New Radiation Technology:
"Ultimate in Precision"
J. Frank Wilson, MD
Medical College of Wisconsin Radiation Oncologist;
Chairman, Radiation Oncology
Named one of the "Best Doctors in America®" 2004 by
Best Doctors, Inc.
This summer, Froedtert & Medical College of Wisconsin became one of the first hospitals in the country to introduce the TomoTherapy Hi-Art System®, an advanced technology for delivering radiation therapy. J. Frank Wilson, MD, explains how this groundbreaking tool will redefine cancer treatment.
Q. How is TomoTherapy different from standard radiation delivery?
TomoTherapy represents the ultimate in delivery of conformal radiation therapy. That means it tightly shapes the radiation dose around the tumor. TomoTherapy maximizes our ability to keep radiation away from critical organs near the tumor target.
In other words, TomoTherapy represents an ultimate in precision. That gives us the opportunity to increase the radiation dose. If you know you're treating just tumor – and can spare the normal tissues in the vicinity from the brunt of the radiation – you may find it desirable to escalate the dose. That's what TomoTherapy can accomplish more effectively and more efficiently than any other methodology out there.
Q. How will TomoTherapy change cancer treatment?
We believe TomoTherapy has a strong potential for redefining how radiation therapy will be given in many instances.
We also think it could expand the types of cancer we can effectively treat with radiation therapy. That's what we will be investigating. We anticipate TomoTherapy will play a new role in treating several cancers, including breast, liver and pancreas cancer, along with brain tumors.
Q. Why these cancers in particular?
There are several reasons. In some cases, it is because of the tumor's placement with regard to critical organs, in a position where it is not easily or safely treated today. It could also be because the cancer is in a part of the body in constant motion due to respiration.
The big advantage of TomoTherapy is this – not only can you deliver treatment in a highly efficient manner, but you can also see where the treatment is going while it is being delivered. That is different from the standard method, and directly impacts the ability to treat a moving target, such as one affected by breathing motion. With TomoTherapy, the radiation is "on" only when the tumor is in the right position.
Q. Will this technology help individualize care?
Yes. We're looking at the TomoTherapy system as a centerpiece in what we're calling the Center for Adaptive Radiation Therapy.
Until now, radiation therapy has been guided mostly based on anatomical images of the tumor. In the future, we anticipate we will be able to identify functional images of the tumor. TomoTherapy will enable us to deliver radiation only where cancer cells are active, not necessarily to the entire target area.
Q. Can one part of a tumor be active and another part inactive?
Yes.
Q. So you don't have to worry so much about the inactive parts.
Right. Or you may find there is a variable response to the treatment. In that case, the areas of the tumor that require a greater dose could receive that dose. TomoTherapy will enable us to treat tumors with that kind of guidance and precision.
Q. What will your role be in introducing TomoTherapy?
Froedtert & Medical College of Wisconsin is one of approximately 20 centers of excellence nationwide designated by TomoTherapy, Inc. to introduce this technology into practice and investigate its true potential.
Right now, there are more questions than answers. Currently, we can't do all the things I just sketched out for you. We have to develop them.
Q. Speaking personally, how do you feel about this new technology?
I'm particularly excited about the potential for tailoring radiotherapy to the individual needs of patients, based not only on their anatomy, but also on the activity of their tumor and their tumor condition. I think TomoTherapy is one of the most exciting developments of the last 35 years.