MRI-Guided Radiation: A Novel Treatment Option for Solid Tumors
Guest
: Emma Fields, MD
From the Show: VCU Health System
When receiving imaging or treatment at VCU Massey Cancer Center, you can trust that you are in expert hands. Dr. Emma Fields discusses MRI-guided radiation therapy, the potential benefits for cancer patients, and more.
Transcription:
Amanda Wilde (Host): When receiving imaging or treatment at VCU Massey Cancer Center, you can trust that you are in expert hands. VCU Health Radiology was designated a Diagnostic Imaging Center of Excellence by the American College of Radiology. One of only 16 University healthcare systems nationwide to receive the designation. And the only healthcare system in the Richmond area to earn this designation. The Department of Radiation Oncology is a national leader in cancer education and care offering state-of-the-art treatment options, national and institutional clinical trials, the latest technology and radiation delivery and training and education programs for the next generation of clinicians and scientists. This is Healthy with VCU Health. And today we'll learn about MRI-guided radiation therapy for cancer patients. I'm Amanda Wilde here with Dr. Emma Fields, Radiation Oncologist at VCU Massey Cancer Center. And Dr. Fields. Welcome to the podcast.
Emma Fields, MD (Guest): Thanks so much for having me.
Host: Dr. Fields, what makes MRI-guided radiation innovative? I mean, how is that different than traditional radiation treatment?
Dr. Fields: Right. So radiation therapy as a whole has come a long way. So what people maybe traditionally think of as radiation, where we set you up on a table and just aim the beam has already improved a lot. Most radiation therapy machines, they're called linear accelerators, are able now to take imaging right before we treat somebody. So typically that imaging is in the form of an x-ray, the fancier machines now can also take a CT scan before we treat somebody. But with this latest technology, not only can we take volumetric imaging, like a CT scan, we can actually take an MRI scan, both before and during radiation. So we can see really precisely where we're aiming, we can see really carefully the anatomy and we can also get some functional information about what is enhancing, what is active tumor before we even turn the beam off.
Host: And does that decrease the side effects from traditional radiation?
Dr. Fields: Well, the idea with this is that the better we can see where we're aiming, the more specifically we can target, and then using imaging during treatment, we can adapt the treatment each time. So instead of sort of planning ahead of time with a set target and a set margin or region of error per se, we can actually adapt that each time. Let's say, based on how the patient is breathing based on how their other organs in the region look. And we can adapt that to make sure we stay away from things that could cause side effects. So yes, that's one of the main things is that it has the potential to decrease dose to organs that are close by and meanwhile, increase dose to the tumor where we're aiming.
Host: So it makes it way more individualized and more precise.
Dr. Fields: Exactly. It's very patient specific. It's very precisely targeted. And the idea because it's so targeted and personalized and adaptive, is that we can do treatments in a limited number of visits. So most of the treatments using the MR linear accelerator are going to be done in five or less visits.
Host: Oh, wow. And so, as opposed to traditional radiation, I know with breast cancer, it's usually six weeks?
Dr. Fields: Six weeks is kind of standard. That's already gone down, even for breast cancer. There are some standard regimens that are three weeks, four weeks, and even down to one week. But this is really for certain cancers. So most commonly, this would be for areas where we want to increase the dose, but we're really limited by things that are close by.
So for me, I treat GYN and GI cancers. So this is particularly exciting for things like pancreas cancer, which has been so traditionally challenging due to its proximity to parts of the small intestine that wrap almost entirely around the pancreas, which limits how much dose we can give without giving something like an ulcer or extreme nausea or damage to that bowel structure. So we can now see that in real time, much better than we ever could. And we can escalate the dose just to where the tumor is. So the patient, when they're in the machine would be able to see their tumor, see their breathing. And they can actually move their tumor into where the beam is going to be targeting in real time.
And the machine will only turn on when the tumor is in exactly the right place. So it accounts for their breathing motion, which our other machines currently don't. My patients describe it as like playing a video game. They're trying to get their target into the place that's exactly perfect. And so they have some control over it, which is nice. The same principle applies for like prostate cancers that are close between the bladder and the rectum. Some lung cancers that are close to critical structures in the chest and many other locations in the body as well.
Host: I was going to ask, but you've kind of touched on what is exciting for you as an oncologist about using this technology, the targeted nature of it sounds pretty exciting. The fact that the patient can also have a hand in the treatment, the actual treatment as it's happening, and that you reduce the area that you are radiating. So you're less likely to get other tissues involved. That's all amazing stuff.
Dr. Fields: You're exactly right. And I think we're just beginning to really get a grasp on how exciting this is. I think this is going to become more commonly used. It's going to be integrated probably, even in our other treatment machines, the idea of sort of an adaptive treatment plan, where we change things as we go through. And I think the types of cancers that we'll use this for will continue to grow as well.
Host: We talked about what the patient sees, what do you and the other radiation therapists do and what do you see when you're using this smart machine?
Dr. Fields: So we see the same thing that the patient does during the treatment itself, but prior to treatment, actually sometimes the patients just watch a movie even, or can just relax and close their eyes. We take some pictures and we actually can recreate their entire treatment plan. So redraw exactly where we're aiming, redraw exactly where we don't want the radiation to go, redesign the radiation. Run quality assurance on it prior to even starting. Now, all that is usually what we would do behind the scenes and it usually takes somewhere between five to 10 business days to do all that. So we're doing all of that in about 30 minutes while the patient just hangs out on the table, and waits to start their customized treatment that is made just for them in that exact position on that exact day.
Host: That is truly amazing. Besides being more effective and time-saving, I mean, are there other potential long-term benefits from this treatment option in regard to patient outcomes?
Dr. Fields: Well, I think that's yet to be known. Some things that we're hoping for are that we can maybe decrease the need for challenging surgeries in some of these cancers, particularly things like pancreas cancer, where the surgery requires such a huge operation. It's possible that giving these very high, precisely targeted doses, we could completely ablate the tumor.
We also hope to see more long term decreases in toxicity, for things such as prostate cancers and liver cancers, hopefully where people can go on and live the rest of their lives, with minimal side effects from their radiation. But I think, you know, the true benefits are even yet to be seen.
Host: But we know it's less invasive, less toxic and has fewer side effects. So that is an amazing start. It's really a mind-blowing new technology.
Dr. Fields: It really is. It's a very cool machine.
Host: Dr. Fields, thank you so much for explaining what MRI-guided radiation is all about.
Dr. Fields: Thank you so much for having me. That was great.
Host: A pleasure. To schedule an appointment or learn more about MRI-guided radiation therapy at Massey, please call 804-828-7232. Or visit masseycancercenter.org. To listen to other podcasts from VCU health, visit vcuhealth.org/podcast. This is Healthy with VCU Health. I'm Amanda Wilde.
Amanda Wilde (Host): When receiving imaging or treatment at VCU Massey Cancer Center, you can trust that you are in expert hands. VCU Health Radiology was designated a Diagnostic Imaging Center of Excellence by the American College of Radiology. One of only 16 University healthcare systems nationwide to receive the designation. And the only healthcare system in the Richmond area to earn this designation. The Department of Radiation Oncology is a national leader in cancer education and care offering state-of-the-art treatment options, national and institutional clinical trials, the latest technology and radiation delivery and training and education programs for the next generation of clinicians and scientists. This is Healthy with VCU Health. And today we'll learn about MRI-guided radiation therapy for cancer patients. I'm Amanda Wilde here with Dr. Emma Fields, Radiation Oncologist at VCU Massey Cancer Center. And Dr. Fields. Welcome to the podcast.
Emma Fields, MD (Guest): Thanks so much for having me.
Host: Dr. Fields, what makes MRI-guided radiation innovative? I mean, how is that different than traditional radiation treatment?
Dr. Fields: Right. So radiation therapy as a whole has come a long way. So what people maybe traditionally think of as radiation, where we set you up on a table and just aim the beam has already improved a lot. Most radiation therapy machines, they're called linear accelerators, are able now to take imaging right before we treat somebody. So typically that imaging is in the form of an x-ray, the fancier machines now can also take a CT scan before we treat somebody. But with this latest technology, not only can we take volumetric imaging, like a CT scan, we can actually take an MRI scan, both before and during radiation. So we can see really precisely where we're aiming, we can see really carefully the anatomy and we can also get some functional information about what is enhancing, what is active tumor before we even turn the beam off.
Host: And does that decrease the side effects from traditional radiation?
Dr. Fields: Well, the idea with this is that the better we can see where we're aiming, the more specifically we can target, and then using imaging during treatment, we can adapt the treatment each time. So instead of sort of planning ahead of time with a set target and a set margin or region of error per se, we can actually adapt that each time. Let's say, based on how the patient is breathing based on how their other organs in the region look. And we can adapt that to make sure we stay away from things that could cause side effects. So yes, that's one of the main things is that it has the potential to decrease dose to organs that are close by and meanwhile, increase dose to the tumor where we're aiming.
Host: So it makes it way more individualized and more precise.
Dr. Fields: Exactly. It's very patient specific. It's very precisely targeted. And the idea because it's so targeted and personalized and adaptive, is that we can do treatments in a limited number of visits. So most of the treatments using the MR linear accelerator are going to be done in five or less visits.
Host: Oh, wow. And so, as opposed to traditional radiation, I know with breast cancer, it's usually six weeks?
Dr. Fields: Six weeks is kind of standard. That's already gone down, even for breast cancer. There are some standard regimens that are three weeks, four weeks, and even down to one week. But this is really for certain cancers. So most commonly, this would be for areas where we want to increase the dose, but we're really limited by things that are close by.
So for me, I treat GYN and GI cancers. So this is particularly exciting for things like pancreas cancer, which has been so traditionally challenging due to its proximity to parts of the small intestine that wrap almost entirely around the pancreas, which limits how much dose we can give without giving something like an ulcer or extreme nausea or damage to that bowel structure. So we can now see that in real time, much better than we ever could. And we can escalate the dose just to where the tumor is. So the patient, when they're in the machine would be able to see their tumor, see their breathing. And they can actually move their tumor into where the beam is going to be targeting in real time.
And the machine will only turn on when the tumor is in exactly the right place. So it accounts for their breathing motion, which our other machines currently don't. My patients describe it as like playing a video game. They're trying to get their target into the place that's exactly perfect. And so they have some control over it, which is nice. The same principle applies for like prostate cancers that are close between the bladder and the rectum. Some lung cancers that are close to critical structures in the chest and many other locations in the body as well.
Host: I was going to ask, but you've kind of touched on what is exciting for you as an oncologist about using this technology, the targeted nature of it sounds pretty exciting. The fact that the patient can also have a hand in the treatment, the actual treatment as it's happening, and that you reduce the area that you are radiating. So you're less likely to get other tissues involved. That's all amazing stuff.
Dr. Fields: You're exactly right. And I think we're just beginning to really get a grasp on how exciting this is. I think this is going to become more commonly used. It's going to be integrated probably, even in our other treatment machines, the idea of sort of an adaptive treatment plan, where we change things as we go through. And I think the types of cancers that we'll use this for will continue to grow as well.
Host: We talked about what the patient sees, what do you and the other radiation therapists do and what do you see when you're using this smart machine?
Dr. Fields: So we see the same thing that the patient does during the treatment itself, but prior to treatment, actually sometimes the patients just watch a movie even, or can just relax and close their eyes. We take some pictures and we actually can recreate their entire treatment plan. So redraw exactly where we're aiming, redraw exactly where we don't want the radiation to go, redesign the radiation. Run quality assurance on it prior to even starting. Now, all that is usually what we would do behind the scenes and it usually takes somewhere between five to 10 business days to do all that. So we're doing all of that in about 30 minutes while the patient just hangs out on the table, and waits to start their customized treatment that is made just for them in that exact position on that exact day.
Host: That is truly amazing. Besides being more effective and time-saving, I mean, are there other potential long-term benefits from this treatment option in regard to patient outcomes?
Dr. Fields: Well, I think that's yet to be known. Some things that we're hoping for are that we can maybe decrease the need for challenging surgeries in some of these cancers, particularly things like pancreas cancer, where the surgery requires such a huge operation. It's possible that giving these very high, precisely targeted doses, we could completely ablate the tumor.
We also hope to see more long term decreases in toxicity, for things such as prostate cancers and liver cancers, hopefully where people can go on and live the rest of their lives, with minimal side effects from their radiation. But I think, you know, the true benefits are even yet to be seen.
Host: But we know it's less invasive, less toxic and has fewer side effects. So that is an amazing start. It's really a mind-blowing new technology.
Dr. Fields: It really is. It's a very cool machine.
Host: Dr. Fields, thank you so much for explaining what MRI-guided radiation is all about.
Dr. Fields: Thank you so much for having me. That was great.
Host: A pleasure. To schedule an appointment or learn more about MRI-guided radiation therapy at Massey, please call 804-828-7232. Or visit masseycancercenter.org. To listen to other podcasts from VCU health, visit vcuhealth.org/podcast. This is Healthy with VCU Health. I'm Amanda Wilde.