Diagnostic imaging  

Ipswich Hospital pilots image-guided radiotherapy to improve breast cancer treatment

23 June 2006

Ipswich, England. Breast cancer patients at Ipswich Hospital NHS Trust are among the first in the country to participate in a study to test image-guided radiotherapy (IGRT), which enables clinicians to obtain better images of the cancer site at the time of treatment and track and adjust for tumour motion caused by the patient.

Clinicians at the hospital are using a new On-Board Imager device from Varian Medical Systems to better image the post-lumpectomy breast for radiotherapy.

“The normal procedure has been to treat the whole breast after a lump has been surgically removed, to make sure any remaining cancerous cells are destroyed,” says Andrew Poynter, Cancer Research Lead at Ipswich Hospital. “Using this new procedure, we implant gold marker seeds in the breast cavity following the surgical excision and we use the On-Board Imager to match the position of these markers at every treatment. This will allow us to match the radiation dose delivered to where there’s the highest risk of recurrence. It’s tailored radiotherapy which some people have dubbed ‘risk-adaptive radiotherapy’. Our initial experiences have been very encouraging.”

The On-Board Imager makes it possible for clinicians to image and treat on a single machine that rotates around the patient to take X-ray images and deliver treatments from virtually any angle. Mounted on the medical linear accelerator, the On-Board Imager device produces high-resolution images of the tumour and tracks changes in tumour shape, size or position over a multi-week course of treatment. It also enables clinicians to track and adjust for tumour motion caused by the patient’s breathing.

This work at Ipswich forms part of a pilot study led by Addenbrookes Hospital in Cambridge, which is examining the feasibility of using IGRT for post-lumpectomy breast cancer patients. The pilot study will provide vital data for a national, multi-centre trial called ‘Import High’ led by Professor John Yarnold at the Institute for Cancer Research. This trial aims to test risk-adapted and partial breast radiotherapy treatment in patients at a high risk of local tumour recurrence.

Using the On-Board Imager, Ipswich is currently the only hospital taking part in the trial that is able to take daily X-ray snapshots using kilovoltage imaging, which means patients receive higher quality images at much lower doses than with megavoltage imaging.

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