LUNG CANCER

Frequently Asked Questions

The Radixact System, the next-generation TomoTherapy® platform, has been designed to enable doctors to more effectively and efficiently deliver precise radiation treatments to more patients. The TomoTherapy platform represented a dramatic advance in the radiation oncology field, as the only system specifically designed for integrated 3D daily image-guidance with intensity modulated radiation therapy (IG-IMRT) that will help you fight your cancer. The TomoTherapy technology, used in the Radixact System, has more than two decades of clinical evidence and has been used to help thousands of lung cancer patients. Today, the Radixact System is routinely used to treat a variety of cancers — from routine to complex tumors, those located in hard-to-reach areas, recurrent tumors and cancers of the skin and blood.

The FDA provided clearance for the TomoTherapy technology in 2002 and in 2016 for the Radixact System, the next generation TomoTherapy platform, for the treatment of tumors anywhere in the body, including lung cancers ranging from early-stage non-small cell lung cancer (NSCLC) to post-surgery treatment of mesothelioma. The TomoTherapy technology included in the Radixact System is supported by published clinical studies in the treatment of a variety of lung  cancers, including:

  • Early-stage non-small cell lung cancer (NSCLC): Lung SBRT with TomoTherapy technology delivers good local control and survival with low toxicity in the treatment of early-stage non-small cell lung cancer.1
  • Medically inoperable lung cancer: Lung SBRT with TomoTherapy technology provides a safe and effective alternative when surgery is not possible.2
  • Mesothelioma: IMRT with TomoTherapy technology delivers excellent local-regional control and survival in the treatment of malignant plural mesothelioma (MPM).3
  • Oligometastases: SBRT with TomoTherapy technology delivers adequate local control with low acute morbidity in the treatment of oligometastases, including multiple metastases.4

Radixact treatment is available at many locations worldwide. TomoTherapy treatments are available at hundreds of locations worldwide.

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Radixact treatment is an outpatient procedure that requires no incisions and no general anesthesia. Most patients will not require hospitalization or a long recovery period. This makes Radixact treatment an excellent option for medically inoperable lung cancer patients, those seeking an alternative to surgery, or those for whom radiation therapy is recommended as a complementary treatment to traditional surgery.

The helical design of the Radixact System — unique among radiation therapy systems — enables 360-degree radiation dose delivery as the patient table moves. The Radixact System revolves around you while thousands of “beamlets” — smaller than the radiation beams of conventional systems — are delivered to the tumor. Each beamlet can deliver a different dose of radiation. Different doses go to different parts of each tumor, with less damage to surrounding healthy tissue.

Integrated imaging and advanced dose-delivery capabilities enable your treatment team to create a more personalized treatment plan and confidently deliver the most precise dose of radiation, directly to the tumor. Radixact helical delivery also enables treatment of a full range of diseases, including larger, more complex tumors, multiple tumors, and recurrent tumors.

Compared to conventional radiation therapy, Radixact treatment with the TomoTherapy technology can deliver good local control while reducing the risk of common side effects. Radixact treatments are completed in one to several weeks, similar to conventional radiation therapy.

Put simply, helical delivery means that the source of the radiation beam(s) (the linear accelerator or LINAC), can move in 360° around the patient during treatment delivery while the patient table moves continuously in the gantry. Whereas conventional radiotherapy systems  can only deliver radiation from a limited number of points, the helical delivery of the Radixact System allows your treatment team to administer the accurate dose of radiation to the tumor from 360 degrees around the patient.

Radiation therapy is a treatment that uses high-energy x-rays (photons) to kill, shrink or control the growth of tumors. Radiation therapy works by damaging cells, disabling them from growing and dividing. The goal of any radiation treatment is to destroy cancer cells while minimizing the side effects on healthy tissue. As imaging technologies have improved over the last several decades, radiation therapy has integrated those improvements to enhance dose delivery and minimize side effects.

Radiation may be recommended as an alternative to surgery or in addition to other therapies. Radiation therapy is constantly evolving with the introduction of new technologies to the market. The Radixact System can deliver a highly advanced type of radiation therapy known as image-guided intensity-modulated radiation therapy (IG-IMRT).

Intensity-modulated radiation therapy (IMRT) is a specialized form of external beam radiation therapy that varies the intensity of each radiation beam. IMRT can help clinicians shape the delivery of radiation to more accurately and precisely fit the contours of the tumor — and minimize dose to surrounding organs and tissues.

IG-IMRT is a type of targeted external beam radiation therapy that enhances IMRT by using images acquired before each treatment to help ensure accurate patient and tumor positioning before delivery of the radiation treatment.

With daily imaging, clinicians gain the confidence necessary to accurately set-up patient on the table before treatment and reduce margins throughout the course of the treatment. And by modulating the intensity of the radiation beams/beamlets, IG-IMRT enables clinicians to carefully shape the radiation dose to fit the contours of the tumor, while minimizing dose to surrounding organs and healthy tissues. This precision and accuracy is particularly valuable when it comes to protecting the heart.

There are more options than ever for treating lung cancer, and the right option depends on your specific tumor location, cancer type and cancer aggressiveness — as well as your health, age and lifestyle. Radixact is an ideal treatment option for a wide range of lung cancers, including even the most complex lung cancers. The best way to determine if Radixact treatment is right for you is to find a Radixact treatment location and make an appointment to discuss your specific details.

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Most radiation side effects are minimal and last only a short time. Side effects can, however, be severe. Possible side effects could include:

  • Fatigue
  • Radiation pneumonitis
  • Scarring of the lung tissues (pulmonary fibrosis)
  • Complications (such as pneumothorax) resulting from fiducial marker insertion
  • Rib pain and/or fracture
  • Exposure to airways and/or nearby tissue
  • Difficulty swallowing
  • Difficulty eating
  • Heart problems (if the treatment area is near the heart)

Ask your doctor for more details about the side effects of your specific radiation therapy.

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You can expect your Radixact treatment to require daily sessions over one to several weeks. Because the Radixact System can deliver radiation continuously, without requiring interruptions to reposition, the entire treatment process typically lasts 10-20 minutes — including patient set-up time.

Treatment sessions are non-invasive outpatient procedures, and no anesthesia is required. Most patients resume normal activity immediately after treatment sessions.

No anesthesia is required for Radixact treatment and treatment sessions are completed on an outpatient basis. The placement of fiducials within the lung may sometimes be required. This procedure would be performed under local anesthesia.

The majority of patients can continue normal activity during and immediately following Radixact treatment — compared to the typical requirement to limit normal activity for one to several weeks after traditional surgery. Just as importantly, by minimizing dose to surrounding healthy tissues and reducing the incidence of side effects, Radixact treatment can offer higher patient quality of life both during and after treatment.

Most patients can continue normal activity during and immediately following Radixact treatment — compared to the typical requirement to limit normal activity for one to several weeks after (traditional) surgery. Many patients experience minimal side effects and can quickly return to their daily routines.

When you breathe, your torso moves. This means that a target located in or near the lungs will continuously move throughout the course of treatment delivery. Failing to adapt and synchronize the delivery of radiation dose with tumor movement can result in decreased dose delivered to the target — and increased dose delivered to surrounding healthy tissues. This can impact the overall effectiveness of the treatment, and can potentially increase the incidence and severity of side effects.

Learn More About How The Radixact Synchronizes With Target Motion

The Radixact System now features Accuray’s unique Synchrony® real-time motion synchronization technology*. It is designed to correct for tumors that move as a result of bodily processes such as respiration, as well as patient movement. Synchrony is the only technology that uses image guidance during treatment delivery to automatically adapt the movement of the radiation beam in synchronization with the movement of the tumor. The beams of radiation are delivered continuously throughout the treatment session as the patient breathes naturally. Unlike other conventional radiotherapy therapy options, the Radixact System does not require uncomfortable patient restraints or breath-hold techniques; you can relax and breathe normally, with full confidence in the Radixact’s synchronization capabilities.

Learn More About How The Radixact Synchronizes With Target Motion

*The Synchrony technology is an optional upgrade available for purchase by hospitals.

Precisely delivering the prescribed radiation dose to the target is essential for optimizing long-term cancer control. Additionally, precise dose delivery reduces irradiation of healthy tissues surrounding the target.

Because lung cancer tumors are located in close proximity to sensitive organs and tissues (i.e., heart), precise delivery is critically important for reducing the incidence and severity of side effects and protecting quality of life both during and after treatment.

Because the precise targeting of the Radixact System significantly reduces irradiation of surrounding healthy tissues, patients treated with the Radixact System could be candidates for re-irradiation, in the event of recurrence. Additionally, patients treated with the Radixact System may sometimes be candidates for surgical interventions, in the event of recurrence.

Because the precise targeting of the Radixact System significantly reduces irradiation of surrounding healthy tissues, patients treated with conventional radiotherapy systems may be candidates for re-irradiation with the Radixact System, in the event of recurrence. Each patient should consult his physician regarding his or her own specific case.

As of January 2020, IG-IMRT treatment for lung cancer is covered by Medicare in all 50 states and the District of Columbia. In addition, many private insurance payers cover IG-IMRT treatment for lung cancer. It is always best to check your insurance policy and if applicable, be sure to review your employee contract to determine if your insurance coverage benefits are limited. If you live outside of the United States, typically the Radixact Center that you would choose for treatment can answer coverage questions.

Not every patient’s lung cancer is effectively treated with IG-IMRT. CyberKnife® SBRT may be an option to treat lung cancer. Talk to your physician about your best options and come to a joint decision.

Resources:

1 Rosen LR, Fischer-Valuck BW, Katz SR et. “Helical image-guided stereotactic body radiotherapy (SBRT) for the treatment of early-stage lung cancer: a single-institution experience at the Willis-Knighton Cancer Center.” Tumori. 2014 Jan-Feb;100(1):42-8. doi: 10.1700/1430.15814.

2 Arcangeli S, Falcinelli L, Bracci S et al. “Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours.” Br J Radiol. 2017 Mar;90(1071):20160853. doi: 10.1259/bjr.20160853.

3 Minatel E, Trovo M, Polesel J et al. “Radical pleurectomy/decortication followed by high dose of radiation therapy for malignant pleural mesothelioma. Final results with long-term follow-up.” Lung Cancer. 2014 Jan;83(1):78-82. doi: 10.1016/j.lungcan.2013.10.013.

5 Sole CV, Lopez Guerra JL, Matute R et al. “Stereotactic ablative radiotherapy delivered by image-guided helical tomotherapy for extracranial oligometastases.” Clin Transl Oncol. 2013 Jun;15(6):484-91. doi: 10.1007/s12094-012-0956-2.