Case Study | April 09, 2015

The TomoTherapy and CyberKnife Systems Highlight Quality of Care for Cancer Patients

Swedish cancer institute offers best of Accuray technologies to the Seattle metropolitan area

The TomoTherapy and CyberKnife Systems Highlight Quality of Care for Cancer Patients

Radiation was delivered to the left chest wall, internalmammary chain, left supraclavicular fossa and medialaxilla of this patient with the TomoTherapy System.

The TomoTherapy and CyberKnife Systems Highlight Quality of Care for Cancer Patients

CyberKnife treatments were delivered to this patient in 10 fractions of 3.4 Gy per fraction over the course of two weeks at Swedish.

The nonprofit healthcare provider Swedish Medical Center (SMC) has been serving the Seattle area for more than 100 years. It has locations in both the city of Seattle and its surrounding suburbs, providing care in specialty areas such as cardiology, neuroscience, orthopedics, pediatrics and more. An integral part of the community, Swedish is unique in that it offers both technologies from Accuray, the TomoTherapy System and the CyberKnife System, for treating cancer patients in the metropolitan region.

TomoTherapy Treatment at Swedish

During its long history, the Swedish Cancer Institute at SMC used a variety of linear accelerators (linacs) to deliver focused radiation therapy to complex tumors. The institute selected the TomoTherapy System for its communitybased treatment center on the hospital’s Ballard campus, where the technology was installed January 2011. It was the first TomoTherapy System in the Seattle area and remains the only radiation therapy device in use at the Ballard center. 

According to Daniel M. Landis, M.D., Ph.D., “TomoTherapy was selected for many reasons. It has allowed us to treat some patients where otherwise there would have been no way to safely treat them on a conventional linac.”

In the summer of 2012, a 52-year-old female, referred from another radiation center, presented with a large multifocal (ER+/PR+ Her2+) infiltrating ductal carcinoma in the left breast. She had previously undergone mastectomy and chemotherapy, followed by radiation to the left chest wall, internal mammary chain, supraclavicular fossa, medial axilla and the T2-T4 vertebral bodies.

“The ability to deliver highly conformal plans to complex tumors and avoid normal structures is extremely useful,” added Landis. He and his team selected TomoTherapy to “concurrently treat [the patient’s] oligometastatic lesion alongside the standard fields while maintaining safe dose volume constraints.” After the treatment, the patient developed no late effects and remained without evidence of recurrence at 24 months.

Making a Difference: CyberKnife Radiosurgery

Sandra Vermeulen, M.D., is the executive director of the Swedish Radiosurgery Center at SMC, where the CyberKnife Robotic Radiosurgery System has been in use since 2006. The department treats approximately 250 patients with the CyberKnife System per year, according to Vermeulen. It is used exclusively for extra-cranial targets such as the breast, lung, spine, pancreas, liver, prostate and bone, as well as for intra-cranial targets where fractionation is required to protect normally sensitive structures, such as the optic chiasm.

“For all other intra-cranial targets, we allow the patient to choose the machine,” she said. “Nine times out of 10, the patient will choose CyberKnife.”

At Swedish Radiosurgery Center, the CyberKnife System was used to treat a 55-year-old female who was diagnosed with bilateral breast abnormalities after a routine mammogram. Bilateral lumpectomies were performed, and pathology confirmed an 8 mm ER/PR+ Her2/Neu- infiltrating ductal carcinoma in the left breast, and an 8 mm ductal carcinoma in situ on the right.

The patient was offered the choice of adjuvant breast irradiation (including whole breast irradiation, multicatheter or single-catheter brachytherapy) or partial breast irradiation using the CyberKnife System. After stereotactic body radiation therapy (SBRT) was denied coverage by the insurance company, Vermeulen and her team delivered intensity-modulated radiation therapy (IMRT) with the CyberKnife System to the lumpectomy cavity on the right breast; whole breast irradiation was ultimately administered to the left. IMRT treatments were delivered in 10 fractions of 3.4 Gy per fraction over the course of two weeks.

“Other than fatigue and minor breast edema, no other side effects from CyberKnife treatments were observed by the patient or her physician,” said Vermeulen. At 38 months out from the CyberKnife treatment, the patient has no local evidence of cancer recurrence and cosmetic outcomes of both breasts are good.

Concluded Vermeulen: “The CyberKnife technology has made a difference in patient care by decreasing treatment side effects, improving outcomes and cures, and enhancing the quality of life.”

Related Content

Turkish Hospital Begins MR-Guided Radiation Therapy With Viewray MRIdian Linac
News | Image Guided Radiation Therapy (IGRT) | September 21, 2018
ViewRay Inc. announced that Acibadem Maslak Hospital in Istanbul, Turkey has begun treating patients with ViewRay's...
Amar Kishan, M.D.

Amar Kishan, M.D.

News | Prostate Cancer | September 11, 2018
UCLA researchers have discovered that a combination of high doses of...
Videos | Radiation Therapy | September 07, 2018
A discussion with Ehsan Samei, Ph.D., DABR, FAAPM, FSPIE, director of the Duke University Clinical Imaging Physics Gr
Boston Scientific to Acquire Augmenix Inc.
News | Patient Positioning Radiation Therapy | September 07, 2018
Boston Scientific has entered into a definitive agreement to acquire Augmenix Inc., a privately-held company which has...
Non-Canonical Strategy May Improve Cancer Radiotherapy
News | Radiation Therapy | August 29, 2018
August 29, 2018 — Although the success or failure of...
Videos | Treatment Planning | August 28, 2018
A discussion with...
Sponsored Content | Webinar | Radiation Therapy | August 28, 2018
Respiratory tumor motion often complicates the delivery of precision radiation treatment.
Tsuyama Chuo Proton Beam Center Treats First Patients With RayStation
News | Treatment Planning | August 27, 2018
Tsuyama Chuo Hospital in Okayama Prefecture, southwest Japan, has commenced clinical use of RayStation to plan pencil...
Radiation Therapy Affects Event Recall for Children With Brain Tumors
News | Radiation Therapy | August 24, 2018
Children with certain types of brain tumors who undergo radiation treatment are less likely to recall the specifics of...
Videos | Radiation Therapy | August 13, 2018
ITN Editor Dave Fornell takes a tour of some of the innovative new technologies on the expo floor at the 2018 America