It sounds like futuristic medicine: a prostate-cancer radiation treatment that uses several implanted transponders, each the size of a grain of rice, to bounce a radio signal to a base receiver. This device, which acts like a Global Positioning System for the body, enables pinpoint radiation of the shifting prostate while sparing healthy tissue, practically eliminating side effects like incontinence and impotence.
Such a precise, revolutionary system isn't a distant dream. The GPS-type device is arriving in the next few months at the Seattle Cancer Care Alliance's Radiation Oncology clinic, a busy and expanding program that brings cancer patients the latest technology and the human expertise to provide first-rate care. The program is in the midst of a three-phase remodel to better meet patients' needs through expansion of its space and staff, as well as procuring the most promising tools of the trade.
The Radiation Oncology clinic changes are part of the seven-phase SCCA remodel. Since clinical operations must continue in conjunction with the expansion, creation or relocation of nearly all SCCA programs, the modifications will occur over time; every alteration affecting another program like dominoes.
Remodel begins in January
For Radiation Oncology, whose first-floor neighbor, Pathology, moves to the seventh floor this month, January marks the start of an 18-month remodel. This will more than double the number of exam rooms and add a high-dose radiation suite, a computerized-tomography (CT) simulator for patient set-up and treatment planning and physician/resident offices.
The clinic recently held an open house for SCCA faculty and staff, in part to show off its new image-guided linear accelerator, an Elekta Synergy, one of the first such machines installed in the United States. The machine generates megavoltage radiation used for intensity-modulated radiation therapy. It also produces kilovoltage radiation used for patient imaging to double-check a patient's radiation-field alignment and tumor position through cone-beam CT reconstruction — all performed on the same table where the patient will be treated. This advanced mode of high-precision radiotherapy utilizes computer-controlled X-ray accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor.
The construction of the SCCA involved pouring concrete vaults under the freeway to house two linear accelerators. With the arrival of the new machine — which itself is the size of a small room at about 10 feet high and 15 feet long — the second vault is now complete, along with the addition of a control room. Though the clinic has doubled its capacity on the linear accelerators, the second machine is in almost full-time use already.
The GPS-type implant system will be used on the original linear accelerator, allowing for a new method of radiation-treatment field alignment and tumor-volume tracking. "You'd be very surprised how much some tissue moves in 30 seconds," said Karen Holloway, department manager and chief therapist. "You don't want the tumor moving outside of your boundaries during treatment. The whole thing allows us to bring in our borders tighter and tighter on a tumor volume and not have to put such a large safety margin around the tumor. When you're right up next to the rectum or bladder, every millimeter you can cut out of a radiation field is good. Anything we can do to bring it in tighter is a celebration."
Holloway said the new tools destroy tumors more effectively with fewer side effects. "We get to keep taking the dose higher to the tumor, which is only good, but we can limit the dose more and more to critical structures, which is great," she said.
The clinic recently added Dr. Janice Kim to do specialty care for the breast-cancer program in the Women's Center, which opens the door for about 200 more patients annually.
The remodel includes the addition of a procedure suite for a new high-dose radiation (HDR) program. In HDR, which is used mainly for breast and gynecological cancers, high-dose radioactive sources are temporarily implanted in patients to treat tumors. Because the radiation is placed inside or adjacent to cancerous tissue, high doses of radiation can be delivered in a few applications. It is a very effective form of treatment when applicable. HDR is currently only offered to SCCA patients at the University of Washington Medical Center. Having the program on-site will be more convenient for patients under the care of SCCA radiation oncologists. Efficiency and ease of patient care will also improve for the physicians, who currently travel between the SCCA and UW to cover their patients' needs.
Offering integrated care
The clinic staff looks forward to the addition of a dedicated patient-positioning/treatment-planning CT simulator. The X-ray equipment obtains image data from different angles around the body and then processes the information through a computer to show cross-sections of body tissues and organs. Radiation Oncology's specially designed equipment allows for positioning of patients in the best arrangement for treatment. For example, a patient's breast tumor may best be treated with her arm extended from her body, a position that could not be accommodated in a regular, narrow scanner.
It's a sign of success that the program quickly outgrew its existing space, said Dr. Ken Russell, the clinic's medical director. "We're growing and thriving, and we now have the most up-to-date technology in this rapidly evolving field," he said. "This new technology is critical to providing the most technologically advanced solutions for the programs we serve at the SCCA. Patients often focus on whether we have the best machine, not understanding that the equipment is only as good as the people who run it. We really have both."
In the quest to shrink or eliminate tumors, the Radiation Oncology clinic staff and physicians are excited about the many equipment and space changes that will allow them to provide the best patient care possible. "The SCCA offers very integrated care, all within a flight of stairs," Russell said. "We have multi-disciplinary clinics, state-of-the-art equipment, inter-disciplinary cooperation. We can take care of all of our patients' needs at one location."