D-H a Leader in New Treatment Technology

November 22, 2013
Lebanon, NH

Photo of Varian TrueBeam linear accelerator

Having access to the latest technology in radiation treatments—especially the Varian TrueBeam linear accelerator at Dartmouth-Hitchcock's Norris Cotton Cancer Center (NCCC)—not only allows for more targeted and effective treatments, it can make those treatments more comfortable and tolerable for patients.

"The 28 treatments I received last summer for cancer of the esophagus were short and remarkably non-invasive," says David Evancich, who received radiation treatments along with chemotherapy at NCCC to dramatically shrink a cancerous tumor in his esophagus (hear him describe his experience in the video below). "They restored my ability to swallow and eat solid food again, which I couldn't do when treatments began." Evancich then underwent surgery in September to remove the remaining cancerous tissue and ensure against any reoccurrence. He is now cancer-free and doing well.

New Degrees of Accuracy

In late October, Radiation Oncology upgraded its TrueBeam system, installing a more advanced patient table called the Varian 6 Degree of Freedom (6DOF) couch. The new device was recently granted FDA approval.

The 6DOF couch system will further enhance accuracy and efficiency of treatments, especially in delicate areas of the body where millimeter accuracy is essential. "The major areas where we envision this being very important are the brain, the spinal cord, and the vertebral bodies of the spine," says radiation oncologist Alan Hartford, MD, PhD, interim section chief of Radiation Oncology.

"This installation is the second in the United States and the fourth worldwide, clearly distinguishing Radiation Oncology at Dartmouth-Hitchcock as a leader in new technology implementation," adds David Gladstone, ScD, chief of Clinical Physics at NCCC and associate professor of medicine at Geisel School of Medicine.

Using sophisticated computer and image-guided technologies, radiation oncology teams routinely align patients in three-dimensions for treatment—front and back, up and down, and side to side, says Hartford. "What the 6DOF couch system gives us is the ability to control for the three additional angular dimensions, what we call pitch, roll, and yaw," he explains.

Improved Efficiencies in Care

This greater degree of accuracy will help make the planning and simulation phase of treatment more efficient. "We'll be able to treat multiple lesions simultaneously in some cases, with comparable results to what we see now, and it will allow us to provide some treatments much more conveniently to patients," says Hartford. "For someone undergoing radiation treatment for a brain tumor, for example, it could mean spending 30 minutes on the table versus two hours."

Advancements in radiation treatment technology all share the same goal: delivering high doses of radiation to tumors, while minimizing the dose to surrounding tissue. "We've recently added a couple of tools in Radiation Oncology which are part of this effort," Hartford says.

"One allows us to monitor the patient using reflected laser light while they are on the treatment table," he says. "If there's too much movement detected, we can stop treatment and make the necessary adjustments before resuming. Another feature, our gating system, allows us to monitor and control for tumors that actually move inside the body, such as those in lung cancer patients, ensuring that we treat them safely and accurately as they breathe."

As impressive as these advancements are, they're only as good as the "people part" of the treatment process, says Evancich. "I can't say enough about the quality of my entire care team, from my radiation oncologist Dr. Bassem Zaki to the group of radiation therapists I had through my treatments," he says. "Everyone was extremely well-trained, knowledgeable, and personable. Having cancer can be a very frightening experience, but they made the process much less intimidating and worrisome than it could have been."

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