June 21, 2011 – In just four years, Clinique Claude Bernard's Private Radiotherapy Center (PRCM, Metz, France) will have doubled the number of patients receiving radiation therapy treatments per year – from 1,100 to a predicted 2,200 patients by the end of this year. This achievement was enabled by equipping first one, then all three of its Elekta Synergy treatment systems with Elekta VMAT (volumetric modulated arc therapy). With VMAT, single or multiple radiation beams sweep in arc(s) around the patient, which can significantly reduce treatment times. On April 28, a patient with breast cancer became PRCM's 2,500th to receive VMAT since the clinic began using the technique in 2009.
"We treat all disease sites with VMAT, including palliative patients," said Guillaume Faure, M.D., co-director of radiation oncology at PRCM, the first center in France to use Elekta VMAT. "We started VMAT breast treatments last month and 37 patients per day are under treatment on one of our Synergy systems. Our early results show that VMAT increases homogeneity to the treated volume and reduces the irradiated lung volume. Skin reactions also are reduced since VMAT obviates the use of electron beams to treat the internal mammary lymph nodes, and precludes the use of radiation boost fields – which is the case for conventional 3-D conformal therapy and intensity modulated radiation therapy [IMRT] breast treatments."
For breast VMAT, treatment time in some cases is reduced by 20 percent, since radiation therapists don't have to re-enter the room to set up electron fields, he adds.
"Using VMAT also speeds up pre-treatment quality assurance, decreasing PRCM's staff workload when compared to IMRT, while reducing the source of errors by decreasing the number of beams to transfer and verify," said Romain Ruchaud, M.Sc., co-director of PRCM.
At PRCM, radiation therapy for a variety of disease sites now takes seconds to deliver rather than minutes:
• 102 seconds: head-and-neck
• 98 seconds: brain
• 81 seconds: rectum
• 79 seconds: prostate
• 79 seconds: lung
• 124 seconds: breast
• 61 seconds: metastases
Beyond treatment speed, VMAT offers patients with metastatic disease major quality of life advantages, according to Faure.
"Organ-at-risk sparing allows us to confidently employ hypofractionation schemes with no difference in toxicity, while reducing the number of treatment sessions and travel for the patient," stated Faure.
VMAT also has created new possibilities to emphasize treatment plan quality over speed.
"This can lead to delivery time increases of up to 30 percent and more dual arc treatment deliveries," Faure stated. "However, we are now approaching dose distributions that are comparable to helical tomotherapy, but with much greater workflow efficiency. On a daily basis, VMAT is enabling us to raise the quality of patient care."
Approval of indications may vary between different countries. Additional regulatory clearances may be required in some markets.
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