Sarah Cannon - June 18, 2018

CUTTINO,LaurieIf you or a loved one has been diagnosed with cancer, your doctor may recommend radiation therapy as part of your treatment plan. Radiation therapy is a localized treatment option that uses targeted doses of high-energy radiation to kill cancer cells in the body, and there have been incredible developments in this type of cancer therapy. Dr. Laurie Cuttino, Radiation Oncologist at Sarah Cannon Cancer Institute at Henrico Doctors’ Hospital, shares the latest advancements, as well as a look ahead to what is on the horizon for patients.

How is radiation therapy progressing?

In general, radiation therapy is moving, as all oncology medicine is, towards a more personalized approach that is based on each patient’s individual diagnosis. The approaches are far less formulaic and much more tailored based on factors like genomic structure and specific tumor markers.

How is technology advancing radiation therapy?

Many radiation oncologists are excited about newer technologies that allow for increased radiation dose delivery to tumors in a way that is more targeted and spares more tissue. With these technologies, we are seeing results in both higher rates of control and lower rates of short term and long term toxicity.

A good example for the use of this type of technology is for brain metastases, where we use a technology called stereotactic radiosurgery. While stereotactic radiosurgery has been done for approximately two decades, one of the newest technologies allows for extraordinarily precise treatment of multiple brain metastases in a fraction of the time. This is a significant development for patients, not only because it is more targeted, but it’s also faster and it can be done in a way that is “frameless,” in that patients do not have to do any invasive immobilization.

How can the developments in radiation therapy influence treatment for different types of cancer?

We are starting to apply treatment models that have historically been used for one disease type to other locations in the body as well. We have known for a long time that delivering high doses of radiation in a targeted way has been effective for brain tumors, but can be difficult in other places in the body due to natural organ motion, which takes place in the lungs and heart, for example.

With stereotactic radiation, we are seeing a new treatment option for lung cancer patients who are either not candidates for surgery due to medical problems, or who simply do not want to have surgery. These large doses of targeted radiation therapy is resulting in positive outcomes. It’s not invasive and can be done between three to five treatments, with each treatment taking approximately 30 minutes. Stereotactic radiation can be very effective with very few side effects both short term and long term. This model is becoming widely available throughout the Sarah Cannon Network.

What does this mean for patients?

Each year, we continue to establish better ways to immobilize patients to best target radiation in the body. For example, when we prepare to do a high-dose treatment for a lung cancer patient, we do a 4D CT scan, which is a series of CT scans that captures the movement of the lungs and the tumor in all phases of the breathing process, and creates a set of images. The lung can move up, down, back and forth and diagonal, and when you are aiming at a tumor, it can move in ways you wouldn’t otherwise be able to anticipate without the 4D scan. These images create an optimized target that accounts for wherever the tumor is going to be in the breathing cycle. This process ensures that we hit the target no matter where the tumor is located in the breathing cycle. Because we’re able to account for the motion, the patient isn’t even aware.

What’s on the horizon in radiation therapy?

What I see becoming a larger focus in the next couple of years is radiation therapy for much more aggressive cancers, such as stage IV cancers and metastatic cancers. In the past, if you have stage IV metastatic cancer, your main treatment options were systemic (chemotherapy, immunotherapy) without radiation therapy. Because we have such advanced tools now that help us deliver high-dose targeted treatment, I now see patients with more aggressive cancers that go after multiple sites within someone’s body. I see us being far more aggressive for radiation therapy in its sophisticated forms moving forward, and would encourage patients with these aggressive cancers to speak with their doctor about radiation therapy.