June 30, 2014 — Clinicians at Froedtert & the Medical College of Wisconsin Clinical Cancer Center are achieving excellent planning results in the first U.S. combination of Elekta's Monaco 5 radiotherapy treatment planning software and Siemens' mARC (modulated arc) therapy technique. The Froedtert & the Medical College team treated their first patient, an individual with prostate cancer, using the combination of Monaco 5 and mARC on March 26.
"mARC is a form of volumetric modulated arc therapy [VMAT], which has significant advantages over step-and-shoot IMRT in radiotherapy delivery speed and/or dose conformity, so we were eager to get mARC working on our Siemens treatment machine," said X. Allen Li, Ph.D., chief physicist, department of radiation oncology at Froedtert & the Medical College of Wisconsin Clinical Cancer Center. "The first case was a complex two-arc plan for treating both pelvic nodes and prostate bed, but on pre-treatment verification we achieved 99 percent agreement between the measured dose distribution and the plan dose distribution, which is very good. And, we've been able to replicate this accuracy in most of cases measured so far."
Li added that the two-arc treatment took eight minutes to deliver, faster than conventional step-and-shoot IMRT delivery. Furthermore, the cancer center plans to add flattening filter-free (FFF) beams in this summer, which will significantly speed up mARC delivery.
"Planning mARC delivery with Monaco 5 is straightforward," stated Li. "From the dosimetrist's standpoint, there is not much difference planning between mARC and other delivery techniques, so in a sense, workflow is identical. Having multiple treatment methods in Monaco 5 is a significant improvement over previous versions and the Monaco 5 contouring tools are excellent — we can contour using multi-modality images, such as those from CT, MRI and PET. I also really like the biological-based optimization, which gives us more flexibility in terms of shaping the dose distribution."
Introduced last year, the latest version of Monaco 5 consolidates the best of Elekta's treatment planning solutions into a single, comprehensive system. A vendor-neutral solution, Monaco 5 allows advanced treatment plans to be created faster and features a completely new user interface. As in all Monaco releases, this new version employs the Monte Carlo dose engine, considered the gold standard for calculating radiation dose.