Medanta Cancer Institute harnesses precision and speed of Elekta VMAT (Volumetric Modulated Arc Therapy) for challenging clinical casesNew Delhi India — Monday, October 25, 2010
In Medanta Cancer Institute’s first two Elekta VMAT cases, physicians were able to simultaneously exploit both the precision and speed benefits of this novel technique. Both patients had cranial tumors located near critical structures—requiring precise targeting of the tumor—and both were inclined to move if the radiation treatment beams were not delivered quickly.
“VMAT is particularly useful for patients who can’t lie still for an extended time, where any movement can impair radiation delivery,” says Tejinder Kataria, M.D., Chairperson of the Radiation Oncology department at Medanta Cancer Institute, part of Medanta – The Medicity (Gurgaon, Haryana, India), among India’s largest multi-specialty medical centers. “It also is beneficial for patients undergoing re-irradiation, as the sharp fall-off dose close to previously treated fields can be achieved, in addition to patients whose tumors are located near critical structures.”
Medanta’s first Elekta VMAT patient was a male with a sinus tumor that had recurred near the site of a tumor that doctors treated during the patient’s infancy. For the first lesion, he received radiation therapy and underwent surgical removal of one of his eyes. “We had the difficult task of preserving the vision in his remaining eye and maintaining his mental function, as the new tumor was lying very close to the brain,” Dr. Kataria explains. “VMAT gave us the required sharpness of dose gradient for planning Intensity Modulated Radiation Therapy [IMRT], as well as rapid treatment delivery to maintain the patient in the same position during therapy. For the 25 therapy sessions, each single arc treatment took just over two minutes of beam delivery time.”
The second Elekta VMAT patient was a 58-year-old man with a brain stem glioma involving the pons. The tumor was situated within the critical pathway of nerve signal transmission between the brain and spinal cord, a site that also serves as the center for important neural functions. “Planning with VMAT gave us the confidence that the high dose target volume will conform to the brain stem without compromising the nearby vital cranial nerves, spinal cord or pharyngeal pathways,” she says. “The patient had to wear a mesh facial mask to immobilize his head during treatment, but since the VMAT beam delivery took less than five minutes to deliver for each of his five sessions, the patient was able to tolerate the treatment well without moving.”
According to Dr. Kataria, the use of Elekta VMAT has reduced the radiation delivery time from approximately 22 minutes to 2-3 minutes. Dr. Kataria anticipates that using Elekta VMAT in simpler cases also will help reduce beam delivery times even further—down to 80 to 90 seconds in some instances.
Since early September, when Medanta Cancer Institute initiated its Elekta VMAT service, clinicians have started therapy for an additional five patients, treating brain and neck lesions (glioma, metastases, oligodendroglioma, pyriform sinus*), in addition to an endometrial tumor.
Medanta performs its Elekta VMAT treatments on an Elekta Infinity system, the first installation of this advanced linear accelerator in India. The medical center will establish a frameless Stereotactic Body Radiation Therapy (SBRT) service, also the country’s first, which will enable treatment of lung or liver tumors in less than 20 minutes.
“Today, there are just a few hundred advanced cancer treatment machines to serve a population of 1.1 billion people,” Dr. Kataria notes. “But Medanta and other major medical centers in India are beginning to acquire cancer care technology rapidly, which will help increase access to sophisticated therapy techniques.”
*Approval of indications may vary between different countries and additional regulatory clearances may be required in some markets.
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