New radiation technology offers hope for patients with inoperable pancreas cancer

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New radiation technology offers hope for patients with inoperable pancreas cancer
Michael Chuong, MD, director of MRI-Guided Radiation Therapy at Miami Cancer Institute.

An advanced form of radiation therapy available at Miami Cancer Institute may extend overall survival and improve quality of life for patients with inoperable pancreas cancer.

The ViewRay MRIdian MR-Linac technology safely delivers an unprecedented high dose of radiation over just five consecutive days directly to the tumor using continuous real-time MRI scans. The images ensure millimeter accuracy and also allow for treatment to be adapted daily to account for changes in the patient’s internal anatomy.

Known as MR-guided stereotactic ablative radiation therapy (SABR), this state-of-the-art treatment is painless, completely non-invasive and requires no anesthesia or needles. Miami Cancer Institute was the second cancer center in the U.S. to begin treating patients with this technology in April 2018.

Investigators from Miami Cancer Institute recently published the first clinical outcomes of chemotherapy followed by MR-guided SABR on an MR-Linac for inoperable pancreas cancer in Practical Radiation Oncology using nearly twice the radiation dose that is safely deliverable on a standard radiation delivery machine. The study included 35 patients ranging in age from 34 to 89 years and reported that one year after SABR nearly 90 percent of patients had their cancer controlled locally and almost 60 percent of patients were alive, both of which are favorable compared to historical outcomes with lower radiation dose. Some patients who initially had inoperable pancreas cancer ultimately were able to undergo successful surgery because of excellent response after SABR.

“A significant number of our patients have surpassed the expected survival for this deadly disease, with many alive several years after their initial diagnosis,” said Michael Chuong, MD, director of MRI-Guided Radiation Therapy at Miami Cancer Institute and a radiation oncologist specializing in gastrointestinal cancers. In fact, Dr. Chuong is encouraged that patient survival beyond two years after initial diagnosis may be more than doubled through the use of ablative radiation dose versus lower radiation dose. He anticipates publishing long-term survival outcomes in the near future.

Dr. Chuong notes that not only has the efficacy of MR-guided SABR been excellent for pancreas cancer, but it also has been very well tolerated, with only about 3 percent of patients experiencing serious side effects and the majority experiencing little to no side effects.

“It is remarkable that we have seen such little treatment toxicity given the incredibly high radiation dose that is delivered to tumors in the pancreas that are surrounded by ― and sometimes literally touching ― the stomach and intestines,” he said. “Patients are in and out within about an hour. They go back to work or play golf, and do their normal activities.”

Patients with inoperable pancreas cancer are currently being enrolled at Miami Cancer Institute onto a multi-institutional phase 2 clinical study on the MRIdian Linac known as the SMART (Stereotactic MRI-guided On-table Adaptive Radiation Therapy (SMART) trial ― for which Dr. Chuong is a national co-principal investigator. This trial is delivering the same ablative dose in five days that Dr. Chuong and colleagues reported in their recent publication.

Some 57,600 people in the U.S. will be diagnosed with pancreatic cancer this year, according to the American Cancer Society. While the death rate for some cancers has dropped significantly in the last decade, it has not improved for pancreas cancer, and with symptoms that mimic other ailments it often goes undetected until it is in an advanced stage. Because the pancreas sits in the abdomen near the stomach, small intestine, liver and spleen, and involves many blood vessels, it can be difficult to remove surgically and radiation must be precisely delivered to avoid damage to structures nearby.

Dr. Chuong encourages those with inoperable pancreas cancer to speak with their doctors about receiving MR-guided SABR, ideally at a high-volume center with significant experience such as Miami Cancer Institute. The Institute offers a host of other clinical trials and cutting edge treatments for pancreas cancer as well.

While an MR-Linac can be used for pancreas cancer, radiation oncologists at Miami Cancer Institute, located on the campus of Baptist Hospital in Kendall, also are using this technology to improve outcomes for patients with many other cancers, including those of the prostate, liver, lung, esophagus, rectum, adrenal gland, and kidney.

Visit https://cancer.baptisthealth.net/miami-cancer-institute/clinical-trials for more information about clinical trials at Miami Cancer Institute.


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