementation of modern radiotherapy in these countries not only poses unique challenges but also provides novel opportunities for improving access. Optimizing costs in these countries through the implementation of hypofractionated schedules also holds the potential to enhance radiotherapy access.

Training and support

It is acknowledged globally that there is a chronic shortage of staff in the radiotherapy field that slows progress toward the adoption of advanced technology. Even in countries with an adequate workforce the quality of training and service provided can vary. Training and research remain the mainstay of providing high-quality standardized care. Onsite training remains irreplaceable, but there are clear benefits using distance training programs in contouring, planning, treatment delivery and quality assurance⁴. The recent COVID-19 pandemic has converted a lot of in-person trainings to remote online activities which is beneficial for remote hospitals. Technological innovations in radiotherapy are translating into real benefits for cancer patients including improved tumor control, minimized side effects, and excellent safety records⁶. However, to effectively integrate a rapid pace of change there needs to be increased support to enable hospitals to successfully leverage radiotherapy’s full potential globally.

What can Accuray do to help resolve some of these challenges?

At Accuray we stand on three pillars: “Quality of Care”, “Efficiency in Care” and “Confidence in Care”. These pillars underpin our resolute commitment to enhancing the landscape of radiation therapy.

Quality of care:

We are committed to optimizing every patient’s treatment experience through patient-customizable radiotherapy solutions that balance advanced capabilities with accessibility. Our systems enable clinics to provide high-quality external beam radiation treatment options spanning from SBRT and SRS to more standard conformal radiation techniques. This diversity of precision delivery modes allows clinics to match the optimal technique to each patient’s cancer or lesion type and goals of care. At the heart of our technology is the capability to conform radiation doses from simple to complex tumor shapes while automatically adapting in real-time for movement and anatomy changes. This fusion of sub-millimeter accuracy with adaptive radiotherapy helps clinics target disease precisely while minimizing dose to surrounding tissues. By empowering clinicians with flexible tools to design truly personalized treatments, we aim to make state-of-the-art cancer care achievable for more patients. Our patient-first philosophy guides continual innovation in harnessing established and emerging technologies to advance the quality, capabilities and reach of radiotherapy worldwide.

Efficiency of care:

We aim to maximize patient access to advanced radiotherapy by optimizing treatment workflows for greater efficiency. Our solutions enable streamlined planning, treatment delivery, and quality assurance through automated and integrated processes, without compromising the individualized care experience. At the same time, the system’s accuracy and adaptability safeguards quality by accounting for each patient’s unique anatomy. Our end-to-end workflow focus makes elevating the standard of care viable for more facilities. With greater efficiency across the treatment pathway, adaptive radiotherapy becomes clinically feasible, helping clinics broaden access without adding time burden. Our efficiency drive strives to quicken the translation of technological promise into clinic-wide patient benefits.

Confidence in care:

We empower clinics to deliver advanced radiation therapy with full confidence by providing comprehensive support systems. Recognizing radiotherapy’s quickly advancing complexity, we offer both virtual and on-site staff training tailored to each clinic’s needs and experience level. Our service options maximize treatment system uptime and underscore our commitment to being available at every step. Clinics can embrace innovations with the assurance of a trusted partner. Most importantly, patients deserve to feel secure through their treatment journey – our partnership gives clinics the tools to establish that confidence. We consider it a privilege to work with clinics so that more patients can access advanced care.

Conclusion

At Accuray, our goal is to give healthcare professionals access to highly precise treatment solutions that enable the delivery of exceptional quality treatments with efficiency and confidence to help them face current radiotherapy challenges. Developing radiotherapy solutions that evolve with patients’ needs is critical in a continuously changing environment. We’re here to equip you to build a resilient department in the fight against cancer. Together, we can advance towards a world where cancer is met with unwavering certainty and compassionate care, empowering patients, and driving future advancements

References

Cancer Tomorrow (iarc.fr) https://gco.iarc.fr/tomorrow/en/dataviz/isotype
Chandra RA, Keane FK, Voncken FEM, Thomas CR Jr. Contemporary radiotherapy: present and future. Lancet. 2021 Jul 10;398(10295):171-184. doi: 10.1016/S0140-6736(21)00233-6. Epub 2021 Jun 21. PMID: 34166607.
Halvorsen P, Gupta N, Rong Y. Clinical practice workflow in Radiation Oncology should be highly standardized. J Appl Clin Med Phys. 2019 Apr;20(4):6-9. doi: 10.1002/acm2.12555. Epub 2019 Mar 12. PMID: 30861297; PMCID: PMC6448160.
Maitre P, Krishnatry R, Chopra S, Gondhowiardjo S, Likonda BM, Hussain QM, Zubizarreta EH, Agarwal JP. Modern Radiotherapy Technology: Obstacles and Opportunities to Access in Low- and Middle-Income Countries. JCO Glob Oncol. 2022 Jul;8:e2100376. doi: 10.1200/GO.21.00376. PMID: 35839434; PMCID: PMC9812473.
Jaffray DA, Knaul F, Baumann M, Gospodarowicz M. Harnessing progress in radiotherapy for global cancer control. Nat Cancer. 2023 Sep;4(9):1228-1238. doi: 10.1038/s43018-023-00619-7. Epub 2023 Sep 25. PMID: 37749355.
Quality assurance in radiation | IAEA

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Overcoming AI Bias: Understanding, Identifying and Mitigating Algorithmic Bias in Healthcare

K Carr — Thu, 23 Nov 2023 13:29:37 +0000

With artificial intelligence (AI) rapidly unlocking new possibilities in healthcare, we take a look at the human- and data-driven biases that are unintentionally integrated into AI technologies. Solving AI bias will be critical to earning the trust required from patients, clinicians, regulators and the general public to drive AI adoption and application in healthcare.

But to understand how the industry can begin to identify, mitigate and prevent AI bias, we need to first recognize what it is and where it comes from.

What is AI bias?

AI bias is defined as “the application of an algorithm that compounds existing inequities in socioeconomic status, race, ethnic background, religion, gender, disability, or sexual orientation and amplifies inequities in health systems^[1].” While AI bias is most often associated with data generalizability — when the data used to train an algorithm is not representative and thus the outputs cannot be generalized confidently or safely — there are several other ways that bias can be introduced and encoded in the algorithms that drive AI technologies.

AI bias already showing up in healthcare

Several instances of algorithmic biases have already been shown to have direct and harmful impacts on the health and safety of patients:

A widely used cardiovascular risk scoring algorithm was shown to be much less accurate when applied to African American patients — likely owing to the fact that approximately 80% of training data represented Caucasians^[2].
AI models that predict cardiovascular disease and cardiac events will be much less accurate in predicting these conditions among female patients if trained on primarily male data sets^[3].
In radiomics, chest X-ray-reading algorithms trained primarily on male patient data were significantly less accurate when applied to female patients^[4].
Algorithms for detecting skin cancer — trained largely on data from light-skinned individuals — are much less accurate in detecting skin cancer in patients with darker skin^[5].
Racial disparities have occurred in the U.S as algorithms were predicting health care costs rather than illness^[6].

The growing body of evidence of AI bias is now getting the attention of legislators and regulators. In the U.S., support for the Algorithmic Accountability Act, which would require companies to assess their AI systems for risks of unfair, biased or discriminatory outputs, is growing. Similar regulations have already been proposed or are in development across Europe, as well as in China.

What are the sources of AI bias?

Human biases built into AI design

The fundamental imperfection of AI lies in its human inception. This bias truly impacts AI from its genesis, as the humans developing an algorithm choose which problem they want to solve based on their own perceptions of priority.

In radiotherapy, this built-in human bias takes the shape of which indications get focus and funding for the development of AI tools, as well as which treatments are the focus of research on AI support. The indications and treatments that AI developers prioritize do not necessarily reflect the actual incidence, urgency or potential value of these indications and treatments.

Another human-driven bias in radiotherapy concerns the development of AI-supported decision-making tools that essentially answer the question, “Which treatment is right for this patient?” Factors like cost/affordability, quality of life, or loss of function may be weighed differently by men vs. women, old vs. young, people of different socioeconomic backgrounds, etc. In many cases, those creating the algorithms are not fully accounting for these variables — and are instead making definitive value judgments that code their own biases into the algorithm.

The data generalizability problem

More data means smarter AI. There has been tremendous progress toward open data sharing practices in the past several years, giving AI developers access to enormous public data sets to train and develop their algorithms. But AI is limited by what it’s seen and doesn’t know what it doesn’t know. The problem is that many populations — including several notably vulnerable and historically underserved populations — remain underrepresented in the data sets used to train healthcare AI tools^[3]. This includes underrepresentation ranging from gender, race, and ethnicity, to socioeconomic status and even sexual orientation.

Beyond access to underrepresented populations, most healthcare organizations are just not collecting the breadth of metadata needed to get a representative sample. Information on race and ethnicity, socioeconomic status or sexual orientation is often not associated with patient health records — making it impossible to analyze and assemble a representative data set across these important variables.

Biased humans + incomplete data = algorithmic bias

Both the built-in human biases and data generalizability issues contribute to a result of algorithmic bias. This kind of algorithmic bias in healthcare technology is particularly hard to see because it typically reinforces longstanding institutional biases. For example, race, ethnicity, and socioeconomic status already impact health outcomes due to deeply ingrained institutional biases. So, if an algorithm results in poorer health outcomes among these groups, it’s extremely difficult to determine if the bias is coming from the algorithm, the other existing biased factors, or both. These deep learning algorithms undoubtedly present the greatest potential benefits but also the greatest potential risks, because the “black box” self-learning model means it’s extremely difficult to determine how the AI is arriving at the output — and thus hard to identify or correct for bias that may develop.

Defining a path to mitigate AI bias

Many experts agree that there will always be bias in AI — much as there is bias in all human decision-making. The key will be finding the balance between the potential benefit of AI and its risks. Awareness of the bias problem is essential. Here are 3 ways in which to mitigate AI bias:

1. Research and development

Building models and collecting data should be representative of the population they’re trying to address. An inclusive development process should also take a multidisciplinary approach, bringing in statisticians and methodologists that have the tools to understand and address data bias/generalizability challenges — as well as clinicians who understand what that data represents from a patient care perspective. Those developing healthcare AI technologies should also consider bringing in representatives from underrepresented populations to consult on the design and development, pointing out potential sources or results of bias.

2. Data collection

The training data set needs to be representative of the population — and specific attention needs to be paid to increasing data representation among historically underserved, underrepresented, and other minority groups. Data sharing remains critical, but data privacy will remain the barrier to broader open data sharing policies. AI innovators should look to tackle the data anonymization and generalizability problem using synthetic data. It is likely that in the future synthetic data will increasingly give AI developers access to large, representative data sets. It is also important to consider utilizing data-driven approaches to optimize clinical trial designs that will help to reduce socioeconomic disparities during data capture, which may help to address trial diversity^[7].

3. Algorithm development & application

Following open science principles, developers must be willing to open up their algorithms and AI technologies to the same level of regulatory and public review as other interventional healthcare technologies. One of the most promising results of an open-science approach to algorithm design is the potential for transparent, deterministic algorithms to be applied on smaller, local data sets by providers. In other words, the general AI model can be trained in a broadly representative data set — then given to a specific user/provider to be applied on the specific patient data that represents the patients they will treat.

Despite, a well-considered algorithm review process the claims of transparency ring hollow — if the algorithm is sealed by a “black box” approach. Developers can validate the “fairness” of the algorithm up to the point of implementation, but there is little way to monitor or control what happens from that point on as the algorithm “learns” within the black box. This is why regulators including the FDA have already begun to indicate that deterministic algorithms, and explainable AI including interpretability, trustability and liability, are the only way to fully vet AI for clinical use.

With great power comes collective responsibility

There’s little doubt that AI will come to benefit all of society in different ways. But it’s also clear that further work is required to reduce potential harm within the healthcare industry. Within the healthcare space, we all have a shared interest in working together to harness this power with great care — a challenge that will entail working outside of purely competitive business mindsets in many instances.

AI will reduce bias in the long term

Lest it seem that AI is introducing bias into the healthcare space, we must remember that institutional biases already have dire effects across the modern healthcare landscape — in clear and proven, as well as complex and unseen ways. The real risk with AI is not that it will create new biases, but rather that it will perpetuate or amplify the existing ones. But by following best practices for transparency and inclusivity and making the necessary collective commitment to mitigating AI bias, the healthcare industry as a whole can actually push things in the other direction — fighting back against the bias that’s already implicit within the healthcare system. That’s because the biggest source of bias is and always will be the human factor — the implicit and explicit biases that shape human decision-making in healthcare. Managed carefully and with shared responsibility, data-driven algorithms have the powerful potential to significantly mitigate this human-factor bias — making AI a positive force not only for expanding clinical possibilities, but for expanding equitable access and delivery of healthcare across the globe.

Listen to Professor Jean-Emmanuel Bibault experience of AI in healthcare

References

Panch T, Mattie H, Atun R. Artificial intelligence and algorithmic bias: implications for health systems. J Glob Health. 2019 Dec;9(2):010318. doi: 10.7189/jogh.09.020318. PMID: 31788229; PMCID: PMC6875681.
Igoe, K (© 2023) Algorithmic Bias in Health Care Exacerbates Social Inequities — How to Prevent It. https://www.hsph.harvard.edu/ecpe/how-to-prevent-algorithmic-bias-in-health-care/
Norori N, Hu Q, Aellen FM, Faraci FD, Tzovara A. Addressing bias in big data and AI for health care: A call for open science. Patterns (N Y). 2021 Oct 8;2(10):100347. doi: 10.1016/j.patter.2021.100347. PMID: 34693373; PMCID: PMC8515002.
Larrazabal AJ, Nieto N, Peterson V, Milone DH, Ferrante E. Gender imbalance in medical imaging datasets produces biased classifiers for computer-aided diagnosis. Proc Natl Acad Sci U S A. 2020 Jun 9;117(23):12592-12594. doi: 10.1073/pnas.1919012117. Epub 2020 May 26. PMID: 32457147; PMCID: PMC7293650.
Lashbrook, A (2018) AI-Driven Dermatology Could Leave Dark-Skinned Patients Behind. The Atlantic. https://www.theatlantic.com/health/archive/2018/08/machine-learning-dermatology-skin-color/567619/
Ziad Obermeyer et al.Dissecting racial bias in an algorithm used to manage the health of populations.Science366,447-453(2019).DOI:10.1126/science.aax2342
Flatiron Health (2023) ‘Driving breakthroughs in cancer care: Key takeaways from ASCO 2023’ https://flatiron.com/resources/asco-2023-key-takeaways-from-improved-oncology-clinical-trials-to-ai

The post Overcoming AI Bias: Understanding, Identifying and Mitigating Algorithmic Bias in Healthcare appeared first on Accuray.

The Importance of Research in the Evolving Field of Radiation Oncology. ASTRO 2023 Highlights

K Carr — Mon, 16 Oct 2023 13:37:22 +0000

The theme for the ASTRO 2023 Annual Meeting ‘Pay it Forward: Partnering with Our Patients’, puts the focus on the patient perspective in clinical trials. This helps shine the spotlight on strengthening patient-centered care, patient quality, and safety issues in the delivery of radiation therapy when designing and carrying out research^[1].

The patient experience has far-reaching implications in clinical trials. It is important that patients are well informed, valued, respected, and listened to, allowing a more patient-centric approach, and helping the execution of the trial.

Why is Patient Experience Important in Clinical Trials?

In an article by Dr. Gina Jansheski, there are 3 core areas where patient experience matters most^[2]:

Improves recruitment and retention – 86% of clinical trials fail to recruit the number of participants they need. This can cause trials to be delayed or cancelled, having a big impact on the researchers, sponsors, participants, and ultimately the patients that may benefit from this treatment. There can also be huge cost implications in setting up a trial only to see it fail before it ever took off the ground.
Provides valuable feedback about the treatment – Patients are a key source for providing valuable insights into how the treatment is working. They provide information on the side effects of treatment and how they are being impacted in their day-to-day lives.
Avoids unreliable results – Effective communication is required before, during and after the trial to minimize stress to the patient and help collect meaningful information. There is a risk that patients who are stressed may report side effects from stress as side effects of the treatment leading to less reliable findings.

Ensuring effective communication, and understanding the participants’ perceptions will help to improve the patient experience in clinical trials which will help to increase recruitment, retention and reliable data.

Why are Events Like ASTRO Important?

ASTRO delivers an incredible program of education and research in the field of radiation oncology. These events are important as they allow healthcare professionals to develop a deep understanding of cancer treatments being investigated. Research can change the future of patient care, helping to improve patient’s quality of life and outcomes so that they can get back to living their lives faster.

Highlights from ASTRO 2023: Research that is Making Strides Forward in Patient Care

Prostate Cancer Research

With a robust five-year dataset, the PACE-B trial demonstrates that five-fraction stereotactic body radiation therapy (SBRT) is as effective as the standard fractionations for low- to intermediate-risk prostate cancer. Genitourinary and gastrointestinal toxicity remained low with no significant differences between the 2 groups. These breakthrough results demonstrate that patients can achieve the same results with a treatment option that is significantly more convenient. As a result, it looks possible that five-fraction SBRT is poised to become the new standard of care for these patients^[3].

Another study reported an update on the outcomes of patients younger than 50 years old treated with 5-fraction SBRT for prostate cancer with the CyberKnife® System. Many younger men will have surgery for prostate cancer as there is a paucity of data on the outcomes in this younger subset. This study represents the largest series evaluating outcomes in very young patients treated with definitive SBRT. PSA of this young cohort of patients were compared to men treated over 50 years old, demonstrating no significant difference between the two groups^[4]. This research underscores the effectiveness of SBRT for patients in this category, providing an alternative to surgery.

Intracranial Research

Stereotactic radiosurgery and hippocampal avoidance techniques are under investigation as an alternative to whole brain radiotherapy (WBRT), primarily due to their potential to reduce neurocognitive decline, helping to maintain memory and improve the quality of life for patients.

Traditionally patients with brain metastases from small cell lung cancer (SCLC) are treated with WBRT. The ENCEPHALON trial is a phase II trial that randomized patients with brain metastases from small-cell lung cancer between WBRT and stereotactic radiotherapy (SRT) with the CyberKnife System. They found that patients receiving WBRT were at higher risk of a significant decline in neurocognitive function than patients receiving SRT. This trial expands the applicability of SRT to this population of patients and demonstrates the efficacy with which the CyberKnife System can minimize dose to healthy tissue to help reduce neurocognitive decline^[5].

Another study exploring a benefit of hypofractionated stereotactic radiotherapy (HFSRT) over WBRT for neurocognitive function is the ESTRON trial. This study compared post operative (HFSRT) to WBRT in patients with 1-10 brain metastases. 54 patients were randomized and results showed that HFSRT provides excellent local control. Further follow-up is required to determine the risk of intracranial progression and neurocognitive function^[6].

The introduction of hippocampal-avoidant whole brain radiotherapy (HA-WBRT) has allowed improvements in short-term memory without compromising treatment efficacy. Planning HA-WBRT with VMAT can be resource-intensive and does not always meet the planning objectives. A single-institution dosimetric study compared VMAT arcs with helical delivery on the TomoTherapy® System to see if improvements in dosimetry and treatment planning time could be achieved. It was found that significant improvements in target coverage and organ at risk sparing could be achieved using the TomoTherapy System^[7].

Breast Cancer Research

Stereotactic partial breast irradiation is a notable advancement that significantly reduces radiation exposure to the heart, lungs, and breast in low-risk breast cancer patients, compared to traditional whole-breast techniques. One study in particular delivered preoperative stereotactic partial breast irradiation in a single fraction with a dose of up to 34 Gy to early-stage breast cancer patients. This approach holds immense promise for patients with early-stage breast cancer, potentially eliminating tumors with radiation and endocrine therapy alone. This could pave the way for a future without surgery. Further follow-up and data are required^[8].

Advancing Care for the Future

All the research presented at ASTRO provides remarkable strides forward in the field of radiation oncology. This research has the potential to enhance patient outcomes and offer greater choice and hope to those facing cancer treatment. It is the participation of patients in these trials that helps to make these advancements possible

To read more abstracts that mention Accuray systems please visit the 25+ years of clinical evidence page.

Click Here

References

ASTRO 2023 https://www.astro.org/Meetings-and-Education/Micro-Sites/2023/Annual-Meeting/Learn/Program/Format-and-Objectiveswebsite
Dr Gina Jansheski (2022) Clinical Trials: Why Is The Patient Experience Important? (healthmatch.io). HealthMatch
van As et al. (2023) 5-Year Outcomes from PACE B: An International Phase III Randomized Controlled Trial Comparing Stereotactic Body Radiotherapy (SBRT) vs. Conventionally Fractionated or Moderately Hypfractioned Exte. ASTRO 2023
Mendez et al. (2023) Robotic SBRT in Prostate Cancer Patients Younger Than 50 Years Old- Updated Results. ASTRO 2023
Bernhardt et al. (2023) Stereotactic Radiotherapy vs Whole Brain Radiaiton Therapy for Patients with 1-10 Brain Metastases from Small Cell Lung Cancer: Results of the Randomized ENCEPHALON (ARO 2018-0) Trial. ASTRO 2023
El Shafie et al. (2023) Hypofractionated Stereotactic Radiotherapy (HFSRT) of the Resection Cavity versus Whole-Brain Radiotherapy (WBRT following Brain Metastasis Resection – Results of the ESTRON Randomized Phase 2 Trial. ASTRO 2023
DiBartolo et al. (2023) Helical TomoTherapy Planning Technique Improves Dosimetry for Hippocampal-Avoidant Whole Brain Radiotherapy Compared with VMAT. ASTRO 2023
Rahimi et al. (2023) Early Results of a Phase 1 Pre-Operative Single Fraction Ablative Trial for Early Stage Breast Cancer. ASTRO 2023

Accuray Incorporated as a medical device manufacturer cannot and does not recommend specific treatment approaches. Individual results may vary.

The post The Importance of Research in the Evolving Field of Radiation Oncology. ASTRO 2023 Highlights appeared first on Accuray.

Overcoming Barriers to Deliver Total Body Irradiation

K Carr — Mon, 11 Sep 2023 09:56:23 +0000

It’s blood cancer awareness month! In this blog article, we are looking at the challenges in total body irradiation (TBI) and how the TomoTherapy^® platform is making a positive difference for radiotherapy centres and their patients. But first here are 3 facts about blood cancer:

The 3 main types of blood cancer are leukaemia, lymphoma and myeloma^[1]
In 2020, there were 474,519 new cases of leukaemia worldwide, making it the 13^th most common cancer^[2]
Approximately every 3 minutes, one person in the United States is diagnosed with leukaemia, lymphoma or myeloma^[3]

When is Total Body Irradiation Used?

Treating leukaemia and lymphoma with transplantation remains one of the most successful forms of therapy^[4]. TBI is an effective component of conditioning for hematopoietic stem cell transplant. However, there are many challenges to deliver TBI:

What are the Challenges?

Patient Positioning

For the majority of patients receiving TBI, the use of parallel opposed fields at an extended source-to-surface distance (SSD) is still the most commonly used technique. As a result, patient set-up often needs manual adjustment between treatment fields, increasing treatment time. Patients may be lying, sitting, or standing in hard-to-maintain positions for an hour or more, causing discomfort.

Organ Shielding and Tissue Compensators

TBI requires special attention from planning to delivery as it is critical to ensure a homogeneous dose while helping minimize dose to organs at risk to reduce side effects. Evidently, conventional linear accelerators typically treat patients with anterior/posterior fields or lateral fields at extended SSD. As a result, they often require compensators, lung blocks, and spoilers to achieve a homogenous dose distribution.

Generally, dose variations within 10% of the prescribed midplane are considered acceptable for TBI treatments ^[5]. However, conventional techniques can be cumbersome and not consistently accurate. Patient anatomy can cause dose variability and tissue compensators may reduce dose beyond expectations, leading to an increased risk of recurrence^[6].

Image Verification and Quality Assurance

To be confident that you are delivering the planned treatment, you need some form of verification. While some centres use diodes to measure dose in the body, it is difficult to ensure accuracy, especially in patients who only have a single fraction. Consequently, image verification is difficult to perform for extended field techniques.

Workload

Delivery time is long, taking up to 1 hour and more depending on the technique. This time is doubled for patients requiring 2 fractions in one day, making it difficult to treat all your scheduled patients in the same day. This can lead to extending working hours on the treatment machine or moving patients to other treatment machines. TBI is resource intensive – it is not a technique that is performed all the time. Therefore, experienced staff must be involved to ensure treatment delivery is delivered as planned.

More recently volumetric arc therapy is being used for TBI but can come at the cost of many isocentres (3-9), multiple arcs, and long treatment times that can increase planning and delivery complexity ^[7,8].

How Does the TomoTherapy Platform Enable You to Overcome Challenges in Total Body Irradiation?

Many centres have successfully introduced the TomoTherapy Platforms to make TBI accessible to more patients including the Radixact® System, the latest generation TomoTherapy System.

Patient Comfort and Shorter Treatment Times

The continuous 360^o delivery allows treatment to be delivered more quickly and as such can be delivered in less than an hour, with some studies reporting treatment times of 35 minutes^[6,9]. A shorter treatment time and lying supine allow patients to be more comfortable, maintaining their treatment position more easily.

Highly Conformal and Homogeneous Dose – No Need for Compensators or Additional Shielding

Higher conformality can be achieved with the Radixact and TomoTherapy Systems with its binary multi-leaf collimator and flattening filter-free fan beam. This allows for steep dose gradients between target volumes and tissues at risk without the need for external compensators or lung blocks. The TomoTherapy System can treat 135 cm of the body by continuous 360^ohelical delivery with simultaneous couch movement through the gantry. This technique reduces the need for field junctions, minimizing dose gaps and overlap. Highly conformal lung sparing can be achieved with mean lung doses of no more than 10 Gy^[9]. Furthermore, a study reported central lung doses of <6 Gy while adjacent organs still received the prescribed dose^[10].

MVCT/kVCT Image Verification

Helical MVCT or kVCT 3D image verification allows you to visualize patient anatomy, enabling you to make corrections in patient set-up to deliver treatment confidently.

What About Patients Who are Taller than 135 cm?

For patients over 135 cm, adequate dose coverage can be achieved by using only 1 junction in the thigh region. Many centres have deployed this technique where a junction in the thigh area is divided into several target volumes. This creates a linear dose gradient to minimize dose variations from any possible set-up errors.^[11]

Learn the advantages of treating Total Body Irradiation on the TomoTherapy System – take a look at our clinical webinar.

Indo-American Hospital Experience with Helical TomoTherapy for Total Body Irradiation^[12]

The Indo-American Hospital’s experience with TBI started when they installed the TomoTherapy System in September 2017, treating their first patient with TBI in November 2017. The most common diagnosis was acute lymphblastic leukemia followed by aplastic anaemia. The dose delivered ranged from 2-12 Gy in 1 – 6 fractions over 1-3 days with a minimum gap of 6-8 hours between fractions.

Patients were immobilized supine with a body-vac and a 3-clamp open face mask. Patients were scanned from vertex to toe. For those longer than 135 cm, two scans were acquired. Out of 50 patients treated, 16% were planned with a single scan.

Planning target volumes (PTV) were created with an inner margin of 2 mm and outer margins of 10 and 15 mm around the body contour. Lungs were contoured with an inner margin of 5 and 10 mm to account for respiration. The median 95% PTV coverage was 96%, and the median dose homogeneity index was 1.28. The median beam on time was 28 minutes.

Treatment verification was deployed in two stages. Firstly images were acquired from the vertex to the bottom of the lungs. Then in a separate scan, images were acquired from the abdomen to the pelvis.

Reproducibility is of paramount importance and is a clear advantage on the Radixact System

Learn more about the Radixact System

Click Here

References

https://nationaltoday.com/blood-cancer-awareness-month/
https://www.wcrf.org/cancer-trends/worldwide-cancer-data/
https://www.lls.org/facts-and-statistics/facts-and-statistics-overview
Wills C et al ‘Total body irradiation: A practical review, Appl Rad Oncol 2016;5(2):11-17
Sengupta A, et al. Surface Dosimetry of Patients Undergoing Total Body Irradiation: A Retrospective Analysis for Quality Assurance. Cureus. 2020 Feb 6;12(2):e6900. doi: 10.7759/cureus.6900. PMID: 32064218; PMCID: PMC7003717.
Gruen A et al Total Body Irradiation (TBI) using Helical Tomotherapy in children and young adults undergoing stem cell transplantation. Radiat Oncol. 2013 Apr 15;8:92. doi: 10.1186/1748-717X-8-92. PMID: 23587349; PMCID: PMC3653702.
Loginova AA, Tovmasian DA, Lisovskaya AO, Kobyzeva DA, Maschan MA, Chernyaev AP, Egorov OB, Nechesnyuk AV. Optimized Conformal Total Body Irradiation methods with Helical TomoTherapy and Elekta VMAT: Implementation, Imaging, Planning and Dose Delivery for Pediatric Patients. Front Oncol. 2022 Mar 10;12:785917. doi: 10.3389/fonc.2022.785917. PMID: 35359412; PMCID: PMC8960917.
Köksal M, Özkan O, Holderried T, Heine A, Brossart P, Gawish A, Scafa D, Sarria GR, Leitzen C, Schmeel LC, et al. Optimized Conformal Total Body Irradiation with VMAT Using a Linear-Accelerator-Based Radiosurgery Treatment System in Comparison to the Golden Standard Helical TomoTherapy. Cancers. 2023; 15(17):4220. https://doi.org/10.3390/cancers15174220
Sarradin V, Simon L, Huynh A, Gilhodes J, Filleron T, Izar F. Total body irradiation using Helical Tomotherapy^®: Treatment technique, dosimetric results and initial clinical experience. Cancer Radiother. 2018 Feb;22(1):17-24. doi: 10.1016/j.canrad.2017.06.014. PMID: 29395854.
Wilhelm-Buchstab T, Leitzen C, Schmeel LC, Simon B, Koch D, Schmeel FC, Schoroth F, Garbe S, Röhner F, Wolf D, Schüller H, Schild HH, Müdder T. Total body irradiation: Significant dose sparing of lung tissue achievable by helical tomotherapy. Z Med Phys. 2020 Feb;30(1):17-23. doi: 10.1016/j.zemedi.2019.05.002. Epub 2019 Jun 22. PMID: 31239184.
Sresty NVNM, Gudipudi D, Krishnam Raju A, Anil Kumar T, Lakshmi VRP, Srikanth G, Narasimha M. Total body irradiation of bone marrow transplant using helical TomoTherapy with a focus on the quality of dose contribution at junction target volumes. Strahlenther Onkol. 2021 Aug;197(8):722-729. doi: 10.1007/s00066-021-01769-2. Epub 2021 Apr 14. PMID: 33852037.
G. Gopal et al,|Total body irradiation (TBI) by helical TomoTherapy – single institution experience from India’. PO-1168 | ESTRO | 2023

Accuray Incorporated as a medical device manufacturer cannot and does not recommend specific treatment approaches. Individual results may vary.

The post Overcoming Barriers to Deliver Total Body Irradiation appeared first on Accuray.

Want to Know How to Provide Best-in-class Technology Without Being Locked Into One Vendor? Learn How the UniteRT Movement is Shifting the Paradigm

K Carr — Mon, 03 Jul 2023 09:16:08 +0000

We all share a common vision – to give cancer patients the best chance to live longer, better lives. Now imagine yourself embarking on a project to select a medical device that will be key to your clinic achieving its treatment goals. What challenges can you foresee? Purchasing a medical device is a long-term commitment – many are in use for more than 10 years. How can you truly have the confidence that what you are buying will give you the flexibility to seamlessly integrate with other innovative technologies now and in the future? The answer to this challenge is to UNITE radiation therapy (UniteRT) solutions.

What is UniteRT?

UniteRT is a collaboration of leading radiation therapy (RT) technology vendors prioritizing patient needs by promoting best-in-class, interoperable RT solutions, regardless of brand, at every phase of care. Members of the UniteRT collaborative are committed to putting healthcare providers and patients first. This helps to ensure providers have access to the best solutions on the market so they can decide what’s right for their department. All members are aligned on the three key principles:

Open Competition
Open Interfaces
Open Communication

Why has Accuray joined the UniteRT movement?

Why UniteRT, why now?

Seeing patients–really seeing them–as the cornerstone of every decision has forced the RT technology community to face the mirror. How can we ensure that patients receive the best possible care? In what ways can we collectively work together to advance the continuum of care holistically and provide the best outcomes for patients? We believe that every patient deserves the best possible treatment, and that you should have the ability to choose the best-in-breed solutions across the care spectrum — from screening, diagnosis, and staging to planning, treatment, and monitoring.

This has prompted several RT technology industry leaders to inject a disruptive paradigm shift into the marketplace. By breaking convention and teaming up with colleagues and competitors to form a bold, industry-changing, unified enterprise.

"A unified enterprise to UNITE radiation therapy solutions"

This collaboration aims to help customers balance the clinical benefits of specialization with the operational advantages of standardization – without the need to standardize into a single ecosystem. By aligning towards a common vision, members of UniteRT are committed to making sure that their solutions can seamlessly work together.

This provides you with the best possible options to choose from. We want to highlight the benefits of an open ecosystem, where you have the freedom to choose the solutions that meet your specific needs, without limitations or compromises.

What are the benefits to you?

As a healthcare provider, you want the flexibility to choose the solutions that are best for your department, without worrying about compatibility issues or being locked into a closed ecosystem. UniteRT is focused on providing just that – aspiring to build a vendor-agnostic ecosystem where you can choose the optimal solutions based on the merits of clinical capabilities. This allows you to move with innovations that continues to drive improvements for your practice and your patients.

"Driving innovation with increased flexibility, broader choices, harmonized pathways, and improved integration"

We’re excited about what UniteRT can do for you, and we hope you are too.

Learn more at https://www.unitert.org/

The post Want to Know How to Provide Best-in-class Technology Without Being Locked Into One Vendor? Learn How the UniteRT Movement is Shifting the Paradigm appeared first on Accuray.

Accuray

Why Motion Matters: The Advantage of Real-time Tracking

The importance of delivering radiation therapy accurately

Strategies used to control motion

Real-time tracking that adjusts to the patient external and internal motion

But how does all that work?

So Instead of Managing Motion Lets Do Something About It.

Pioneering Advanced Radiotherapy in Kenya

Cancer Burden in Kenya

What is the Status of Radiotherapy Services in Kenya?

Bringing advanced radiotherapy to KUTRRH with the CyberKnife System

Interview with Ruth Manyagi at KUTRRH

How easy is it to access radiotherapy in Kenya?

How far do people come to your center?

How many patients receive radiotherapy daily at KUTRRH?

What was the reason behind purchasing a CyberKnife System?

What was it like to get a team together to work on the CyberKnife System?

What are the future aspirations of the CyberKnife System at KUTRRH?

References

Bringing Together Leading Liver Cancer Experts in the 7th APAC Liver Roundtable

Liver Cancer Roundtable Members in Action

What Clinical Evidence Have the Members of Liver Roundtable Achieved?

The Therapeutic Landscape is Evolving in the Treatment of Liver Cancer

The members of the roundtable continue to drive the status of radiotherapy in the treatment of liver cancer.

Want to see more clinical evidence - visit our 30 years of clinical evidence page HERE

Experts Gather in Bangkok to Advance Precision Radiation Therapy for Breast Cancer Treatment in ASEAN Region

Bringing Together Leading Breast Cancer Experts

Key Focus Areas

A Platform for Comprehensive Discussions

A Journey Towards Advancing Breast Cancer Treatment

ISRS 2024 News

Highlighting Abstracts for Brain Cancer Awareness Month

Safety and efficacy of CyberKnife radiosurgery for limited number of large volume brain metastases: analysis of single center real-world data1

Safety and efficacy of CyberKnife radiosurgery plus anlotinib hydrochloride in patients with recurrent glioblastoma: a prospective phase II single-arm study2

10-year outcome after central dose optimized robotic stereotactic radiotherapy for brain metastases from different histologies3

CyberKnife stereotactic radiosurgery for vestibular schwannoma: meta-analysis of long-term tumor control and hearing preservation outcomes4

CyberKnife Stereotactic Radiosurgery for Extramedullary Plasmacytoma in the External Auditory Canal: A Clinical Case Report5

Thought-Provoking Sessions at ISRS

AI in radiosurgery

Access disparities

Learn more about ISRS and the benefits of being a member with Birgit Fleurent, ISRS Strategy Leader

Learn more about the CyberKnife System

References

ESTRO 2024 NEWS

ESTRO 2024 Theme: Radiation Oncology - Bridging the Care Gap

Navigating The Oligometastatic Frontier: Strategies for Adaptation and Personalized Management

Harnessing the Power: Radixact System and Surface Guided Radiation Therapy (SGRT)

ESTRO 2024 Abstract Highlights

CyberKnife System

Radixact/TomoTherapy System

References

Accuray Innovation & Partnership Hub

Accuray Hosts Successful Northern Europe User Meeting

Radixact® System Session

CyberKnife® System Session

SBRT Highlights from the RSS Scientific Meeting 2024

Robotic SBRT for High-risk Prostate Cancer: The Georgetown Experience

Acute Toxicity Following PSMA-Directed Focal Salvage Robotic SBRT for Local Recurrences Following Prior Robotic Prostate SBRT

Further Research Beyond RSS Demonstrates the Effectiveness of Radiotherapy in High-risk Prostate Cancer Patients

Introducing Jeffrey Carpenter, Accuray Deputy Chief Information Security Officer

What was the purpose of the Open Cyber Security Conference?

Jeffrey’s closing keynote speech and workshop

Three reasons why it is important to attend these events?

About Jeffrey

Addressing the Disparities in Radiotherapy in Asia-Pacific Region: Perspectives from Dr. Imjai Chitapanarux

Meeting the demand for radiotherapy services

What is FARO?

What is the status of public awareness and screening in this region?

From the patient's perspective, what do you see as the biggest barriers to closing cancer gaps?

What about geographic distance?

From a healthcare provider's perspective what challenges are there in providing advanced radiotherapy services?

Which of these barriers is easiest/hardest to address?

Where have you seen the most promising progress?

References:

Radiotherapy – An Overlooked Pillar of Cancer Care: Learn how Radiotherapy UK is driving change for a better future

Barriers to cancer treatments in the UK span beyond proximity

Sarah Quinlan, Director of Radiotherapy UK

What do you see as the biggest gaps in cancer care in the UK?

What has caused such a disparity in access to radiotherapy in the UK compared to other high-income countries?

What are the biggest barriers to getting funding for Radiotherapy Services?

Safety and efficacy of CyberKnife radiosurgery for limited number of large volume brain metastases: analysis of single center real-world data¹

Safety and efficacy of CyberKnife radiosurgery plus anlotinib hydrochloride in patients with recurrent glioblastoma: a prospective phase II single-arm study²

10-year outcome after central dose optimized robotic stereotactic radiotherapy for brain metastases from different histologies³

CyberKnife stereotactic radiosurgery for vestibular schwannoma: meta-analysis of long-term tumor control and hearing preservation outcomes⁴

CyberKnife Stereotactic Radiosurgery for Extramedullary Plasmacytoma in the External Auditory Canal: A Clinical Case Report⁵

Understanding
the Global Cancer Care Gap

Access Gaps Produce Outcome Disparities⁴

Childhood Cancer Survival Rates⁵

Growing Cancer Burden Will Magnify Equity Issues⁶

Major Disparities Within
Developed Nations, Too⁷