PROSTATE 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 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, and recurrent tumors.

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 prostate cancers. The TomoTherapy technology included in the Radixact System is supported by published clinical studies with a large number of patients.

  • Moderately Hypofractionated Prostate Cancer Treatment: Several studies demonstrate that the TomoTherapy technology is excellent for moderately hypofractionated treatment of large target volumes that include the prostate and the pelvic lymph nodes1, 2, 3 Clinical consensus indicates that some level of hypofractionation is appropriate for the effective treatment of prostate cancers.
  • Ultra-Hypofractionation for Prostate Cancer: Initial clinical evidence supports the use of TomoTherapy technology for ultra-hypofractionation. In one clinical study, patients that received “ultra-hypofractionated” treatment — radiation was delivered in just 8 sessions — with TomoTherapy saw 5-year relapse rates comparable to a combination of traditional radiotherapy and brachytherapy — however, with significantly lower toxicity and shorter overall course of treatment.4
  • Adjuvant & Salvage Treatment for Prostate Cancer: Several studies support the use of TomoTherapy technology for patients following prostatectomy (adjuvant therapy) or for those whose cancer has recurred either after prostatectomy or radiotherapy (salvage treatment).5, 6

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

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Treatment with the Radixact System is an outpatient procedure that does not require incisions or general anesthesia. Most patients will not require hospitalization or a long recovery period. This makes Radixact treatment an excellent option for medically inoperable prostate 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, recurrent tumors.

Compared to conventional radiation therapy, Radixact treatment with the TomoTherapy technology can deliver good cancer control while reducing the risk of common side effects. Radixact treatment can also typically be completed in less time — as little as 6-8 weeks, compared to 9 weeks with 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.

Treatment with the Radixact System is a non-invasive external radiation procedure and avoids the inconvenience and risk associated with radioactive seed implants.

Radiation therapy is the gold standard for the treatment of prostate cancer at different disease stages. This form of treatment 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.

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).

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 many delicate structures that impact urinary, bowel, bladder and sexual function.

There are more options than ever for treating prostate 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 can be an ideal treatment option for a wide range of prostate cancers, including even the most complex cases. 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, sometimes be severe because of rectum or bladder wall exposure to radiation. Possible side effects could include, but are not limited to:

  • Constipation, fecal urgency, fecal incontinence, hemorrhoid, rectal bleeding
  • Urinary retention, urinary urgency, increased frequency, incontinence, urinary bleeding
  • Blood in stool
  • Erectile dysfunction
  • Diarrhea
  • Fatigue
  • Sore and red skin in the treatment area

Ask your doctor for more details about potential side effects associated with your specific radiation therapy treatment.

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You can expect your Radixact treatment to require daily sessions for 6-8 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 prostate may sometimes be required. This procedure would be performed under local anesthesia.

Most patients can continue normal activity during and immediately following Radixact treatment — compared to the typical requirement to limit normal activity for 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 several weeks after traditional surgery.

The prostate gland can move substantially and unpredictably throughout the course of treatment — as much as half an inch in as little as 30 seconds because of normal patient bodily functions (filling of the bladder, gas in the bowel, or even slight patient movement)1, 7. 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 to urinary, bowel and sexual function.

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, including filling of the bladder and digestion, 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 radiation therapy options, the Radixact System does not require uncomfortable patient restraints; you can relax 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.

Precision is particularly valuable when it comes to protecting the many delicate structures that impact urinary, bowel and sexual function.

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 it can precisely target tumors, the Radixact System may provide a safe radiation treatment option even for some previously irradiated patients. Each patient should consult his physician regarding his own specific case.

As of January 2020, IG-IMRT treatment for prostate 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 prostate 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 prostate cancer is effectively treated with IG-IMRT. Some patients might be a candidate for stereotactic body radiation therapy (SBRT) with the Radixact or the CyberKnife Systems. Talk to your physician about your best options and come to a joint decision.

References

1 Di Muzio NG, Fodor A, Noris Chiorda B, et al. “Moderate Hypofractionation with Simultaneous Integrated Boost in Prostate Cancer: Long-term Results of a Phase I-II Study.” Clin Oncol (R Coll Radiol). 2016 Aug;28(8):490-500. doi: 10.1016/j.clon.2016.02.005.

2 Tomita N, Soga N, Ogura Y, et al. “High-dose radiotherapy with helical tomotherapy and long-term androgen deprivation therapy for prostate cancer: 5-year outcomes.” J Cancer Res Clin Oncol. 2016 Jul;142(7):1609-19. doi: 10.1007/s00432-016-2173-9.

3 Yamazaki H, Masui K, Suzuki G, et al. “High-Dose-Rate Brachytherapy Monotherapy versus Image-Guided Intensity-Modulated Radiotherapy with Helical Tomotherapy for Patients with Localized Prostate Cancer.” Cancers (Basel). 2018 Sep 10;10(9). pii: E322. doi: 1.

4 Macias VA, Barrera-Mellado I. “Ultra-hypofractionated radiation therapy for unfavourable intermediate-risk and high-risk prostate cancer is safe and effective: 5-year outcomes of a phase II trial.” BJU Int. 2019 Oct 15. doi: 10.1111/bju.14925.

5 Saldi S, Bellavita R, Lancellotta V, et al. “Acute Toxicity Profiles of Hypofractionated Adjuvant and Salvage Radiation Therapy After Radical Prostatectomy: Results of a Prospective Study.” Int J Radiat Oncol Biol Phys. 2019 Jan 1;103(1):105-111. doi: 10.10.

6 Fodor A, Berardi G, Fiorino C, et al. “Toxicity and efficacy of salvage carbon 11-choline positron emission tomography/computed tomography-guided radiation therapy in patients with lymph node recurrence of prostate cancer.” BJU Int. 2017 Mar;119(3):406-413.

7 Kupelian P. et al. “Multi-institutional clinical experience with the Calypso System in localization and continuous, real-time monitoring of the prostate gland during external radiotherapy.” Int. J. Radiat. Oncol. Biol. Phys. 2007; 67(4): 1088–98.