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Physicians in India Show Intense Interest in Arc-Based Radiation Therapy for Patients with Cancer
Atlanta, GA2011-02-02
U.S.-based Elekta VMAT user draws crowds at Association of Radiation Oncologists of India Conference (AROICON)
The prospect of dramatically increasing radiation therapy treatment speed using dynamic, arc-based radiation therapy is capturing the imagination of Indian clinicians, if Dr. Vivek Mehta’s recent experience is any indication. Dr. Mehta, a radiation oncologist at Swedish Cancer Institute (Seattle, Wash., USA) gave three lectures on Elekta VMAT at the 32nd National Annual Conference of the Association of Radiation Oncologists of India Conference (AROICON) Nov. 25-28, 2010, in Patna, India, which drew capacity attendance and provoked vibrant interaction and discussion among participants.
“VMAT is an emerging technique that is coming to India,” says Dr. Mehta, director, Center for Advanced Targeted Radiation Therapies at Swedish Cancer Institute. “Due to Swedish’s leadership in implementing VMAT, it was appealing to the AROICON committee to have us talk about it to their members.”
Dr. Mehta presented results from Swedish Cancer Institute’s first 100 patients treated with Elekta VMAT. One presentation was on non-stereotactic VMAT, one covered high-dose, hypofractionated VMAT using a stereotactic body radiation therapy (SBRT) technique for lung tumors, and a third lecture discussed general VMAT use at an invitation-only Elekta symposium.
Many attendees were as interested in how VMAT compared with IMRT as they were about efficiencies of treatment speed.
"Clinicians asked whether VMAT is better than IMRT, in which clinical cases IMRT might be superior to VMAT and what planning challenges VMAT may present," he says. “What made our presentation interesting to the attendees was the actual proof from our center. For the first 100 patients we treated with VMAT we ran a comparison IMRT plan. We could show how we did on conformality, speed and QA, and how many times we ended up using one, two or three arcs and how long each plan took to deliver based on the number of arcs.”
Dr. Mehta stressed to the audiences that the first 100 VMAT patients actually represented the first 100 patients considered for VMAT who also were candidates for IMRT. Both VMAT and IMRT plans were developed for these patients and the patient received either VMAT or IMRT based on the superiority of the plan as assessed by the physician.
“Out of those first 100 cases we looked at, 95 patients went on to receive VMAT,” Dr, Mehta notes. “The audiences were interested in the reasons why five percent of the patients had IMRT, and we were able to give them various reasons, such as the IMRT plan in a particular case gave a steeper dose fall-off near an organ-at-risk. The ‘take-home’ message for them was VMAT can replace the bulk of your IMRT and is efficient, but it doesn’t completely replace IMRT, which is OK because you still have IMRT.”
Another interest in VMAT among Indian clinicians is related to resources, Dr. Mehta observes.
“Ninety-five percent of patients in India pay for cancer treatment, so improving efficiency—treating more patients during a given day—enhances the clinic’s financial stability,” he says. “A technique such as VMAT SBRT is an enabler for them to treat these patients in a time-efficient manner without the capital outlay of a new machine.”
Dr. Mehta’s third presentation, which included Swedish Cancer Institute’s Elekta VMAT experience, was an Elekta symposium attended by nearly 70 invited physicians.
“The leading Indian physicians who attended the symposium seemed truly engaged and interacted enthusiastically with Dr. Mehta. In these discussions, there was a sense that all concerned were inspired to seek practical solutions that also offered the best possible care for patients,” says Rajinder Singh Dhada, VP Strategic Partnerships.