In January, Cleveland-based University Hospitals Seidman Cancer Center became one of the first facilities in the U.S. to offer adaptive radiotherapy.
At the time, Daniel Spratt, MD, chair of radiation oncology at the UH Cleveland Medical Center and the Vincent K. Smith Chair in radiation oncology at UH Seidman Cancer Center, said the treatment would “transform the way so many cancers are treated,” according to a Jan. 23 news release from the health system.
Three months after going live with the Varian Ethos 2.0 adaptive radiotherapy system, Dr. Spratt spoke to Becker’s about the new technology and what he sees as the next targets in radiation therapy.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What motivated UH’s early adoption of adaptive radiotherapy and what does it mean for the future of cancer care at UH?
Dr. Daniel Spratt: First and foremost, our goal here at UH and UH Seidman Cancer Center is to provide the best patient experience. Some of that obviously comes down to eradicating their cancer and improving their quality of life, but other components are the convenience of treatment, the environment of treatment and the accuracy of the treatment.
Radiation therapy, historically, has an understandable scary connotation. Sometimes I describe radiation therapy as having an evolution similar to that of cars over the past 100 years, and surgery has an evolution similar to that of bicycles over the last 100 years. They both have evolved, but radiation therapy has changed exponentially.
Historically, when a patient comes in for radiation therapy, they get what’s called a planning scan before treatment. We plan the radiation treatment based upon the way their anatomy looks that day, physical things that won’t be the same minute to minute or day to day. We’ve planned these treatments knowing there’s some uncertainty, but [we are] doing our best.
Online adaptive radiation technology has allowed us to do what we have never been able to do before. We can now get a diagnostic-quality scan on the treatment unit and with AI assistance, we can delineate the healthy tissues from the tumor, plan the radiation therapy rapidly in minutes and then very rapidly deliver the treatment for each and every single treatment. Whereas historically, doing the scan, the contouring, the planning would take over a week, we can do it now in just a few minutes.
Q: What considerations should other hospital and health system leaders keep in mind when deciding to invest in this technology?
DS: Number one, the studies are pretty clear that the higher patient volume the center has, the better outcomes will be. That’s probably even more true for more complex surgery or radiation therapies. You do need a critical mass of volume and staff to be able to adequately give the resources to it.
At the same time, studies have shown that you probably increase your catchment of patients who are willing to drive to see you for treatment. Because adaptive radiotherapy is more precise, fewer treatment sessions are necessary. This can increase a facility’s catchment by at least threefold, if not more. We’re finding a lot of patients from other states will travel here because of the decreased number of treatment sessions.
While it is definitely an efficiency and operational value, it is also a differentiator, at least right now. Any type of radiation machine is not cheap — but it’s something that will become, over the next 10 years, probably ubiquitous. Right now is a great opportunity to be at the forefront to offer this technology.
Q: What do you see as the next frontier for radiation oncology?
DS: One of the evolving areas that we’re using radiation therapy in is as a way to prolong life in patients with locally advanced and metastatic cancer, in place of or in addition to systemic treatments. In parallel, there’s a whole field that’s called radiopharmaceuticals which is essentially injectable radiation. We’re increasing the combination of external radiation therapies with those that can be administered by injection.
Additionally, we’re now increasingly realizing that radiation can perform equally, if not even more effectively, in the treatment of essential tremor, refractory depression, refractory OCD and certain non-cancerous tumors. Even though historically we’ve only used radiation for cancer, we’re finding that because there has been so much advancement in the field, radiation may actually be an optimal treatment tool outside of cancer.
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