Less toxic, more effective
A treatment that's less toxic for healthy tissue but more toxic for tumors. That's a win-win for cancer patients.
According to David Sher, MD, MPH, a radiation oncologist at Rush University Medical Center, it's a win-win that's being realized more and more with stereotactic body radiation therapy. This advanced form of targeted treatment zaps tumors with high doses of radiation while sparing healthy tissue.
More precision means less time in treatment
According to Sher, the radiation beam itself hasn't changed much in the past 20 years; it still destroys tumors by damaging cancer cells so they can't reproduce. What has changed is the ability to harness radiation's power. With new machines (like the TrueBeam STx used at Rush) and sophisticated computer software, radiotherapy teams can sculpt radiation beams to conform, within one millimeter, to the shape of a tumor. And, equally important, they can guide the radiation so it stays precisely focused.
"In the past, we used lead blocks to shield the areas we didn't want to treat," says Sher. "But these blocks were clunky, imprecise and inflexible; it was nearly impossible to target a small tumor or one with an unusual contour." With stereotactic radiation, 120 metal (tungsten) slats move in and out of the path of the radiation — essentially creating a moving block that matches the beams to the size and shape of the tumor, even those with unique contours.
"Think of it in terms of a bottle of pills," says Sher. "Before stereotactic radiation, it was like shooting at the whole bottle to make sure we hit one particular pill. Now we can identify, aim at and hit that single pill we're targeting." And when treating a tumor on the lung, which moves with each breath the patient takes, the technology calculates the body's movement to predict its pattern.
In the case of lung cancer, because stereotactic radiation helps spare sensitive, healthy structures like the chest wall or esophagus, radiation oncologists can give dramatically higher doses of radiation. And higher doses kill cancer cells much more effectively — and in less time. For example, stereotactic radiation for small lung cancer tumors generally requires only one to five sessions, while traditional radiation might involve treatment five days a week for six to eight weeks.
Less time dealing with side effects
High-dose precision means significantly better control of the cancer with less damage to healthy cells. This can decrease side effects, which is particularly important with lung cancer because damage to surrounding healthy tissues, such as in the lungs or esophagus, can lead to ongoing shortness of breath or painful swallowing.
Sher's patients go home right after the treatment, less affected by the radiation and better able to resume their normal lives. "They usually know they were treated because they have some fatigue or mild shortness of breath, but that usually clears up quickly," he says. "Part of the win-win is that the patient's quality of life is largely preserved."
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